Technology and Health Care 22 (2014) 453–458 453

DOI 10.3233/THC-140803
IOS Press

Effects of art and music therapy on

depression and cognitive function of the
elderly

Mi Lim Ima,∗ and Jeong In Leeb

a Department of Nursing, Baekseok University, Dongnamgu, Cheonan, Korea
b Department of Nursing, Hyechon College, Seo-gu, Daejeon, Korea

Received 29 October 2013

Accepted 23 January 2014

Abstract. The purpose of this study was to examine effects of art and music therapy on depression and cognitive function of
the elderly. This was one group pre-test, post-test design. Data were collected from January to March, 2013, from 94 elderly.
The results were collected as followers: 1. Art therapy was revealed a statistical significant difference between before and after
treatment on the depression of participants. 2. Music therapy was revealed a statistical significant at previous and after treatment
on the depression of participants. 3. Treatment according to the severity of depression than the music therapy and art therapy
were examined statistically significantly lower. This study will be provided basic information in order to develop program for
success healthy life of elderly.

Keywords: Art and music therapy, depression, cognitive function

1. Introduction

Korea will witness the coming of an aged society by 2018 when 14% or more of the population is
expected to be older than 65 years, and the coming of a hyper-aged society by 2018 with over 20.2% of
the population older than 65 years [16]. However, various social issues arise with the aging population,
with geriatric diseases being one issue that is seriously raised as a result of increased life expectancy
with the development of medicine [17]. Growing old population has changed the structure of disease
with an increase in chronic degenerative diseases with consequent medical costs for this group at a point
of serious threat [13].
In old age, not only those lifestyle diseases but also musculoskeletal diseases such as degenerative
diseases and osteoporosis progress faster, and many physiological changes occur to bring about car-
diorespiratory diseases including heart failure and chronic obstructive pulmonary disease. Along with
physiological changes, mental health issues have also emerged as a critical problem with geriatric de-
pression drawing much attention [2].

∗
Corresponding author: Mi Lim Im, Department of Nursing, Baekseok University, 76 Munamro, Dongnamgu, Cheonan,
Korea. E-mail: nug21c@bu.ac.kr.

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454 M.L. Im and J.I. Lee / Effects of art and music therapy on depression and cognitive function of the elderly

Depression in older people is seen frequently in those cases with age-induced physical weakness
accompanying physical illnesses and difficulty in adapting to older life due to such factors as death
of spouse or inability to cope with being marginalized or being lonely; thus, the mental health and
wellbeing of the person would be affected seriously with his/her quality of life deteriorating. Depression
in the elderly can be manifested as anxiety, physical symptoms, hypochondria, concentration disorders,
and pseudodementia including memory lapse [2,4].
15% to 25% of the elderly population have serious depression that mars normal daily activities, and
some 50% of dementia patients show various types of depression with 17% to 31% diagnosed as having
major depression disorder.
In Korea, the dementia population is ever fast growing in old people as the number of the post-elderly,
ie., those who are 80 years or over, increases, as a serious social issue is posed. On the other hand,
these elderly with dementia are very prone to emotional hurt to a point where they can show serious
nervousness, depression, abnormal behavior, etc. even with little changes. Personal exchanges cease
as they do not feel satisfaction in interpersonal relationships so they feel loneness and frustration and
experience depression and isolation [18]. Lee Jung-ae and Chung Hyang-kyun (1993) reported that
24% of those elderly with cognitive disorders have depression, suggesting a close relationship between
cognitive impairment and depression in the elderly. Intervention in the form of treatment shows some
commonality in which treatment of one of these factors, either cognitive impairment or depression, can
improve both factors in some cases [12].
In addition to drugs, music, occupational activities, art, gardening, behavior modification, and pets can
be used for the treatment of depression and cognitive impairment (dementia) with the aim of maximizing
various functions under the given circumstances to improve cognitive functions, mood and behavioral
symptoms [10]. Most of the research on these treatment tools have focused on confirming the effects of
one type of treatment including The Effects of Art therapy in Dementia [10] and The Effects of Music
therapy on Dementia [17].
The purpose of this study was to seek ways to prevent depression and cognitive impairment in the
elderly by examining the degree of improvement after music and art therapy.

2. Methods

2.1. Study design

The study was conducted with one group using a pre-and post-testing method to examine the effects
of art and music therapy on depression and cognitive abilities in the elderly.

2.2. Study subjects and procedure

The study was conducted with 94 elderly people who were 60 years or older residing in metropolitan
areas from January to March 2013. They volunteered to participate in the study after being introduced to
the art and music therapy programs and did not have any problem participating in these leisure programs
with none of them having any difficulty in walking or traveling and with their visual and hearing abilities
good enough to participate in the programs. Out of 94, the number of participants for the art program
was 65 and that for the music program, 29. The program was administered by one art therapist and one
music therapist having gone through training on the respective program. The treatment was conducted
for a total of 12 times for 12 weeks through a once-a-week 60-minute session. The contents of the
 M.L. Im and J.I. Lee / Effects of art and music therapy on depression and cognitive function of the elderly 455

Table 1
General characteristics of participants n = 94
Characteristics Range Frequency (%)
Age 60–65 11(11.7)
66–70 12(12.8%)
71–80 52(55.3%)
Over 81 19(20.2)
Therapy method Art 65(69.1)
Music 29(30.9)

music therapy were developed by the therapist, which included Korean small drum play along with scarf
activities, playing of rhythm instruments, childhood related activities, tone chime playing, ching-ching
song (impromptu lyrics composed by a leader with the participants chanting the ching-ching chorus)
chanting, playing of recreated music pieces, and other activities. The contents of the art therapy were
also developed by the therapist, which included mandara drawing, drawing taking turns, mud crafts,
expression of body parts, collage, recreating happy moments in one’s life, imagining those helping one’s
life, and other activities. Two research technicians conducted evaluation on depression and cognitive
abilities before and after program participation.

3. Research instruments

3.1. Short-form of Korean Geriatric Depression Scale (S-KGDS)

Adapted from the Geriatric Depression Scale developed by Sheikh and Yesavage [15], the Korean
version of Geriatric Depression Scale, S-KGDS, was used as the tool to measure the degree of depression
in old people. It was composed of 15 questions with their validity and reliability tested. Each item can be
answered either yes or no, where yes was treated as 0 and no, 1 for scoring. The total score was tallied,
in which the lower the score, the severer the degree of depression. The Cronbach’s a coefficient was
0.71.

3.2. Mini-Mental State Examination for Korea

The Mini-Mental State Examination for Korea (MMSE-K) was the tool used to evaluate cognitive
abilities in old people, in which Kwon et al. [8] modified the Mini-Mental State Examination (MMSE)
by Folstein et al. [3] for Korean subjects. MMSE is composed of a total of 12 questions testing various
cognitive areas including orientation, memory, attention, mathematical abilities, language, understand-
ing, and judgment. The total score ranges 0–30 points, in which the higher the score, the better the
cognitive abilities. In the study, the score of 24 or above was defined as normal; 18–23, mild cognitive
impairment; and 17 or below, severe cognitive impairment. The Cronbach’s a coefficient for MMSE-K
was 0.84 at the time of standardization, but was 0.92 in the study.

4. Statistical analysis

SPSS/PC (SPSS, Inc., Chicago, IL) was used for data analysis. A two-way verification was used in
which its statistical significance was determined at α value of 0.05. The following are the details of the
test:
456 M.L. Im and J.I. Lee / Effects of art and music therapy on depression and cognitive function of the elderly

Table 2
Depression and cognitive function after art therapy of participants n = 65
Depression Cognitive function
M(SD) r t p M(SD) r t p
Before treatment 8.71(5.27) 0.32 5.52 0.000 25.03(3.24) 0.768 −1.748 0.085
After treatment 5.20(2.83) 25.49(2.97)

Table 3
Depression and cognitive function after music therapy of participant n = 29
Depression Cognitive function
M(SD) r t p M(SD) r t p
Before treatment 9.76(5.78) 0.85 3.29 0.003 25.48(3.62) − − −
After treatment 7.66(6.50) 25.48(3.62)

– Real number, percentage, average, and standard deviation were obtained to examine the general
characteristics of the subjects, depression, and the degree of cognitive abilities (dementia).
– Paired t-test was used to measure the changes in depression and cognitive abilities (dementia) before
and after the art and music therapy programs.
– T-test was used to measure the differences between the art and music programs for the subjects.

5. Results

The results obtained from this study were as follows;

1. The general characteristics of the participants were shown in Table 1.
2. There was a statistical significant difference between before and after the art treatment the partici-
pants who had art therapy treatment (t = 5.52, p = 0.000) (Table 2).
3. It was revealed that there was a statistical significant difference between before and after music
therapy treatment on the participants (t = 3.29, p = 0.003) (Table 3).

6. Discussion

This study confirms that art therapy is an effective method to reduce depression in the subjects, similar
to the results found by Kim Young-ri and Kim Yoon-jung [6] and Oh Bok-rye [14] with their subjects
showing lower depression scores after art therapies. Art therapy is a way to stimulate the central nervous
system by allowing the elderly to optimally use both hands and to promote ego, thereby, positively
affecting depression in this group by letting them to express oppressed feelings [10,19].
The Art therapy makes patients easily to contemplate themselves since it reduces the resistance of
revealing and it also helps to the formulation of positive self-ego by respecting patients’ imagination and
unique personality. Especially, autonomy and responsibility are given to the patients by the Art therapy.
In addition, the art therapy is very useful to phase patients’ the situation of negative recognition out
through expressing anger and hostility using the positive measures that are allowed in a society and
helps to treat depression by accepting current situation that is protected by the patients [6].
The subjects’ depression scores decreased after the music therapy, similar the results found by Kihl
Tae-sook and Chang Suk-jin [7] and Hsu and Lai [5]. Music brings out emotions in people, eventually
 M.L. Im and J.I. Lee / Effects of art and music therapy on depression and cognitive function of the elderly 457

leading to behavioral changes [1]. It releases oppressed feelings and grants opportunities to express
feelings on one’s own [17].
The subject feels comfortable psychologically through the music by expressing latent emotion that is
not revealed outside.
The results of this study showed that the art and music therapies reduced the level of depression in
the elderly but had no effect on cognitive abilities. However, studies showed that cognitive abilities and
depression symptoms are closely related in the elderly with high levels of depression bring about depres-
sion symptoms; that cognitive impairment would boost depression symptoms [9], and that depression
frequently accompanies cognitive impairment in the elderly. Thus, these results suggest that an effective
intervention on depression would be also effective in improving depression symptoms and preventing
and delaying cognitive impairment.
It is confirmed through this study that the art and music therapy are effective to solve the subject’s
depression. The measures on the elderly’s recognition and psychological problems should be prepared
comprehensively with the measures on physical health since the elderly’s depression and defects of
recognition function are affected by physical diseases.

7. Conclusions

This study was conducted in one group using a pre- and post-testing method for the goal of determin-
ing the effects of art and music therapy on depression and cognitive abilities in the elderly and its results
were as follows:
– The depression scores in the subjects were statistically significantly low after art therapy.
– The depression scores in the subjects were statistically significantly low after music therapy.
– Based on the methods of therapy, the degree of depression was significantly low after art therapy.
Thus, the results confirmed that the art and music therapy programs were effective in reducing the
degree of depression.
Prolonging of human life expectancy is a victory in modern medicine; however, the efforts to promote
health in old people had been lagging despite the increased elderly population, making decreased quality
of life in the elderly a social issue. Especially, physical aging and consequent illnesses mar psychological
health of the elderly and bring about negative emotions, thereby, posing as a threat to mental health.
Thus, the development of a diverse range of programs is need for the promotion of mental health and
the prevention of cognitive impairment in old people.

References
[1] Choi, B. C. Music Therapy. Seoul: Hakjisa. 1999.
[2] Chung, H. A. A Literature Review a Program of Intervention of patient Geriatric Depression. Society of Occupational
Therapy for the Agged and Dementia. 2008; 2(1): 59-67.
[3] Folstein, M. F., Folstein, S. E., & McHugh, P. R. Mini-mental state: A pratical method for grading cognitive state of
patients for the clinician. Journal of Psychiatric Research. 1975; 12(3): 189-198.
[4] Gurland, B. J. The impact of depression on quality of life of the elderly. Clinics in Geriatric Medicine. 1992; 8(2):
377-386.
[5] Hsu, W. C., & Lai, H. Effects of music on major depression in psychiatric inpatients. Archives of Psychiatric Nursing.
2004; 18(5); 193-199.
[6] Kim, Y. R. & Kim, Y. J. The Effects of Group Art Therapy on Relieving Depression of the Elderly Stroke Patients.
Journal of Family Relations. 2009; 14(3): 213-237
458 M.L. Im and J.I. Lee / Effects of art and music therapy on depression and cognitive function of the elderly

[7] Kihl, T. S. & Chang, S. J. A Analysis on Effect of Rhythm Action Game for Improvement of Geriatric Depression and
Self-esteem of Elderly Patients. Journal of Korean Computing Game Society. 2012; 25(3): 93-103.
[8] Kwon, Y. C. & Bak, J. H. Development of the Test for the Elderly = Korean Version of Mini-Mental State Examination
(MMSE-K). Journal of the Korean Neuropsychiatric Association. 1989; 28(1): 125-135.
[9] Lee, H. J. & Kahng, S. K. The Reciprocal Relationship between Cognitive Functioning and Depressive Symptom: Group
Comparison by Gender, Korean Journal of Social Welfare Studies. 2011; 42(2): 179-203.
[10] Lee, H. S. & Kim, S. Y. A Study on the Effects of Art Therapy on the Dementia Elderly. Journal of Korean Gerontological
Society. 2008; 28(4): 1279-1295.
[11] Lee, J. A., & Chung, H. K. A Study on the Depression and Cognitive Impairment in the Rural Elderly. Journal of
Preventive Medicine and Public Health. 1993; 26(3): 412-429.
[12] Lee, J. S., Lee, W. H., Lee, W. K., & Oh, H. S. Cognitive Dysfunction in the Geriatric Depression Living in the Institution.
Journal of Korean Geriatric Psychiatry. 2006; 10(1): 20-27.
[13] Ministry of Health & Welfare. A study on the development of the public medical care security system for the geriatric
(I). 2004.
[14] Oh, B. R. The effects of art therapy on self and depression , Unpublished master’s thesis, Hanil Baptist University. 2006.
[15] Sheikh, J. I., & Yesavage, J. A. Geriatric depression scale(GDS): Recent evidence and development of a shorter version.
Clinical Gerontologist. 1986; 5 : 165-173.
[16] Statistics Korea. http://kostat.go.kr/portal/korea/index.action. 2013.
[17] Yang, H. K. The Effects of the Recreational Music Therapy on the Cognitive Functional of the Aged People with De-
mentia. Journal of Korean Gerontological Society. 2006; 26(4): 749-765.
[18] Yang, H. Y. The affect of group-art therapy on the self-expression of elderly with dementia. Korean Journal of Family
Welfare. 2008; 13(2): 107-129.
[19] Yun, Z. H. Effects of the Group Art Therapy on the Behaviors and Emotionsof the Demented Old people. Unpublished
master’s thesis, Daegu University. Daegu. 2000.
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