Civic Engagement by Older Adults: Potential import of the

social capital of an aging societyWorkshop on Measuring Social Activity and Civic Engagement:

May, 2007Linda 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 = 1,030a no change/slight improvement in disability used as reference category in analysesb high feelings of usefulness reference category in analysesc 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

Mobility disability (19.5%)

ADL disability (13.3%)

Mortality (24.5%)

ORa ORa ORa Model 1: Unadjusted Low feelings of usefulnessb 3.61** 3.22** 4.11** Moderate feelings of usefulnessb 1.21 1.14 1.14 Model 2: +Sociodemographic covariatesc

Low feelings of usefulnessb 3.18** 2.60* 3.35** Moderate feelings of usefulnessb 1.20 1.11 1.13 Model 3: +Behavioral, psychosocial covariatesd

Low feelings of usefulnessb 3.08** 2.65* 3.13** Moderate feelings of usefulnessb 1.07 1.05 0.99

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?

A win-win: target roles to societal unmet needs

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…

Cortical plasticity;Memory

Executive function

Experience Corps

Participation-

Generative Role

Performance

InterventionPrimary Pathways Mechanisms

Performance-based measures Secondary outcomes and intermediate mechanisms

Primary/ [Self Report] Outcomes

Strength, balance

↑ or preserved function or delayed decline in:

Social Integration & SupportGenerativit

y

Physical Activity

Cognitive Activity

Social Activity, Engmnt. Psycho-Social

Well-being

Complex task performance

Walking Speed

Frailty

Mobility Function

Causal Pathway: Experience Corps

IADLs

Falls

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

Walking Distance(block) per Week

31.4%

-9.0%-15.0%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Intervention Control

Group

% o

f C

ha

ng

e f

rom

BL

to

FU

Fried 2004

Pilot RCT Results: EC Baltimore; 4-8 months follow-up

EC participants

n=59

Controls N=54

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

Implications re: health disparities

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)

reading

disciplinary removals

school attendance

social skills

aggression

motivation to learn

Reading/Academic

Performance

Classroom Behavior

alphabet recognition

vocabulary

concentration/readiness

school service utilization

Intervention Primary Pathways Mechanisms Primary Outcomes

Causal PathwayChild Outcomes

Experience Corps

Participation-

Generative Role

Performance

AcademicStimulation

BehavioralManagement

ReadinessFor Learning

Experience Corps

Participation-

Generative Role

Performance

Intervention Primary Pathways Mechanisms Primary Outcomes

Improvedteacher

retention

Improved aggregate academic

performance

Improved school climate

Causal Pathway

Improved volunteer retentionHigher program satisfaction

Higher personal and collective efficacy

Child building pathway

(direct impact on children K-3 from

face-to-face interaction)

Social capital pathway

(indirect impact on the school)

School Parameters:Community resourcesParent participationCollective efficacy

Teacher parameters:Teacher efficacyTeacher moraleTime on task

Child Parameters:Literacy SkillsReadiness to learnBehavioral disruptions

School Outcomes

Cost Benefits:ChildrenSchool

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.