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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
One vision… • “Successful aging”… • The intersection of physical and cognitive/psychological health, and social engagement • Rowe and Kahn, Science 1987
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
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
Feelings of Usefulness as a Predictor of Disability & Mortality Over 7-Years in the MSSA p < .05, ** p < .01, *** p < .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
Physical activity and health in aging: • Strong associations with prevention of disease, cognitive decline, disability, mortality • Little success in motivating Americans >50 years to adopt physically active lifestyles: ¼ active; 1/3 sedentary • Community-based, multilevel approaches needed
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?
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
Early elementary school years are a critical period predicting subsequent educational, occupational, physical and mental health outcomes
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
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…
Causal Pathway: Experience Corps Performance-based measures Secondary outcomes and intermediate mechanisms Primary/ [Self Report] Outcomes Primary Pathways Intervention Mechanisms Falls Strength, balance Physical Activity ↑ or preserved function or delayed decline in: 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
Baseline Characteristics of Experience Corps Participants Age ( Range: 60-91) 60-65 31% 66-70 33% > 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%
Change in Blocks Walked Per Week Fried 2004
Pilot RCT Results: EC Baltimore; 4-8 months follow-up Tan 2006 Fried 2004
Can a high intensity, multimodal volunteer role contribute to improved health in aging? • Disability: mobility • Frailty • Falls • Cognitive function: memory, executive function
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
Import and Implications: • Social model for health promotion • Compression of morbidity • Health disparities • Benefits of an aging society
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
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?
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)
Causal Pathway Child Outcomes Intervention Primary Pathways Mechanisms PrimaryOutcomes vocabulary alphabet recognition Academic Stimulation reading Reading/ Academic Performance Experience Corps Participation- Generative Role Performance disciplinary removals aggression Behavioral Management social skills school attendance Classroom Behavior motivation to learn concentration/ readiness Readiness For Learning school service utilization
Causal Pathway School Outcomes Intervention PrimaryPathways Mechanisms Primary Outcomes Child Parameters: Literacy Skills Readiness to learnBehavioral 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 moraleTime on task Improved teacher retention Social capital pathway (indirect impact on the school) School Parameters: Community resources Parent participationCollective efficacy Improved volunteer retention Higher program satisfaction Higher personal and collective efficacy
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
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
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.