Background Although arts and cultural engagement has the potential to reduce social deficits, such as loneliness and social isolation, in Western countries, it is unclear whether the protective association can also be seen in different cultural settings such as Asia. This study examined the association between arts and cultural engagement, focusing on the continuity and type of engagement, and subsequent loneliness and social isolation among older adults in Japan, one of the fastest-ageing countries.

Methods This three-year longitudinal study included 4,383 older adults (mean age = 74.3 years; 51.3% women) from the Japan Gerontological Evaluation Study 2019 and 2022 waves. Loneliness was assessed using the three-item UCLA Loneliness Scale (range: 3-9). Social isolation was assessed using the Steptoe Social Isolation Index, which measures marital status, interaction with children, relatives and friends, and social participation (range: 0-5 points). Engagement in eleven arts and cultural activities, such as singing, painting, and traditional Japanese cultural activities, was evaluated. Respondents were classified into four groups based on the continuity of engagement across waves: none, decreasing, increasing and sustained engagement. Additionally, using a latent class analysis, four classes of engagement type at baseline were identified: low, receptive (e.g. film viewing or music listening), creative (e.g. gardening or handicraft) and diverse engagement.

Results Regarding engagement continuity, 24.2% were continuously not engaged, 18.1% decreased engagement, 7.9% increased engagement, and 49.8% had sustained engagement. Regarding engagement types, 41.7% were in the low class, 20.3% were in the receptive class, 34.8% were in the creative class, and 3.2% were diverse engagers. In ordinary least squares regression models, those who increased (coef.=-0.22 [95% CI=-0.41, -0.04]) or sustained (coef.=-0.26 [-0.36, -0.16]) their engagement across waves reported lower loneliness than those who did not engage. Individuals with sustained engagement also reported lower social isolation (coef.=-0.18 [-0.27, -0.09]). Regarding engagement type, engaging in diverse activities was associated with lower loneliness compared to low engagement (coef.=-0.34 [-0.59, -0.10]), while creative (coef.=-0.13 [-0.22, -0.04]) and diverse (coef.=-0.33 [-0.54, -0.12]) engagement were associated with lower social isolation. Associations were independent of demographic and socioeconomic confounders.

Conclusion Our findings suggest that offering a diverse range of creative, arts, and cultural activities and supporting sustained engagement of older adults may help alleviate their social deficits. Although this study could not conclude causality due to observational analysis, it extends the evidence for addressing social deficits with arts and cultural engagement in Western countries to Asian settings.