Ageing: is volunteerism the answer to social exclusion?

Jean WooDepartment of Medicine &

TherapeuticsThe Chinese University of

Hong Kong

Positive ageing

Social network and continuing societal contribution

HealthAdequate finances

[Ng SH et al]

Table 1. Sample in 2004 and its follow-up in 2005 stratified by age

2004(n = 2,970)

2005(n = 2,120)

Age (years)

40-49 873 609 (70%)*

50-59 811 584 (72%)*

60-69 771 553 (72%)*

70-74 515 374 (73%)*

* Retention rate

Positive Ageing (PA) Components(1) Avoiding disease (health)

pain, medication, mobility, overall(2) Physical and cognitive functioning (functional

independence)energy, sleep, memory, cognitive mastery

(3) Engagement with life (3a) social-emotional contributions (love)family, relatives, neighbours, friends, overall(3b) instrumental-productive contributions (work)work/career, family, society, NGO/community

5-point response format (higher score = more positive)

Rowe & Kahn (1998); Chou & Chi (2002); Hsu & Chang (2004); Chong et al. (2005)

Confirmatory factor analysis (2004) Established goodness of fit: chi square (98) = 512, RMSEA = .038, SRMR = .027, CFI = .959

Confirmatory factor analysis (2005)Replicated the goodness of fit:chi square (98) = 480, RMSEA = .043, SRMR = .029, CFI = .952

Validation (2006)Against known groups and Cantril’s (1965) ladder measure of QoL

Table 2. Regressing the 2005 PA Index on Measures Obtained in 2004 (beta coefficients)

Age (young = more positive) -.284 ***

Marital status/No. of children (ns)

Living arrangement/income (ns)

Education level .046 *

Gender (men = more positive) -.121 ***

Social network .151 ***

Life-style .064 **

Financial security .099 ***

Primary/secondary control (ns)

Humour .083 ***

Future-time perspective .130 ***

Note. Variance accounted for: 14.1% 17.3% 26.3%

This study suggest that social inclusion is an important facet of positive ageing

Unlike age itself or gender, social inclusion or the converse, social exclusion, may be amenable to manipulation, in attaining the goal of positive ageing

Factors predisposing to social exclusion

Employment policies Insurance policies Non-elder friendly physical environment Societal attitudes Negative self attitude relating to the aging

process

Possible adverse health consequences of ‘exclusion’

Relationship between the feeling of worthlessness and 4 year non-suicide mortality [Wong SYS et al, unpublished results]

1999 men aged 65 years and over recruited from all over Hong Kong as part of a health survey, followed for 5 years.

‘Worthlessness’ was defined as answering ‘YES’ to the question ‘Do you feel worthless the way you are?’ [one of the questions from GDS-15]

Findings

11% felt worthless These subjects were older, more depressed,

had more chronic diseases and were more likely to be smokers

Age adjusted mortality rates at 5 years were 44.7 v. 24 per 1000 persons

RR for increased mortality was 1.32 [95%CI 1..01-1.72],adjusting for confounding factors

Findings and implications

Depression itself was not a risk factor for predicting mortality

Social exclusion may have health impacts mediated via psychological pathways.

Volunteer programmes

Factors promoting participation: Hong Kong elderly has a low participation rate compared with other countries. Reasons?

Nature of volunteer programme: of benefit to self, to others, to society, achieving the aim of being valued by others/society.

Figure 3. Voluntary works participation rate among people aged 65 or above

4%

27%

4%

40%

24%

32%

0%

10%

20%

30%

40%

50%

Hong Kong (2001-2002)

Japan (2001)

Singapore (2004)

Australia (2004)

U.S. (2003)

England & Wales(2001)

Per

cent

age

Chau PH & Woo J.How well are seniors in Hong Kong doing?An international comparison

HKJC Cadenza Project 2008

Models based on Erikson’s theory of generativity

Expansion of care beyond oneself, towards others, and transferring knowledge and wisdom to younger generations

Harnessing the untapped desire for generativity in an aging population could lead to benefits for both the older adult and society

Need to create new programmes and policies

Current views

Expectation of disengagement from socially valued roles after retirement

Reversal of this view could lead to positive health consequences for the ageing individual as well as lead to the development of social capital.

The Experience Corp in Baltimore

Places older volunteers in public elementary schools in roles designed to meet school needs

Increase the social, physical and cognitive activity [as demonstrated by increased strength, less decline in walking speed, and increased social network]

Effective as a social model for health promotion for an ageing population[Fried LP et al. J Urban Health 2004;81:64-78]

Benefit for the school

Meaningful improvements in school environment and children’s reading scores and behaviour

[Rebok GW et al J Urban Health 2004;81:79-93]

Characteristics of the ‘ideal’ programme

Interventions that address complex social problems simultaneously at the individual, organizational, and community levels

Health promotion interventions should take into account the social context, to achieve compliance

Meeting the generativity needs of volunteers

Hong Kong examples

Lay led CDSMP meeting the generativity needs?

Older workers restaurant initiative? Visiting other older people who are frail,at

home or old age home? Counselling? Pushing library or snacks trolley around

hospitals?

Future directions

Design programmes based on the principles mentioned: need for articulation of the objectives

Need to evaluation to show that the programme is achieving its aim

Conclusion

Social inclusion is the other side of the coin to social exclusion.

Both needs to be tackled at the same time Volunteerism is only effective if purposely designed

based on generativity, and pilot programmes are evaluated before they are continued.

Participation rates likely depend on programmes that are viewed as true social inclusion, rather than just ‘accumulating good deeds’.