Preventing Cognitive Decline through Museum-Based Psychosocial Rehabilitation for Elders and Caregivers

Preventing Cognitive Decline through Museum-Based Psychosocial Rehabilitation for Elders and Caregivers | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preventing Cognitive Decline through Museum-Based Psychosocial Rehabilitation for Elders and Caregivers Supalak Khemthong, Chewasit Boonyakiet, Winai Chatthong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7700768/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Cognitive decline and mild cognitive impairment represent growing concerns in geriatric mental health, yet psychosocial rehabilitation has rarely incorporated cultural institutions as community-based resources. This study examined how museum-based psychosocial rehabilitation supports cognitive health, emotional well-being, and intergenerational connection among older adults and their caregivers in Thailand. Sixteen elder–caregiver dyads (N = 32) participated in a structured visit to six curated museum galleries in Bangkok. Participants photographed meaningful exhibits and engaged in narrative interviews guided by photo-elicitation, while observational field notes documented affective and social interactions. Cognitive functioning was assessed with the Montreal Cognitive Assessment (education-adjusted), and depressive symptoms were measured using the Patient Health Questionnaire-9. Thematic analysis identified four recurring patterns of engagement: Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection. Elders with lower cognitive scores emphasized collective cultural identity, while non-impaired participants more frequently highlighted autobiographical memory and relational narratives. Observations revealed embodied expressions of emotion, such as touch, tears, and laughter, alongside concerns including caregiver burden and self-reliance. Quantitative findings showed minimal depressive symptoms across both groups, with caregivers generally demonstrating stronger cognitive performance than elders. These results suggest that museum-based cultural engagement functions as a low-cost psychosocial rehabilitation strategy that fosters memory recall, emotional regulation, and identity continuity. By situating cultural participation within preventive frameworks, museums can serve as accessible community resources for promoting healthy and creative aging. Occupational Medicine Psychiatry Biomedical Engineering Gender Studies psychosocial rehabilitation museum-based intervention mild cognitive impairment caregivers healthy aging 1 Introduction In Thailand, the proportion of older adults in the population is growing rapidly, making aging and intergenerational relationships central to the social fabric. Preserving cognitive health, supporting emotional well-being, and strengthening family bonds have therefore become urgent priorities. While healthcare and social services remain essential, holistic, non-clinical approaches are increasingly recognized for their role in addressing the cognitive, emotional, and cultural dimensions of aging (Miki et al., 2024). Social prescribing has emerged as a promising strategy linking primary care to community resources that promote mental health and well-being (World Health Organization, 2022). Within this framework, cultural institutions such as museums can function as therapeutic environments where older adults and caregivers connect and co-create meaning. Their sensory and symbolic richness can activate autobiographical memory, reinforce cultural identity, and foster intergenerational empathy (Šveb Dragija & Jelinčić, 2022; Falk & Dierking, 2013). These experiences align with theories of narrative transportation and contextual learning, which emphasize the role of shared meaning-making in shaping personal and relational outcomes (Green & Brock, 2000; Roppola, 2012). Preventing cognitive decline, particularly mild cognitive impairment (MCI), has become a public health priority. Research on creative aging underscores the importance of everyday forms of creativity—such as storytelling, photography, and cultural reflection—in fostering resilience, stimulating memory, and enhancing social participation (Cohen, 2006; White, 2017; Aula & Masoodian, 2025). Community-based cultural engagement has been associated with improved mood, autonomy, and cognitive stimulation (Stickley et al., 2021; Chacur et al., 2024). Recent studies also suggest that immersive and digital storytelling approaches may further enhance engagement among older adults (Yi et al., 2024; Zhu et al., 2024). Despite these advances, gaps remain in understanding how museum-based engagement may function as psychosocial rehabilitation for elders and caregivers in real-world, non-clinical contexts. Few studies have investigated how such experiences influence cognitive outcomes, identity construction, emotional expression, or intergenerational reflection. Mixed-methods designs are particularly well-suited to addressing these gaps, capturing both the measurable and lived dimensions of engagement (Ward et al., 2020; Roh & Weon, 2022). This study addresses these gaps by exploring how elder–caregiver dyads experienced a visit to Museum Siam in Bangkok. Using photo-elicited narratives and quantitative assessments of cognition and mood, the study examined how participants articulated emotional well-being, cultural identity, and intergenerational connection. Specifically, it asked: How do older adults and caregivers describe emotional engagement, cultural identity, and relational well-being in a museum setting? What recurring themes reflect personal, cultural, cognitive, and intergenerational meaning? In what ways can museum-based engagement contribute to psychosocial rehabilitation and the prevention of cognitive decline? 2 Methods 2.1 Study Context This study was conducted at Museum Siam, a public museum in Bangkok, Thailand, known for its interactive exhibitions on Thai history, culture, and identity. Six galleries were purposefully selected for their accessibility and thematic relevance, covering symbolic identity, royal traditions, education, cuisine, beliefs, and photography. These settings were chosen for their potential to evoke memory, stimulate reflection, and foster intergenerational dialogue. 2.2 Subject Selection and Allocation Participants were divided into two groups: older adults (n = 16) and caregivers (n = 16), forming a total sample of 32 individuals. Purposive sampling was applied to recruit dyads from community and museum networks. 2.2.1 Inclusion Criteria Older adults Aged 60 years or older, legally competent, able to communicate in Thai, and capable of using a mobile phone to take photographs. Scored less than 9 out of 27 on the Thai version of the Patient Health Questionnaire (PHQ-9), indicating no to mild depressive symptoms (Lotrakul et al., 2008). Scored greater than 16 out of 30 on the Montreal Cognitive Assessment, Thai version (MoCA-Thai), indicating no dementia to mild cognitive impairment (Hemrungrojn et al., 2021). Caregivers Aged 25–59 years, legally competent, and either relatives, children, grandchildren, or volunteers accompanying older adults to the museum; able to communicate in Thai and use a mobile phone to take photographs. Scored less than 9 on the Thai PHQ-9, indicating no to mild depressive symptoms (Lotrakul et al., 2008). Scored greater than 16 on the MoCA-Thai, indicating no dementia to mild cognitive impairment (Hemrungrojn et al., 2021). 2.2.2 Exclusion Criteria Older adults Diagnosed with neurological disorders leading to severe cognitive impairment, including dementia, stroke, Parkinson’s disease, or delirium. Diagnosed by a psychiatrist with moderate-to-severe psychiatric illness, gaming disorder, or active hallucinations. Under medication affecting electroencephalography (EEG) measurement, such as tricyclic antidepressants or clozapine. Receiving treatments likely to interfere with the study, such as electroconvulsive therapy (ECT). Presenting with abnormal hand movements, including tremors or extrapyramidal side effects from medication. Caregivers Diagnosed with neurological, psychiatric, or musculoskeletal disorders. Presenting with physical disabilities including impaired mobility, vision, or hearing. 2.3 Participants and Procedure Each dyad participated in a one-hour museum visit, during which participants photographed one meaningful object or moment in each of the six galleries. After the visit, each participant selected the single photograph they considered most significant and engaged in a semi-structured narrative interview. Interviews explored how the chosen image reflected well-being, identity, and emotional experience. Sessions were audio-recorded and transcribed verbatim. 2.4 Data Collection Data were derived from four complementary sources: Participant photographs – used as visual anchors for narrative elicitation. Narrative interviews – capturing subjective reflections on memory, emotion, and cultural identity. Observational field notes – documenting gestures, affect, and spontaneous intergenerational interactions. Quantitative assessments – cognitive functioning was measured using the Montreal Cognitive Assessment (MOCA-Thai, education-adjusted), and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic information (age, gender, education, socioeconomic status, museum visiting history, and pre-existing conditions) was also collected. 2.5 Data Analysis Qualitative transcripts were analyzed thematically, guided by frameworks on creative aging and museum learning (Hooper-Greenhill, 2007; Roppola, 2012). Codes were developed inductively, refined through iterative reading and constant comparison, and organized into themes reflecting emotional, symbolic, and relational dimensions. Caregiver–elder dynamics were considered throughout analysis, and bilingual translation with participant review helped preserve cultural meaning. Quantitative data were analyzed using descriptive statistics and group comparisons. Independent-samples t-tests were used to compare elders and caregivers on cognitive and mood measures, while chi-square tests examined group differences in demographic variables. Cross-tabulations linked cognitive status (mild cognitive impairment vs. non-impaired) with thematic patterns. Integration of qualitative and quantitative findings followed a convergent mixed-methods design, emphasizing complementarity between numerical outcomes and narrative meaning. 2.6 Researcher Positionality The research team, trained in psychosocial occupational therapy and museum studies, approached museums as potential sites of creativity, rehabilitation, and intergenerational connection (Soares, 2020). Reflexivity was maintained through documentation of assumptions and interpretive decisions, with emphasis placed on privileging participants’ voices and cultural context. 3 Results 3.1 Participant Characteristics Sixteen dyads participated in the study, comprising 16 elders (E) and 16 caregivers (C). Elders had a mean age of 71.6 years (SD = 6.2, range 61–80), while caregivers averaged 48.8 years (SD = 5.0, range 41–57) as seen in Table 1. Both groups were predominantly female (75% of elders, 94% of caregivers). Education levels differed between groups: caregivers were generally more highly educated (56% with university degree or higher), whereas elders showed greater variability, including primary education or no formal schooling. Socioeconomic status was mostly stable across groups, with most reporting “sufficient with savings.” Chi-square analysis indicated no group differences in gender (χ² = 0.01, p = .90) or SES (χ² = 1.31, p = .73), but a trend for education (χ² = 10.1, p = .07), with caregivers more likely to have higher education. Museum visit frequency differed significantly (χ² = 7.75, p = .05): most elders were first-time visitors (75%), while caregivers had more prior visits, suggesting novelty of experience was greater for elders. Table 1 Participant Characteristics by Group Group Mean Age (years) Gender Education SES 1 Museum Visits 2 Elders (n=16) 71.6 ± 6.2 12F / 4M Varied; 2 none, 2 primary, 3 secondary, 6 bachelor, 3 postgrad 10 adequate savings, 5 sufficient, 1 insufficient 12 first-time, 2 second, 2 third Caregivers (n=16) 48.8 ± 5.0 15F / 1M 2 vocational, 9 bachelor, 5 postgrad 8 adequate savings, 6 sufficient, 1 welfare, 1 insufficient 5 first-time, 4 second, 3 third, 4 >3 times ¹SES categories: adequate savings = financially comfortable; sufficient = meet daily needs; insufficient = some financial difficulty; welfare = dependent on state assistance. ²Museum visit categories reflect frequency of prior visits to Museum Siam. 3.2 Cognitive and Mood Outcomes MOCA (education corrected) and PHQ-9 were administered to both groups. Caregivers scored significantly higher in cognition than elders (M = 27.7 vs 24.6, t = 3.46, p = .005). Several elders scored below the MCI threshold (<26), while caregivers generally performed in the normal range. Both groups reported minimal depressive symptoms, with no significant difference in PHQ-9 scores (M = 1.5 vs 1.4, t = 0.30, p = .77). Table 2 Cognitive and Mood Outcomes by Group Group MOCA (mean ± SD) PHQ-9 (mean ± SD) MCI (n, %) Non-MCI (n, %) Elders (n = 16) 24.6 ± 2.2 1.4 ± 1.0 9 (56.3%) 7 (43.7%) Caregivers (n = 16) 27.7 ± 1.2 1.5 ± 0.6 2 (12.5%) 14 (87.5%) MCI = Mild Cognitive Impairment, defined as MOCA < 26. PHQ-9 = Patient Health Questionnaire, depressive symptoms. 3.4 Narrative Analysis This study analyzed 16 elder–caregiver dyads (n = 32), combining demographic, cognitive, and mood assessments with photo-elicited narratives and observational data. Four major themes were identified—Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection—which varied by cognitive status and caregiving role. These themes illustrate how museum engagement contributes to healthy aging (maintaining well-being, connection, and function) and creative aging (using everyday creative practices such as photography, memory recall, and storytelling to generate meaning). 3.4.1 Culture as Anchor of Identity and Comfort Seventeen participants described photographs of Buddhist statues, royal portraits, and sacred sites as sources of reassurance, calm, and strength. One elder explained: “Every time I see the Buddha statue, I feel calm and reassured” (NDMI-E-007). Quantitatively, Cultural Anchoring was the most frequent theme among participants with MCI, representing nearly half of their responses (45.5%). This aligns with elders’ lower MOCA scores (mean = 24.4), suggesting that even when autobiographical recall is diminished, semantic cultural memory remains a powerful reservoir for meaning-making. Caregivers, who performed in the normal range cognitively (mean MOCA-NEW = 27.7), often echoed cultural pride in terms of transmission to the next generation. Innovative contribution: This theme shows how cultural continuity supports healthy aging by grounding identity despite cognitive decline, and creative aging by enabling symbolic reinterpretation of heritage. 3.4.2 Civic Consciousness and Moral Continuity Twelve participants expressed pride in Thai history and responsibility to future generations. One caregiver reflected: “The Democracy Monument took me back to when I was a child, waiting for my mother during the protests” (NDMI-C-008). Narratives of civic memory emerged across both groups but took different forms: MCI elders referenced moral lessons in more general, symbolic terms, while non-MCI caregivers gave specific autobiographical accounts. Statistical analyses showed no significant differences in PHQ-9 between those emphasizing civic themes and others (means ~1.4–1.6), suggesting that civic engagement was emotionally meaningful without being tied to mood strain. Innovative contribution: Civic Consciousness demonstrates how museums act as moral learning environments, reinforcing creative aging through intergenerational storytelling that integrates personal and historical memory. 3.4.3 Nostalgia of Childhood Eleven participants recalled formative experiences in classrooms and early friendships. “Seeing the classroom reminded me of my school days—carefree, full of laughter with my friends” (NDMI-E-001). This theme was predominantly expressed by non-MCI participants (75%), especially elders with higher MOCA-NEW scores. Statistical trends suggest that cognitively intact participants were more likely to engage in rich autobiographical recall, whereas MCI elders leaned toward cultural anchors. Innovative contribution: This theme illustrates that museum environments selectively activate different memory systems—autobiographical memory in non-MCI participants and semantic cultural memory in MCI participants—highlighting the museum’s potential as a diagnostic and therapeutic space. 3.4.4 Intergenerational Affection and Divergent Meaning-Making Fourteen participants emphasized gratitude and closeness. “Seeing my mom’s face light up—she was curious, excited, like a child again” (NDMI-C-002). Quantitatively, non-MCI elders most often expressed intergenerational affection (71%), though it was also common among caregivers. Elders who voiced this theme had lower MOCA-NEW scores (mean = 21.0) and slightly higher PHQ-9 scores (mean = 3.0), suggesting that relational warmth may buffer cognitive and emotional vulnerability. Caregivers, with consistently strong cognition and low depressive symptoms, framed affection in terms of caregiving joy and pride. Importantly, dyadic analysis revealed 12 cases of divergence versus 4 cases of convergence. Divergence often took the form of elders emphasizing spirituality or historical continuity, while caregivers stressed autonomy or immediate joy. Far from creating conflict, divergence fostered relational dialogue and empathic resonance, an example of relational creativity in action. Innovative contribution: Intergenerational Affection shows how emotional closeness functions as an adaptive buffer (healthy aging), while dyadic divergence fosters creative reinterpretation of experiences (creative aging). 3.4.5 Observational Insights Field notes confirmed embodied expressions of engagement, such as touch, posture, and tears. For example, one caregiver quietly held her mother’s hand as she reminisced about her school days. Another elder turned away while recalling a deceased relative, illustrating the quiet labor of revisiting grief. Spontaneous affirmations— “You still remember all this! You’re amazing” (NDMI-C-002) —reinforced the museum as a relational space of mutual recognition. Notably, these affective gestures occurred equally in MCI and non-MCI dyads, underscoring that empathic resonance transcends cognitive status. 3.4.6 Psychosocial Concerns Beyond joy and bonding, some narratives surfaced concerns such as caregiver strain, self-reliance, or unresolved grief. A caregiver noted: “One must rely on oneself,” (NDMI-C-016) reflecting resilience alongside limited perceived support. While not statistically linked to higher PHQ-9 scores, these concerns reveal the dual nature of cultural engagement: a source of joy and bonding, but also a mirror for vulnerability and strain. 3.4.7 Summary of Integrated Findings Healthy aging: Museums supported elders’ resilience, identity continuity, and emotional connection even in cognitive vulnerability. Creative aging: Everyday creative practices (photography, storytelling, reflection) enabled generational dialogue and reinterpretation of cultural symbols. Innovative contributions: Theme–cognition linkage: MCI participants gravitated toward cultural/civic anchors; non-MCI participants toward autobiographical nostalgia. Dyadic divergence as relational creativity: Divergences enriched dialogue, showing museums as relational laboratories. Emotional buffering: Intergenerational affection buffered cognitive/mood vulnerability, demonstrating the protective power of relational co-occupation. 3.5 MCI versus Non-MCI Status Based on MOCA-NEW, 11 participants (34%) met criteria for MCI, including 9 elders and 2 caregivers. Chi-square analysis confirmed that elders were significantly more likely to meet MCI criteria (χ² = 4.99, p = .026). PHQ-9 scores did not differ significantly between MCI and non-MCI participants (M = 1.6 vs 1.3, p = .57), indicating minimal mood differences across cognitive groups. Thematic expression varied: MCI participants more frequently emphasized Cultural Anchoring and Civic Consciousness, while non-MCI participants more often highlighted Intergenerational Affection and Nostalgia of Childhood, suggesting autobiographical recall was stronger among cognitively preserved participants. 3. 6 Gallery Selection by Elders and Caregivers Cross-tabulation was conducted to compare the distribution of gallery selections between elders (n = 16) and caregivers (n = 16). As shown in Table X, both groups engaged with similar galleries, with the most frequently chosen being Thai Since Birth , Thai Witthaya (education), and Thai Beliefs . Elders tended to select more from Thai Snap and Thai Taste , reflecting personal and nostalgic memory triggers, whereas caregivers more often chose Thai Witthaya and Thai Beliefs , suggesting stronger connections to education and faith-based displays. However, Chi-square analysis indicated no statistically significant difference between the two groups in overall gallery selection (χ² = 1.81, df = 5, p = 0.87). This suggests that while subtle thematic preferences were observed, both elders and caregivers distributed their selections across galleries in broadly similar patterns. 3.7 Caregiver Roles Among the 16 caregivers, the majority were immediate family members, with children representing over half of the sample (n = 9, 56%). Other roles included grandchildren (n = 2, 12%), relatives (n = 2, 12%), hired caregivers (n = 2, 12%), and one volunteer caregiver (n = 1, 6%). This distribution highlights the centrality of family, particularly adult children, in providing care for older adults, while also demonstrating contributions from extended family, formal caregiving arrangements, and volunteer support. Such variation reflects both traditional family-based caregiving structures in Thailand and the emerging presence of supplementary care models that support older adults and their families. In terms of health, most caregivers reported living with chronic conditions, with two rating their disease control as fair and four as good. Common conditions included hypertension, hyperlipidemia, rheumatoid arthritis, and gastrointestinal diseases such as ulcerative colitis and chronic gastritis, alongside sensory decline such as hearing impairment. These findings illustrate not only the predominance of adult children in caregiving roles, but also the dual challenge faced by caregivers who must manage their relatives’ needs while addressing their own chronic health conditions. 3.8 Elders’ Health Profile Among the 16 older adults, health status varied, with four reporting that their chronic conditions were under fair control and three under good control. The most common conditions included hypertension and hyperlipidemia, often occurring together, followed by diabetes and cardiovascular disease. Additional diagnoses included stroke, uterine fibroids, and prostate cancer, reflecting the diverse range of age-related illnesses present in the sample. Despite these health challenges, several elders remained actively engaged during the museum program, suggesting that cultural participation may serve as an important avenue for psychosocial rehabilitation. These findings highlight both the physical vulnerabilities and the resilience of older adults, underscoring the need for supportive interventions that address not only medical stability but also social and cognitive well-being. 4 Discussion This study examined how museum-based engagement supported emotional well-being, cognitive stimulation, and relational connection among older adults and their caregivers. Four themes—Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection—showed how exhibits facilitated memory, identity, and intergenerational dialogue. Quantitative findings provided context: elders were more likely to meet criteria for mild cognitive impairment (MCI), while caregivers generally demonstrated stronger cognition but reported mild depressive symptoms. Together, these results highlight museums as psychosocial rehabilitation spaces with potential to support cognitive decline prevention and healthy aging. 4.1 Addressing the Research Questions Participants expressed emotional engagement through narratives of cultural pride, gratitude, and relational affection. Elders with MCI more often emphasized broad cultural anchors, while non-MCI participants drew on autobiographical memory, underscoring how cognitive status shapes meaning-making. 4.2 Interpretation in Light of Theory and Literature Findings align with literature on narrative transportation, reminiscence, and creative aging. Cultural artifacts offered restorative comfort (Aula & Masoodian, 2025; Jelinčić & Šveb, 2021), while reflections on national history supported civic empathy (Soares, 2020). Nostalgic recall activated autobiographical memory (Falk & Dierking, 2013), a process linked to self-referential networks that aid emotional regulation (Addis & Szpunar, 2024). Observed smiles, tears, and touch confirmed narrative immersion (Green & Brock, 2000), illustrating how museums foster resilience and coherent life narratives. 4.3 Intergenerational Similarities and Differences Dyadic analysis revealed both convergence and divergence. Elders emphasized spirituality and cultural heritage, while caregivers reflected on caregiving pride and joy. Generational differences did not weaken closeness but enriched dialogue and empathy, echoing work on caregiving complexity (Ward et al., 2020; Stickley et al., 2021). Implications for Practice These findings position museums as low-barrier, culturally grounded settings for psychosocial rehabilitation. Elders reported stress relief and identity continuity, while caregivers experienced validation beyond task-based roles. This complements social prescribing initiatives (WHO, 2022; NASP, 2023), addressing calls for rigorous evaluation of psychosocial outcomes (Percival et al., 2022; Ashe et al., 2024). Museums may also advance aging literacy, fostering shared understanding of independence, interdependence, and resilience. For occupational therapy, museums represent occupation-centered environments that support co-occupation and relational reciprocity. For museum professionals, results underscore the value of exhibitions that invite reflection and intergenerational dialogue. 4.4 Strengths and Limitations Strengths include the mixed-methods design, combining photo-elicited narratives, observations, and cognitive and mood assessments, and the dyadic approach capturing intergenerational dynamics. Limitations include the small, urban Thai sample, single-visit design, and cultural specificity. Broader projects including neurophysiological measures (EEG) were not reported here. Future research should examine longitudinal outcomes, include more diverse samples, and test museum-based interventions as structured psychosocial rehabilitation. 5 Conclusion Museums can function as therapeutic and relational spaces that foster resilience, identity continuity, and intergenerational solidarity. By integrating qualitative narratives with cognitive and mood outcomes, this study affirms the role of cultural engagement as a community-based psychosocial rehabilitation tool supporting cognitive health and caregiver well-being. Declarations Ethics Approval The study received ethics approval from the Mahidol University Central Institutional Review Board (Certificate No. MU-CIRB 2025/142.0105). Participant Consent All participants were fully informed about the research objectives and procedures and provided written consent prior to participation. The authors affirm that all participants provided written informed consent for participation in this study. 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Immersive experiences in museums for elderly with cognitive disorders: A user-centered design approach. Scientific Reports, 14, 1971. https://doi.org/10.1038/s41598-024-51929-4 Zhu, D., Al Mahmud, A., & Liu, W. (2024). Digital storytelling intervention for enhancing the social participation of people with mild cognitive impairment: Co-design and usability study. JMIR Aging, 7, e54138. https://doi.org/10.2196/54138 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7700768","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":519823363,"identity":"3da0e4f2-1e2f-4566-83e4-f2e83256287f","order_by":0,"name":"Supalak Khemthong","email":"","orcid":"https://orcid.org/0000-0002-1974-3862","institution":"Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Supalak","middleName":"","lastName":"Khemthong","suffix":""},{"id":519823364,"identity":"c463e072-5aa5-4f45-8488-c8ed95b23568","order_by":1,"name":"Chewasit Boonyakiet","email":"","orcid":"https://orcid.org/0009-0003-5648-493X","institution":"National Discovery Museum Institute","correspondingAuthor":false,"prefix":"","firstName":"Chewasit","middleName":"","lastName":"Boonyakiet","suffix":""},{"id":519823365,"identity":"6e0de228-9d38-4e78-a607-912d5a2f0853","order_by":2,"name":"Winai Chatthong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIiWNgGAWjYDACZiBOACH2BiDbgJmBDyJ+gAgtPAcgWtjAwgl4tEBBAoNEAkg7EVoMjvMe/PCAwS6Pf+brxM8FBdZybAzMDz8w/riDW8thvmSg+cnFErdzN0vPMEg3ZmNgM5ZgSHiGU4vZYR4DoJYDiQ23czdI8xgcTmwDCgIddhifFuMfIC3zb57d/Buihf0bIS1mYFs23ODdBrWFB78t9kAtFgkGyYkbz+Rus+YB+YWZp1giIQ23Fsn+M8Y3f1TYJc47fnbzbZ4/1nL87O0bP3ywwa0FAgyQOdDIHQWjYBSMglFAAQAAeKxPFroWXDUAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5845-940X","institution":"Mahidol 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09:48:24","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":95492,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7700768/v1/74d68537e716ab876a8b36fa.html"},{"id":92249080,"identity":"9ec5b085-589d-4c32-839b-034c901bc2ab","added_by":"auto","created_at":"2025-09-26 10:12:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":741433,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7700768/v1/eaccaa71-51b2-4af9-9887-9f2d75671a7d.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePreventing Cognitive Decline through Museum-Based Psychosocial Rehabilitation for Elders and Caregivers\u003c/p\u003e","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eIn Thailand, the proportion of older adults in the population is growing rapidly, making aging and intergenerational relationships central to the social fabric. Preserving cognitive health, supporting emotional well-being, and strengthening family bonds have therefore become urgent priorities. While healthcare and social services remain essential, holistic, non-clinical approaches are increasingly recognized for their role in addressing the cognitive, emotional, and cultural dimensions of aging (Miki et al., 2024).\u003c/p\u003e\n\u003cp\u003eSocial prescribing has emerged as a promising strategy linking primary care to community resources that promote mental health and well-being (World Health Organization, 2022). Within this framework, cultural institutions such as museums can function as therapeutic environments where older adults and caregivers connect and co-create meaning. Their sensory and symbolic richness can activate autobiographical memory, reinforce cultural identity, and foster intergenerational empathy (\u0026Scaron;veb Dragija \u0026amp; Jelinčić, 2022; Falk \u0026amp; Dierking, 2013). These experiences align with theories of narrative transportation and contextual learning, which emphasize the role of shared meaning-making in shaping personal and relational outcomes (Green \u0026amp; Brock, 2000; Roppola, 2012).\u003c/p\u003e\n\u003cp\u003ePreventing cognitive decline, particularly mild cognitive impairment (MCI), has become a public health priority. Research on creative aging underscores the importance of everyday forms of creativity\u0026mdash;such as storytelling, photography, and cultural reflection\u0026mdash;in fostering resilience, stimulating memory, and enhancing social participation (Cohen, 2006; White, 2017; Aula \u0026amp; Masoodian, 2025). Community-based cultural engagement has been associated with improved mood, autonomy, and cognitive stimulation (Stickley et al., 2021; Chacur et al., 2024). Recent studies also suggest that immersive and digital storytelling approaches may further enhance engagement among older adults (Yi et al., 2024; Zhu et al., 2024).\u003c/p\u003e\n\u003cp\u003eDespite these advances, gaps remain in understanding how museum-based engagement may function as psychosocial rehabilitation for elders and caregivers in real-world, non-clinical contexts. Few studies have investigated how such experiences influence cognitive outcomes, identity construction, emotional expression, or intergenerational reflection. Mixed-methods designs are particularly well-suited to addressing these gaps, capturing both the measurable and lived dimensions of engagement (Ward et al., 2020; Roh \u0026amp; Weon, 2022).\u003c/p\u003e\n\u003cp\u003eThis study addresses these gaps by exploring how elder\u0026ndash;caregiver dyads experienced a visit to Museum Siam in Bangkok. Using photo-elicited narratives and quantitative assessments of cognition and mood, the study examined how participants articulated emotional well-being, cultural identity, and intergenerational connection. Specifically, it asked:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eHow do older adults and caregivers describe emotional engagement, cultural identity, and relational well-being in a museum setting?\u003c/li\u003e\n \u003cli\u003eWhat recurring themes reflect personal, cultural, cognitive, and intergenerational meaning?\u003c/li\u003e\n \u003cli\u003eIn what ways can museum-based engagement contribute to psychosocial rehabilitation and the prevention of cognitive decline?\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"2 Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted at Museum Siam, a public museum in Bangkok, Thailand, known for its interactive exhibitions on Thai history, culture, and identity. Six galleries were purposefully selected for their accessibility and thematic relevance, covering symbolic identity, royal traditions, education, cuisine, beliefs, and photography. These settings were chosen for their potential to evoke memory, stimulate reflection, and foster intergenerational dialogue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Subject Selection and Allocation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were divided into two groups: older adults (n = 16) and caregivers (n = 16), forming a total sample of 32 individuals. Purposive sampling was applied to recruit dyads from community and museum networks.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1 Inclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOlder adults\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eAged 60 years or older, legally competent, able to communicate in Thai, and capable of using a mobile phone to take photographs.\u003c/li\u003e\n \u003cli\u003eScored less than 9 out of 27 on the Thai version of the Patient Health Questionnaire (PHQ-9), indicating no to mild depressive symptoms (Lotrakul et al., 2008).\u003c/li\u003e\n \u003cli\u003eScored greater than 16 out of 30 on the Montreal Cognitive Assessment, Thai version (MoCA-Thai), indicating no dementia to mild cognitive impairment (Hemrungrojn et al., 2021).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCaregivers\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eAged 25\u0026ndash;59 years, legally competent, and either relatives, children, grandchildren, or volunteers accompanying older adults to the museum; able to communicate in Thai and use a mobile phone to take photographs.\u003c/li\u003e\n \u003cli\u003eScored less than 9 on the Thai PHQ-9, indicating no to mild depressive symptoms (Lotrakul et al., 2008).\u003c/li\u003e\n \u003cli\u003eScored greater than 16 on the MoCA-Thai, indicating no dementia to mild cognitive impairment (Hemrungrojn et al., 2021).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2 Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eOlder adults\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDiagnosed with neurological disorders leading to severe cognitive impairment, including dementia, stroke, Parkinson\u0026rsquo;s disease, or delirium.\u003c/li\u003e\n \u003cli\u003eDiagnosed by a psychiatrist with moderate-to-severe psychiatric illness, gaming disorder, or active hallucinations.\u003c/li\u003e\n \u003cli\u003eUnder medication affecting electroencephalography (EEG) measurement, such as tricyclic antidepressants or clozapine.\u003c/li\u003e\n \u003cli\u003eReceiving treatments likely to interfere with the study, such as electroconvulsive therapy (ECT).\u003c/li\u003e\n \u003cli\u003ePresenting with abnormal hand movements, including tremors or extrapyramidal side effects from medication.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCaregivers\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDiagnosed with neurological, psychiatric, or musculoskeletal disorders.\u003c/li\u003e\n \u003cli\u003ePresenting with physical disabilities including impaired mobility, vision, or hearing.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Participants and Procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach dyad participated in a one-hour museum visit, during which participants photographed one meaningful object or moment in each of the six galleries. After the visit, each participant selected the single photograph they considered most significant and engaged in a semi-structured narrative interview. Interviews explored how the chosen image reflected well-being, identity, and emotional experience. Sessions were audio-recorded and transcribed verbatim.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were derived from four complementary sources:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eParticipant photographs \u0026ndash; used as visual anchors for narrative elicitation.\u003c/li\u003e\n \u003cli\u003eNarrative interviews \u0026ndash; capturing subjective reflections on memory, emotion, and cultural identity.\u003c/li\u003e\n \u003cli\u003eObservational field notes \u0026ndash; documenting gestures, affect, and spontaneous intergenerational interactions.\u003c/li\u003e\n \u003cli\u003eQuantitative assessments \u0026ndash; cognitive functioning was measured using the Montreal Cognitive Assessment (MOCA-Thai, education-adjusted), and depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic information (age, gender, education, socioeconomic status, museum visiting history, and pre-existing conditions) was also collected.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQualitative transcripts were analyzed thematically, guided by frameworks on creative aging and museum learning (Hooper-Greenhill, 2007; Roppola, 2012). Codes were developed inductively, refined through iterative reading and constant comparison, and organized into themes reflecting emotional, symbolic, and relational dimensions. Caregiver\u0026ndash;elder dynamics were considered throughout analysis, and bilingual translation with participant review helped preserve cultural meaning.\u003c/p\u003e\n\u003cp\u003eQuantitative data were analyzed using descriptive statistics and group comparisons. Independent-samples t-tests were used to compare elders and caregivers on cognitive and mood measures, while chi-square tests examined group differences in demographic variables. Cross-tabulations linked cognitive status (mild cognitive impairment vs. non-impaired) with thematic patterns. Integration of qualitative and quantitative findings followed a convergent mixed-methods design, emphasizing complementarity between numerical outcomes and narrative meaning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6 Researcher Positionality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research team, trained in psychosocial occupational therapy and museum studies, approached museums as potential sites of creativity, rehabilitation, and intergenerational connection (Soares, 2020). Reflexivity was maintained through documentation of assumptions and interpretive decisions, with emphasis placed on privileging participants\u0026rsquo; voices and cultural context.\u003c/p\u003e"},{"header":"3 Results","content":"\u003cp\u003e\u003cstrong\u003e3.1\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eParticipant Characteristics\u003cbr\u003e\u003c/strong\u003eSixteen dyads participated in the study, comprising 16 elders (E) and 16 caregivers (C). Elders had a mean age of 71.6 years (SD = 6.2, range 61\u0026ndash;80), while caregivers averaged 48.8 years (SD = 5.0, range 41\u0026ndash;57) as seen in Table 1. Both groups were predominantly female (75% of elders, 94% of caregivers). Education levels differed between groups: caregivers were generally more highly educated (56% with university degree or higher), whereas elders showed greater variability, including primary education or no formal schooling. Socioeconomic status was mostly stable across groups, with most reporting \u0026ldquo;sufficient with savings.\u0026rdquo; Chi-square analysis indicated no group differences in gender (\u0026chi;\u0026sup2; = 0.01, p = .90) or SES (\u0026chi;\u0026sup2; = 1.31, p = .73), but a trend for education (\u0026chi;\u0026sup2; = 10.1, p = .07), with caregivers more likely to have higher education. Museum visit frequency differed significantly (\u0026chi;\u0026sup2; = 7.75, p = .05): most elders were first-time visitors (75%), while caregivers had more prior visits, suggesting novelty of experience was greater for elders.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eParticipant Characteristics by Group\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eMean Age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eSES\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eMuseum Visits\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eElders \u0026nbsp; \u0026nbsp;(n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e71.6 \u0026plusmn; 6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e12F / 4M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eVaried; 2 none, 2 primary, 3 secondary, 6 bachelor, 3 postgrad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e10 adequate savings, 5 sufficient, 1 insufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e12 first-time, 2 second, 2 third\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003eCaregivers (n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e48.8 \u0026plusmn; 5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e15F / 1M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e2 vocational, 9 bachelor, 5 postgrad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e8 adequate savings, 6 sufficient, 1 welfare, 1 insufficient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.6667%;\"\u003e\n \u003cp\u003e5 first-time, 4 second, 3 third, 4 \u0026gt;3 times\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026sup1;SES categories: adequate savings = financially comfortable; sufficient = meet daily needs; insufficient = some financial difficulty; welfare = dependent on state assistance.\u003c/p\u003e\n\u003cp\u003e\u0026sup2;Museum visit categories reflect frequency of prior visits to Museum Siam.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCognitive and Mood Outcomes\u003cbr\u003e\u003c/strong\u003eMOCA (education corrected) and PHQ-9 were administered to both groups. Caregivers scored significantly higher in cognition than elders (M = 27.7 vs 24.6, t = 3.46, p = .005). Several elders scored below the MCI threshold (\u0026lt;26), while caregivers generally performed in the normal range. Both groups reported minimal depressive symptoms, with no significant difference in PHQ-9 scores (M = 1.5 vs 1.4, t = 0.30, p = .77).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e Cognitive and Mood Outcomes by Group\u003c/p\u003e\n\u003ctable border=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMOCA (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePHQ-9 (mean \u0026plusmn; SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMCI (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNon-MCI (n, %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eElders (n = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e24.6 \u0026plusmn; 2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.4 \u0026plusmn; 1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (56.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (43.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCaregivers (n = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.7 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.5 \u0026plusmn; 0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e14 (87.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eMCI = Mild Cognitive Impairment, defined as MOCA \u0026lt; 26. PHQ-9 = Patient Health Questionnaire, depressive symptoms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Narrative Analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study analyzed 16 elder\u0026ndash;caregiver dyads (n = 32), combining demographic, cognitive, and mood assessments with photo-elicited narratives and observational data. Four major themes were identified\u0026mdash;Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection\u0026mdash;which varied by cognitive status and caregiving role. These themes illustrate how museum engagement contributes to healthy aging (maintaining well-being, connection, and function) and creative aging (using everyday creative practices such as photography, memory recall, and storytelling to generate meaning).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.1 Culture as Anchor of Identity and Comfort\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventeen participants described photographs of Buddhist statues, royal portraits, and sacred sites as sources of reassurance, calm, and strength. One elder explained:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Every time I see the Buddha statue, I feel calm and reassured\u0026rdquo; (NDMI-E-007).\u003c/p\u003e\n\u003cp\u003eQuantitatively, Cultural Anchoring was the most frequent theme among participants with MCI, representing nearly half of their responses (45.5%). This aligns with elders\u0026rsquo; lower MOCA scores (mean = 24.4), suggesting that even when autobiographical recall is diminished, semantic cultural memory remains a powerful reservoir for meaning-making. Caregivers, who performed in the normal range cognitively (mean MOCA-NEW = 27.7), often echoed cultural pride in terms of transmission to the next generation.\u003c/p\u003e\n\u003cp\u003eInnovative contribution: This theme shows how cultural continuity supports healthy aging by grounding identity despite cognitive decline, and creative aging by enabling symbolic reinterpretation of heritage.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.2 Civic Consciousness and Moral Continuity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwelve participants expressed pride in Thai history and responsibility to future generations. One caregiver reflected:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The Democracy Monument took me back to when I was a child, waiting for my mother during the protests\u0026rdquo; (NDMI-C-008).\u003c/p\u003e\n\u003cp\u003eNarratives of civic memory emerged across both groups but took different forms: MCI elders referenced moral lessons in more general, symbolic terms, while non-MCI caregivers gave specific autobiographical accounts. Statistical analyses showed no significant differences in PHQ-9 between those emphasizing civic themes and others (means ~1.4\u0026ndash;1.6), suggesting that civic engagement was emotionally meaningful without being tied to mood strain.\u003c/p\u003e\n\u003cp\u003eInnovative contribution: Civic Consciousness demonstrates how museums act as moral learning environments, reinforcing creative aging through intergenerational storytelling that integrates personal and historical memory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.3 Nostalgia of Childhood\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEleven participants recalled formative experiences in classrooms and early friendships.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Seeing the classroom reminded me of my school days\u0026mdash;carefree, full of laughter with my friends\u0026rdquo; (NDMI-E-001).\u003c/p\u003e\n\u003cp\u003eThis theme was predominantly expressed by non-MCI participants (75%), especially elders with higher MOCA-NEW scores. Statistical trends suggest that cognitively intact participants were more likely to engage in rich autobiographical recall, whereas MCI elders leaned toward cultural anchors.\u003c/p\u003e\n\u003cp\u003eInnovative contribution: This theme illustrates that museum environments selectively activate different memory systems\u0026mdash;autobiographical memory in non-MCI participants and semantic cultural memory in MCI participants\u0026mdash;highlighting the museum\u0026rsquo;s potential as a diagnostic and therapeutic space.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.4 Intergenerational Affection and Divergent Meaning-Making\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFourteen participants emphasized gratitude and closeness.\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Seeing my mom\u0026rsquo;s face light up\u0026mdash;she was curious, excited, like a child again\u0026rdquo; (NDMI-C-002).\u003c/p\u003e\n\u003cp\u003eQuantitatively, non-MCI elders most often expressed intergenerational affection (71%), though it was also common among caregivers. Elders who voiced this theme had lower MOCA-NEW scores (mean = 21.0) and slightly higher PHQ-9 scores (mean = 3.0), suggesting that relational warmth may buffer cognitive and emotional vulnerability. Caregivers, with consistently strong cognition and low depressive symptoms, framed affection in terms of caregiving joy and pride.\u003c/p\u003e\n\u003cp\u003eImportantly, dyadic analysis revealed 12 cases of divergence versus 4 cases of convergence. Divergence often took the form of elders emphasizing spirituality or historical continuity, while caregivers stressed autonomy or immediate joy. Far from creating conflict, divergence fostered relational dialogue and empathic resonance, an example of relational creativity in action.\u003c/p\u003e\n\u003cp\u003eInnovative contribution: Intergenerational Affection shows how emotional closeness functions as an adaptive buffer (healthy aging), while dyadic divergence fosters creative reinterpretation of experiences (creative aging).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.5 Observational Insights\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eField notes confirmed embodied expressions of engagement, such as touch, posture, and tears. For example, one caregiver quietly held her mother\u0026rsquo;s hand as she reminisced about her school days. Another elder turned away while recalling a deceased relative, illustrating the quiet labor of revisiting grief. Spontaneous affirmations\u0026mdash; \u0026ldquo;You still remember all this! You\u0026rsquo;re amazing\u0026rdquo; (NDMI-C-002) \u0026mdash;reinforced the museum as a relational space of mutual recognition.\u003c/p\u003e\n\u003cp\u003eNotably, these affective gestures occurred equally in MCI and non-MCI dyads, underscoring that empathic resonance transcends cognitive status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.6 Psychosocial Concerns\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeyond joy and bonding, some narratives surfaced concerns such as caregiver strain, self-reliance, or unresolved grief. A caregiver noted:\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;One must rely on oneself,\u0026rdquo; (NDMI-C-016) reflecting resilience alongside limited perceived support. While not statistically linked to higher PHQ-9 scores, these concerns reveal the dual nature of cultural engagement: a source of joy and bonding, but also a mirror for vulnerability and strain.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4.7 Summary of Integrated Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealthy aging: Museums supported elders\u0026rsquo; resilience, identity continuity, and emotional connection even in cognitive vulnerability.\u003c/p\u003e\n\u003cp\u003eCreative aging: Everyday creative practices (photography, storytelling, reflection) enabled generational dialogue and reinterpretation of cultural symbols.\u003c/p\u003e\n\u003cp\u003eInnovative contributions:\u003c/p\u003e\n\u003cp\u003eTheme\u0026ndash;cognition linkage: MCI participants gravitated toward cultural/civic anchors; non-MCI participants toward autobiographical nostalgia.\u003c/p\u003e\n\u003cp\u003eDyadic divergence as relational creativity: Divergences enriched dialogue, showing museums as relational laboratories.\u003c/p\u003e\n\u003cp\u003eEmotional buffering: Intergenerational affection buffered cognitive/mood vulnerability, demonstrating the protective power of relational co-occupation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMCI versus Non-MCI Status\u003cbr\u003e\u003c/strong\u003eBased on MOCA-NEW, 11 participants (34%) met criteria for MCI, including 9 elders and 2 caregivers. Chi-square analysis confirmed that elders were significantly more likely to meet MCI criteria (\u0026chi;\u0026sup2; = 4.99, p = .026). PHQ-9 scores did not differ significantly between MCI and non-MCI participants (M = 1.6 vs 1.3, p = .57), indicating minimal mood differences across cognitive groups. Thematic expression varied: MCI participants more frequently emphasized Cultural Anchoring and Civic Consciousness, while non-MCI participants more often highlighted Intergenerational Affection and Nostalgia of Childhood, suggesting autobiographical recall was stronger among cognitively preserved participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Gallery Selection by Elders and Caregivers\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Cross-tabulation was conducted to compare the distribution of gallery selections between elders (n = 16) and caregivers (n = 16). As shown in Table X, both groups engaged with similar galleries, with the most frequently chosen being \u003cem\u003eThai Since Birth\u003c/em\u003e, \u003cem\u003eThai Witthaya\u003c/em\u003e (education), and \u003cem\u003eThai Beliefs\u003c/em\u003e. Elders tended to select more from \u003cem\u003eThai Snap\u003c/em\u003e and \u003cem\u003eThai Taste\u003c/em\u003e, reflecting personal and nostalgic memory triggers, whereas caregivers more often chose \u003cem\u003eThai Witthaya\u003c/em\u003e and \u003cem\u003eThai Beliefs\u003c/em\u003e, suggesting stronger connections to education and faith-based displays. However, Chi-square analysis indicated no statistically significant difference between the two groups in overall gallery selection (\u0026chi;\u0026sup2; = 1.81, df = 5, p = 0.87). This suggests that while subtle thematic preferences were observed, both elders and caregivers distributed their selections across galleries in broadly similar patterns.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.7 Caregiver Roles\u003cbr\u003e\u003c/strong\u003eAmong the 16 caregivers, the majority were immediate family members, with children representing over half of the sample (n = 9, 56%). Other roles included grandchildren (n = 2, 12%), relatives (n = 2, 12%), hired caregivers (n = 2, 12%), and one volunteer caregiver (n = 1, 6%). This distribution highlights the centrality of family, particularly adult children, in providing care for older adults, while also demonstrating contributions from extended family, formal caregiving arrangements, and volunteer support. Such variation reflects both traditional family-based caregiving structures in Thailand and the emerging presence of supplementary care models that support older adults and their families. In terms of health, most caregivers reported living with chronic conditions, with two rating their disease control as fair and four as good. Common conditions included hypertension, hyperlipidemia, rheumatoid arthritis, and gastrointestinal diseases such as ulcerative colitis and chronic gastritis, alongside sensory decline such as hearing impairment. These findings illustrate not only the predominance of adult children in caregiving roles, but also the dual challenge faced by caregivers who must manage their relatives\u0026rsquo; needs while addressing their own chronic health conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.8 Elders\u0026rsquo; Health Profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 16 older adults, health status varied, with four reporting that their chronic conditions were under fair control and three under good control. The most common conditions included hypertension and hyperlipidemia, often occurring together, followed by diabetes and cardiovascular disease. Additional diagnoses included stroke, uterine fibroids, and prostate cancer, reflecting the diverse range of age-related illnesses present in the sample. Despite these health challenges, several elders remained actively engaged during the museum program, suggesting that cultural participation may serve as an important avenue for psychosocial rehabilitation. These findings highlight both the physical vulnerabilities and the resilience of older adults, underscoring the need for supportive interventions that address not only medical stability but also social and cognitive well-being.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study examined how museum-based engagement supported emotional well-being, cognitive stimulation, and relational connection among older adults and their caregivers. Four themes\u0026mdash;Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection\u0026mdash;showed how exhibits facilitated memory, identity, and intergenerational dialogue. Quantitative findings provided context: elders were more likely to meet criteria for mild cognitive impairment (MCI), while caregivers generally demonstrated stronger cognition but reported mild depressive symptoms. Together, these results highlight museums as psychosocial rehabilitation spaces with potential to support cognitive decline prevention and healthy aging.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.1 Addressing the Research Questions\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eParticipants expressed emotional engagement through narratives of cultural pride, gratitude, and relational affection. Elders with MCI more often emphasized broad cultural anchors, while non-MCI participants drew on autobiographical memory, underscoring how cognitive status shapes meaning-making.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.2 Interpretation in Light of Theory and Literature\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFindings align with literature on narrative transportation, reminiscence, and creative aging. Cultural artifacts offered restorative comfort (Aula \u0026amp; Masoodian, 2025; Jelinčić \u0026amp; \u0026Scaron;veb, 2021), while reflections on national history supported civic empathy (Soares, 2020). Nostalgic recall activated autobiographical memory (Falk \u0026amp; Dierking, 2013), a process linked to self-referential networks that aid emotional regulation (Addis \u0026amp; Szpunar, 2024). Observed smiles, tears, and touch confirmed narrative immersion (Green \u0026amp; Brock, 2000), illustrating how museums foster resilience and coherent life narratives.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.3 Intergenerational Similarities and Differences\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eDyadic analysis revealed both convergence and divergence. Elders emphasized spirituality and cultural heritage, while caregivers reflected on caregiving pride and joy. Generational differences did not weaken closeness but enriched dialogue and empathy, echoing work on caregiving complexity (Ward et al., 2020; Stickley et al., 2021).\u003c/p\u003e\n\u003ch3\u003eImplications for Practice\u003c/h3\u003e\n\u003cp\u003eThese findings position museums as low-barrier, culturally grounded settings for psychosocial rehabilitation. Elders reported stress relief and identity continuity, while caregivers experienced validation beyond task-based roles. This complements social prescribing initiatives (WHO, 2022; NASP, 2023), addressing calls for rigorous evaluation of psychosocial outcomes (Percival et al., 2022; Ashe et al., 2024). Museums may also advance aging literacy, fostering shared understanding of independence, interdependence, and resilience. For occupational therapy, museums represent occupation-centered environments that support co-occupation and relational reciprocity. For museum professionals, results underscore the value of exhibitions that invite reflection and intergenerational dialogue.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.4 Strengths and Limitations\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eStrengths include the mixed-methods design, combining photo-elicited narratives, observations, and cognitive and mood assessments, and the dyadic approach capturing intergenerational dynamics. Limitations include the small, urban Thai sample, single-visit design, and cultural specificity. Broader projects including neurophysiological measures (EEG) were not reported here. Future research should examine longitudinal outcomes, include more diverse samples, and test museum-based interventions as structured psychosocial rehabilitation.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eMuseums can function as therapeutic and relational spaces that foster resilience, identity continuity, and intergenerational solidarity. By integrating qualitative narratives with cognitive and mood outcomes, this study affirms the role of cultural engagement as a community-based psychosocial rehabilitation tool supporting cognitive health and caregiver well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e The study received ethics approval from the Mahidol University Central Institutional Review Board (Certificate No. MU-CIRB 2025/142.0105). Participant Consent All participants were fully informed about the research objectives and procedures and provided written consent prior to participation. The authors affirm that all participants provided written informed consent for participation in this study. No identifying information is included in the manuscript, and consent for publication of anonymized data was obtained as part of the informed consent process.\u003c/span\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAddis, D. R., \u0026amp; Szpunar, K. K. (2024). Beyond the episodic\u0026ndash;semantic continuum: The multidimensional model of mental representations. Philosophical Transactions of the Royal Society B: Biological Sciences, 379(1913), Article 20230408. https://doi.org/10.1098/rstb.2023.0408\u003c/li\u003e\n\u003cli\u003eAshe, M. C., Dos Santos, I. K., Alfares, H., Chudyk, A. M., \u0026amp; Esfandiari, E. (2024). 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JMIR Aging, 7, e54138. https://doi.org/10.2196/54138\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"a07d54b0-d499-4265-a7d6-af7c4cfc4567","identifier":"10.13039/501100004704","name":"National Research Council of Thailand","awardNumber":"N84A680470","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mahidol University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"psychosocial rehabilitation, museum-based intervention, mild cognitive impairment, caregivers, healthy aging","lastPublishedDoi":"10.21203/rs.3.rs-7700768/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7700768/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCognitive decline and mild cognitive impairment represent growing concerns in geriatric mental health, yet psychosocial rehabilitation has rarely incorporated cultural institutions as community-based resources. This study examined how museum-based psychosocial rehabilitation supports cognitive health, emotional well-being, and intergenerational connection among older adults and their caregivers in Thailand. Sixteen elder\u0026ndash;caregiver dyads (N\u0026thinsp;=\u0026thinsp;32) participated in a structured visit to six curated museum galleries in Bangkok. Participants photographed meaningful exhibits and engaged in narrative interviews guided by photo-elicitation, while observational field notes documented affective and social interactions. Cognitive functioning was assessed with the Montreal Cognitive Assessment (education-adjusted), and depressive symptoms were measured using the Patient Health Questionnaire-9. Thematic analysis identified four recurring patterns of engagement: Cultural Anchoring, Civic Consciousness, Nostalgia of Childhood, and Intergenerational Affection. Elders with lower cognitive scores emphasized collective cultural identity, while non-impaired participants more frequently highlighted autobiographical memory and relational narratives. Observations revealed embodied expressions of emotion, such as touch, tears, and laughter, alongside concerns including caregiver burden and self-reliance. Quantitative findings showed minimal depressive symptoms across both groups, with caregivers generally demonstrating stronger cognitive performance than elders. These results suggest that museum-based cultural engagement functions as a low-cost psychosocial rehabilitation strategy that fosters memory recall, emotional regulation, and identity continuity. By situating cultural participation within preventive frameworks, museums can serve as accessible community resources for promoting healthy and creative aging.\u003c/p\u003e","manuscriptTitle":"Preventing Cognitive Decline through Museum-Based Psychosocial Rehabilitation for Elders and Caregivers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-26 09:48:19","doi":"10.21203/rs.3.rs-7700768/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4b59cb4-e92d-432f-9519-9a41fde9bd52","owner":[],"postedDate":"September 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55383947,"name":"Occupational Medicine"},{"id":55383948,"name":"Psychiatry"},{"id":55383949,"name":"Biomedical Engineering"},{"id":55383950,"name":"Gender Studies"}],"tags":[],"updatedAt":"2025-09-26T09:48:20+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-26 09:48:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7700768","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7700768","identity":"rs-7700768","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}