Dynamic Creative Arts Group Intervention to Alleviate Loneliness and Support Well-Being in Older Adults With Cognitive Changes (Dynamic-Arts)

The intervention consists of 10 sessions, held twice a week, in closed groups of 8-10 older adults with subjective or mild cognitive impairment. Each session lasts 90 minutes and includes an opening check-in, a warm-up activity, a semi-structured creative activity followed by dynamic group discussion, and a closing ritual. Creative arts, including visual art, music, movement, and drama, are used to support emotional expression and interpersonal connections. Sessions address personal identity, meaningful relationships, family, life experiences, group belonging, and separation. The facilitator encourages participants to share experiences, explore emotions, respond to one another, and reflect on relationships within the group. The intervention emphasizes here-and-now interactions, mutual support, and the development of meaningful connections.

A dynamic group intervention integrating creative arts for older adults with subjective or mild cognitive impairment. The intervention includes 10 sessions, held twice weekly, lasting 90 minutes each. Sessions combine group discussions with visual art, music, movement, and drama. The therapeutic focus is on here-and-now interactions, emotional expression, interpersonal learning, and the development of meaningful relationships. Creative activities provide additional verbal and nonverbal ways to communicate, share experiences, and connect with others. The facilitator encourages mutual support, reflection, and a sense of belonging within the group.

• Dynamic group with creative arts

Perceived loneliness will be assessed using the Three-Item Loneliness Scale . The scale measures how often participants feel a lack of companionship, left out, or isolated from others. Each item is rated on a 3-point scale (1 = Hardly Ever, 2 = Some of the Time, 3 = Often). Total scores range from 3 to 9, with higher scores indicating greater perceived loneliness. The questions will be read aloud to participants.

Social interaction will be measured by the Lubben Social Network Scale . This is a short measure of social isolation and perceived social support in older adults . It includes three items assessing kinship (family) ties and three items of nonkin (friendship) ties. Scores range from 0-30. A clinical cut off score of less than 12 indicates risk for social isolation.

A non-formal observation will focus on actual social interaction of the participants. Verbal and nonverbal behaviors, engagement with other members of the center or staff will be considered Social interaction.

A 10 item self-report measure of positive and negative affect, representing the affective component of subjective well-being. Items are rated from 1-never to 5-always, with separate scores for positive and negative affect (range: 5-25), with higher scores indicating greater levels of the specific affect.

The Satisfaction With Life Scale is a self-report measure, assessing global life satisfaction. Each of the 5 items is rated on a 7 point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree), total scores range from 5-35, higher scores indicate better life satisfaction.

The number of doctor visits or general visits to primary care clinic within the last two weeks (collected by self-report ).

The question asked is: "In general, would you say your health is: excellent/very good/good/fair/poor?". This single item, self-rated, health measure is widely used in older adults studies and has demonstrated strong validity.

Subjective quality of life will be assessed using the Bath Assessment of Subjective Quality of Life in Dementia . This 14-item self-report questionnaire assesses two domains: life satisfaction and feelings of positive quality of life. Items are rated on a 5-point scale from 0 to 4. Scores are transformed to a 0-100 scale, with higher scores indicating better subjective quality of life.

The Canterbury Wellbeing Scale is a short, self-report, visual analogue scale to assessing subjective wellbeing 'in the moment' of people with cognitive decline. It consists of five subscales (happy/sad, well/unwell, interested/bored, confident/not confident, optimistic/not optimistic) rated 0-100, with a total score ranging from0 to 500). Higher scores means better wellbeing.

Perceived group processes will be assessed using a 7-item questionnaire developed for this study, based on existing measures of group cohesion, therapeutic alliance, and Yalom's therapeutic factors in group psychotherapy. The questionnaire assesses participants' perceptions of relationships with other group members and the facilitator, emotional sharing, interpersonal learning, and sense of belonging. Each item is rated on a 5-point agreement scale, from strongly disagree (1) to strongly agree (5). Higher scores indicate more positive perceptions of group processes.

A study-specific questionnaire will collect demographic and functional information, including age, sex, country of birth, marital status, education, living arrangements, and previous occupation. Additional questions address self-reported vision, hearing, mobility, independence in basic activities of daily living, and using formal care support. Two questions assess subjective memory decline and related concerns.

The assessment will be used as an objective cognitive screening tool; scores of 26 and above will indicate Subjective Cognitive Impairment, whereas scores ranging from 19-25 will be considered Mild Cognitive Impairment and scores of 18 and below will be considered severe cognitive deficit.

Participant satisfaction and perceived benefits will be assessed using a questionnaire developed for this study. It includes 13 items rated on a 5-point scale, assessing overall satisfaction, comfort with emotional sharing, perceived changes in mood and confidence, sense of belonging, interpersonal connections, perceived reduction in loneliness, facilitator support, and the contribution of creative arts to emotional expression. Additional open-ended questions explore participants' experiences, preferences, and suggestions for improvement.