Longitudinal regimes of arts and cultural engagement and frailty among older adults in the United States: a g-formula approach

OBJECTIVES: A growing body of evidence links arts and cultural engagement (ACEng) with various health outcomes, however, its longitudinal relationship with frailty as a multidimensional clinical syndrome remains underexplored. This study aims to investigate the dynamic nature of ACEng and its impact on frailty, addressing critical methodological challenges. METHODS: We analysed longitudinal data from 3,775 older adults (aged 50+) in the U.S. Health and Retirement Study (2005-2018). ACEng was measured as receptive cultural events (e.g. concerts, movies, museums) and two participatory activities, including (1) singing or playing a musical instrument (2) doing arts and crafts. Frailty was assessed using a 50-item frailty index covering nine health domains. Data were analysed using the g-formula approach. RESULTS: ACEng was highly dynamic, particularly for receptive activities. Late and sustained engagements across three ACEng activities were associated with lower levels of frailty at follow-up. However, most of these effects were sensitive to adjustments of time-varying frailty, except for sustained engagement in culture events. This sustained exposure was associated with a 0.35-point lower frailty compared to the never exposed (95% confidence interval: -0.53 to -0.17, p < 0.001). DISCUSSION: The relationship between ACEng and frailty is complex and shaped by dynamic, potentially bidirectional relationships. This underscores the importance of using longitudinal designs and causal methods to understand ACEng regimes and their health impacts, accounting for time-varying confounders. Future research should explore distinct active ingredients and underlying mechanisms between receptive and participatory activities and how they can be leveraged to mitigate frailty and other health outcomes.