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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…. - PowerPoint PPT Presentation
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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?
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
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.