Civic Engagement by Older Adults: Potential import of the social capital of an aging society

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Civic Engagement by Older Adults Potential
import of the social capital of an aging society

• Workshop on Measuring Social Activity and Civic
  Engagement
• May, 2007
• Linda P. Fried, M.D., M.P.H.
• Professor and Director,
• The Johns Hopkins Center on Aging and Health

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One vision

• Successful aging
• The intersection of physical and
  cognitive/psychological health, and social
  engagement
• Rowe and Kahn, Science 1987

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Potential Importance of Social Engagement for
Older Adults

• Roleless old age vs. productivity, meaningful
  activities, wisdom/growth
• Import of generativity to successful aging
• Evolution in images of aging
• Social capital the benefits (c/w costs) of an
  aging society
• Vehicle for health promotion

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Population-based approaches to compression of
morbidity - and successful aging

• What people DO matters with aging
• Generativity through engagement
• Wisdom
• Loneliness/Isolation
• Social networks, support
• Regular structured activities
• Physical activity
• Cognitive activity

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Feelings of Usefulness as a Predictor of
Disability Mortality Over 7-Years in the MSSA
p lt .05, p lt .01, p lt .001 N 1,030 a
no change/slight improvement in disability used
as reference category in analyses b high feelings
of usefulness reference category in analyses c
model 2 adds age, years of education d model 3
adds physical activity, alcohol use, smoking,
volunteerism, social integration, depressed
mood, and self-efficacy
Gruenewald et al., J of
Gerontology, 2007
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Physical activity and health in aging

• Strong associations with prevention of disease,
  cognitive decline, disability, mortality
• Little success in motivating Americans gt50 years
  to adopt physically active lifestyles ¼ active
  1/3 sedentary
• Community-based, multilevel approaches needed

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HO Generative roles might

• Be a vehicle to attract and retain more and
  more diverse - older adults than standard
  exercise programs
• Be intentionally designed to enhance physical,
  cognitive and social activity, providing
  stimulating environments, generalizable
  activities
• Population-based approach to health promotion?

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A win-win target roles to societal unmet needs
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One Model for such a Win-Win Experience Corps

• High intensity volunteering for older adults
• High impact roles in public elementary schools
  improving outcomes for children
• Critical mass of older adults
• Shift outcomes for schools
• Force for social benefit
• Social networks and friendships
• Health promotion program embedded
• Fried et al, 2004

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Early elementary school years are a critical
period predicting subsequent educational,
occupational, physical and mental health
outcomes
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Experience Corps model

• Volunteers 60 and older
• Serve in public elementary schools K-3
• Meaningful roles important unmet needs
• High intensity 15 hours per week
• Sustained dose full school year
• Critical mass, teams in each school
• Monthly stipend to reimburse for expenses
• Health behaviors physical, social and cognitive
  activity
• Diversity
• Freedman M, Fried LP Experience Corps monograph,
  1997

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Roles for Older Volunteers- Experience Corps -

• Academic support
• Literacy support
• Opening/maintaining school libraries
• Math support
• Computer support
• Behavioral support
• conflict resolution, positive attention
• School attendance
• Parental outreach
• Public Health Asthma club
• More roles to come

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Causal Pathway Experience Corps
Performance-based measures Secondary outcomes and
intermediate mechanisms
Primary/ Self Report Outcomes
Primary Pathways
Intervention
Mechanisms
Falls
Strength, balance
? or preserved function or delayed decline in
Physical Activity
Walking Speed
Experience Corps Participation- Generative Role
Performance
Frailty
Mobility Function
Cortical plasticity Memory Executive function
Complex task performance
Cognitive Activity
IADLs
Social Integration Support Generativity
Social Activity, Engmnt.
Psycho-Social Well-being
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Baseline Characteristics of Experience Corps
Participants

• Age ( Range 60-91) 60-65 31
• 66-70 33
• gt 71 36
• Gender Male 18
• Race Black 92
• White 8
• Married 24
• Education High school or less 82
• Health Excellent/very good 29
• Good 60
• Fair 12

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Change in Blocks Walked Per Week
Fried 2004
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Pilot RCT Results EC Baltimore 4-8 months
follow-up
EC participants n59 Controls N54 P value (adjusted)
More physically active At follow-up 53 23 .01
Kcal/wk- difference, baseline to f/u Overall Low activity, baseline 810? 1130 ( 40) 420 ? 880 (110) 670 ?560 (-20) 490 ? 500 ( 2) .52 .03
Stronger at follow-up 44 18 .02
Tan 2006 Fried 2004
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Implications re health disparities
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Can a high intensity, multimodal volunteer role
contribute to improved health in aging?

• Disability mobility
• Frailty
• Falls
• Cognitive function memory, executive function

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Randomized, Controlled Trial of Experience Corps
in Baltimore

• Funded by NIA BSR
• Randomize
• 1046 people 60 and older to EC or control
• Randomize 48 public elementary schools to EC or
  controls
• Outcomes
• Primary Disability mobility
• Secondary IADL disability memory, frailty,
  falls

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Import and Implications

• Social model for health promotion
• Compression of morbidity
• Health disparities
• Benefits of an aging society

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Data Considerations

• Aspects of civic engagement
• Social capital
• Arenas of contribution
• Health promotion
• Benefits/costs per program societally
• Motivators
• Facilitators
• Health impacts compression of morbidity effects

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Data considerations Potential measures

• Paid Work full/part-time
• Volunteering
• With or without reimbursement/stipend
• Number of hours per week
• Role/venue
• Activities related to prior work history
• Motivations
• Facilitators
• Sociodemographic characteristics?
• Out of pocket costs
• Generative?
• Impact?

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The Future of Successful Aging

• We maintain that the future of old age depends
  to a significant degree on making images of aging
  more positive, empowering people to live healthy
  lives, and redesigning society to include more
  age-friendly technology and opportunities for
  challenging and meaningful roles in old age.
  (Baltes, Smith, Staudinger, 1992)

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Causal Pathway
Child Outcomes
Intervention
Primary Pathways
Mechanisms
Primary Outcomes
? vocabulary
? alphabet recognition
Academic Stimulation
? reading
Reading/ Academic Performance
? disciplinary removals
Experience Corps Participation- Generative Role
Performance
? aggression
? social skills
Behavioral Management
? school attendance
Classroom Behavior
? motivation to learn
? concentration/ readiness
Readiness For Learning
? ? school service utilization
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Causal Pathway
School Outcomes
Intervention
Primary Pathways
Mechanisms
Primary Outcomes
Child Parameters ?Literacy Skills ?Readiness to
learn?Behavioral disruptions
Improved aggregate academic performance
Child building pathway (direct impact on
children K-3 from face-to-face interaction)
Experience Corps Participation- Generative Role
Performance
Cost Benefits Children School
Improved school climate
Teacher parameters ?Teacher efficacy ?Teacher
morale?Time on task
Improved teacher retention
Social capital pathway (indirect impact on the
school)
School Parameters ?Community resources ?Parent
participation?Collective efficacy
Improved volunteer retention Higher program
satisfaction Higher personal and collective
efficacy
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Hypothesized Outcomes for Children and Schools

• Selective improvements in reading/ academic
  performance, classroom behavior, and
  readiness-to-learn among urban children
  participating in the EC program
• Help reduce student absenteeism
• School climate will improve
• Increased teacher retention
• Direct positive association between improved
  school performance and older EC volunteer
  retention and satisfaction

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Implications Volunteering Designed as a Social
Model for Health Promotion

• Cost-benefit Investing in older adults to invest
  in children
• Opportunity to invest in health promotion for
  older adults, while not pitting generations
  against each other for resources
• Brings health promotion into community to groups
  not typically reached health disparities

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Older Adults as A Source of Social Capital for
Urban Education

• Urban public schools
• education to the majority of children in the US.
• Most under-resourced and lack the human capital
  to meet their educational mission.
• Older adults can offer
• the stability, consistency, and caring which are
  essential to learning,
• their experience and presence as role models.
• the social capital needed to support the
  educational needs of children directly on a large
  scale.