Running head: POLICY PAPER 1

Policy Paper: Social Engagement in Older Adults

Kari M. Nilsen

Wichita State University

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ABSTRACT

Social engagement in older adults is of vital importance because of the links between

social isolation and loneliness with physical and mental health outcomes. Older adults who are

not socially engaged tend to make fewer healthy choices than those who are socially engaged,

and they tend to die sooner with fewer social contacts. This has significant impact for the health

care system because the more people engage in unhealthy behaviors; the more they require a

doctor’s care, or being placed into long term care settings. Lawmakers, caregivers, social

organizations, and families can help diminish the effects of social isolation and loneliness by

implementing policy that is specifically targeted towards social isolation in older adults. There

are many programs that currently work, but due to budget and awareness issues, they are not

being utilized by those who may need them the most. The Reauthorization of the Older

Americans Act in 2015 will hopefully help with these problems, as one of the tenants of the act

is to give more money to senior centers, which will help get more programs and awareness out to

the public regarding the importance of social engagement in older adults.

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INTRODUCTION

There has been a recent change in the Medicaid system, both nationally and in the State

of Kansas, to take people out of institutions and place them back into their communities. There

are several reasons for this advance. Most notably are the financial implications involved. In the

State of Kansas, $438 million in Medicaid dollars are being spent on Kansas’s nursing homes

annually, and this rate is rising by the year. The Kansas solution includes changes to system by

aiding the transition away from institutional care and towards services that can be provided in

individuals’ homes and communities. About 9,900 Medicaid nursing home residents, more than

55 percent of the total, rely on Medicaid because they cannot afford the $3,600 a month it costs

to stay in the average nursing home, and 5.2 percent of Kansans 65 and older live in nursing

homes, far more than the national average of 3.8 percent. Nearly one in five Kansas nursing

home residents have “low care needs” that could be served in less expensive, alternate

community settings (Smith, O’Keefe, Carpenter, Doty, & Kennedy, 2008).

Many older adults who live alone are at a risk of being placed in LTC settings against

their will due to inadequate social support (Steinbach, 1992). People who live alone, who are not

very socially engaged, or who do not have many social interactions, run the risk of being viewed

by the outside world as socially isolated, lonely, or depressed (Shankar, McMunn, Banks, &

Steptoe, 2011), but this is not necessarily true. The expectation of social encounters can also

impact isolation and loneliness levels positively or negatively. Being able to maintain quality

social relationships are important to older adults as they age (Bitzan & Kruzich, 1990).

Although their families do not typically abandon nursing home residents, the lost of a

caregiver or close family often results in the placement in a nursing home. This placement then

can lead to the loss of personal relationships with significant others outside of the home. New

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relationships inside the nursing home may develop, especially among the very old who suffered

from a lack of access to social activities and friends outside of the care setting. However, for

those who are not able to develop new relationships or engage in social activities, their physical

and mental health may decline at much quicker rates than those who are still able to engage in

meaningful encounters with others (Bitzan & Kruzich, 1990).

Social isolation and loneliness are believed to impact healthy behaviors. These health

behaviors can be aided through positive social cues and support, or negatively through a lack of

these social cues from others. Social isolation and loneliness have been related to a greater

probability for lack of medical adherence, unhealthy behaviors such as smoking and lack of

physical exercise, and not paying attention to one’s own physical or mental changes (Shankar,

McMunn, Banks, & Steptoe, 2011). Social engagement is also an important influence on well

being, both emotionally and psychologically, for people as they age (Hubbard, Tester, & Downs,

2003).

Several studies have shown that older adults with severe disengagement, poor social

networks, and few social ties had an increased risk of subsequent cognitive decline, such as

Alzheimer’s and Parkinson’s disease (Stoykova, Matharan, Dartigues, & Amieva, 2011).

Encouraging and developing ways to increase the social networks of older adults could lead to

increased independence and better health outcomes, which could lead to fewer costs associated

with hospital and doctor visits.

Very few people are doing work to lower rates of social isolation and increase social

engagement in older adults, even though we know these are important areas to focus on. There

are few viable interventions in the literature, but policy could begin to take an active role in

giving people options and increasing awareness, especially in the area of public health policy

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(Nicholson, 2012). If this matter is not addressed in a timely manner, especially with the

increasing number of older adults in America, the number of Medicaid recipients using federal

funds to pay for nursing home, or similar, care will continue to be a drain on an already unsteady

system. Adequate social support for older adults, especially those in LTC settings, will lead to

more satisfied older adults who can contribute more to their communities, and in turn, lead

healthier lives.

Social Engagement in Older Adults

Older adults are often an unrecognized source of social and civic engagement in our

society. They give back in many ways, such as through time spent in paid work, formal and

informal volunteering, and through caregiving activities. Seeing as many older adults are free of

child-rearing duties, and some free from job responsibilities, they tend to have more free time to

give back to their community and other organizations than younger adults do. Data from the

2002 Health and Retirement Study (HRS) is typically used to define what social engagement

looks like in the older adult population (Zedlewski & Schaner, 2005).

According to the HRS study, older adults stay busy as they age, even though social

engagement starts to decline as they get older. They also remain engaged in a variety of

activities, with the younger old more likely to be employed in a paid work setting and only 10%

of those 75 and older are still employed. Thirty percent of adults over the age of 65 provide

formal volunteering, however, and this number stays consistent as we move up the life span.

Fifty percent report being involved in informal volunteering, and almost 40% say they provide

caregiving for family and friends. Caregiving rates tend to decline over time also, as family

members and friends pass away or move.

An active lifestyle is widely accepted as a way to live a long life with better health. Older

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adults with disabilities tend to be less socially engaged, which can lead to more negative health

effects due to the lack of others around. When other people are around, they notice when we are

looking ill or that we are not taking care of ourselves. When there is no one around, these things

can be overlooked. These effects are not limited to race, gender, or socioeconomic status either.

Remaining socially engaged is important for all older adults, regardless of their background (de

Leon, 2005).

Social engagement is important because those that volunteer, work, or provide care tend

to reflect those that are more physically or cognitively able to do so. Health does prohibit being

socially engaged, but not being socially engaged can also lead to more declines in physical and

mental health. By remaining active and providing knowledge and skills to others, older adults

can get mental and physical exercise that many help halt some declines of age. Also, by

becoming more socially engaged, older adults may help stop some of the negative stereotypes of

aging, such as not being a worthwhile member of society after retirement.

There is also research being conducted on how older adults can age gracefully by

remaining socially engaged by simply using the computer. Using the computer can help those

with dementias to decrease the rate at which their dementias progress, as well as the amount of

depression they experience as a result. Ways to remain socially engaged suggested are to nurture

social networks and remain in contact with friends and family, play mind games, find a part-time

job, join a club, volunteer, or offer assistance to family members. These activities can help older

adults stay socially and intellectually engaged, and lead to fewer health declines (McCoy, 2013).

These articles have implications for policy because they point out that older adults are

productive members of society who are an untapped resource. The problem may be that they are

not being utilized effectively, and by those who could really benefit from their skills and

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knowledge base. Many low-income older adults may not have the ability or resources that

higher-income adults do, and finding ways that they could also remain engaged is important.

They are not drains on our resources, and can actually contribute in ways that could save time

and money for others. They actually want to give back, but policy needs to be written as to how

that could happen, and where these sources should come from. Also, by remaining healthy and

active, they could potentially have fewer health issues that would require less financial payout

for themselves, their families, and the insurance system. It could also help them to remain

independent longer, leading to less strain on families and the nursing home system.

The idea of aging in place is one that has many definitions, some which may be

maladaptive to “successful” aging for older adults. It refers to the ability to age in your home

while still being physically, mentally, and cognitively healthy. This can be maladaptive because

it implies that if you are disabled, have any cognitive issues, or suffer from dementias, you are

not aging “successfully”. It is more important to stress that even with all the natural problems

that occur with aging, social engagement can help people lower to effects of any of these more

negative effects. By remaining socially engaged, older adults can compensate for losses by

becoming more proficient at other skills. For example, if they are less mobile and are not able to

get out of the house, they can learn to use the computer to stay connected with the world and

other people. Old age can be freeing, especially when people become unburdened through

retirement and when children move out, but if people do not remain connected to other people

and activities, older adults can become the burden on others that they do not want to be

(Boudiny, 2013).

Policy Prevalence

The policy I am proposing to increase social engagement in the older adult population

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will affect primarily adults aged 65 and over. It could also potentially help caregivers, family

members, and medical staff as well, however, due to the fact that social engagement has been

shown to help lower rates of cognitive decline and dementias (Stoykova, Matharan, Dartigues, &

Amieva, 2011). Encouraging and developing ways to increase the social networks of older adults

could lead to increased independence and better health outcomes, which could lead to lowered

costs associated with hospital and doctor visits. This can also take some of the burden off of

family members and caregivers when they are trying to care for their clients and loved ones.

In 2012, there were 41.4 million people aged 65 and older in the United States (Administration

on Aging, 2012). This is an 18% increase in the past decade, and the number continues to grow.

Twenty-eight percent (11.8 million) live alone, and they are at the greatest risk for social

isolation and loneliness, and would be the most likely people to benefit from a social engagement

policy change, but others would as well. The median income for this group is $27,707 for men

and $15,362 for females, which indicates that they tend to be in a lower socioeconomic status

(SES) than most, but SES does not change who is affected by diminished social engagement.

Even those who are in a high SES can experience negative health and mental health effects from

being isolation or lonely. Also of importance is to note that is social engagement can be done by

anyone, especially those who have mobile limitations. In a study of the benefit of social

engagement done at Harvard, more active older adults lived longer than less active ones. Social

and productive activities were found to be just as beneficial to the aging process as physical

activities (Glass, de Leon, Marottoli, & Berkman, 1999).

There is the potential for an economic impact with a policy shift regarding social

engagement. If this matter is not addressed in a timely manner, especially with the increasing

number of older adults in America, the number of Medicaid recipients using federal funds to pay

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for nursing home, or similar, care will continue to be a drain on an already unsteady system.

Adequate social support for older adults, especially those in long term care settings, will lead to

more satisfied older adults who can contribute more to their communities, and in turn, lead

healthier lives.

Those that could impact the rates of social engagement through public policy are

lawmakers, by passing the Reauthorization of the Older Americans Act (National Council on

Aging, 2015), which will place a greater importance on healthy aging and social engagement for

older adults, as well as doctors, caregivers, researchers, social organizations, and senior centers.

These key players can begin with small steps and by showing the older adults they work with the

results of positive social engagement. Many people are afraid of developing dementias or being

placed in a nursing home, and it will be important to stress the preventative measures that can be

put in place to combat these issues, among them healthy social engagement. This is not an

exhaustive list, and families and the older adults themselves are also going to have to begin to

recognize the importance of social engagement on their physical and mental health outcomes.

Solutions

There are many solutions that are available for the increasing of social support for older

adults. The most important may be increasing funding that goes to volunteer and employment

opportunities for older adults, as well as the funding that goes into senior centers. By increasing

the social engagement opportunities for older adults, especially those that may be more “at risk”

due to a lack of social support, there is a chance that this would help them age in more healthy

ways, and not require the types of care that many currently need through the Medicaid system.

Other solutions include a revamping of the long term care system in America, and encouraging

more physical activities in the residents. For those who are nursing home eligible, but chose to

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stay in their own homes, there should be more community support such as social organizations

and engagement opportunities. We as a nation can get back to a place where we age in ways that

are less isolated and restricted, and where we look out for our neighbors, and in order to do this,

policy changes in how we deal with older adults are needed.

It can be very hard to just create social engagement opportunities for older adults, even

though we know they need these opportunities. There are many agencies and organizations that

are actively working to create these opportunities. This is a great way for policy changes to come

in and help to instigate and encourage change in the ways we provide these opportunities

(Gonzales, Matz-Costa, & Morrow-Howell, 2015). Generally, nonprofit organizations that utilize

volunteers have largely disregarded older adults, despite numerous calls-to-action. The federal

government has programs such as Senior Corps, Retired Senior Volunteer Program, Foster

Grandparent Program, and Senior Companion Program. These programs work by using the skills

and abilities of the older adult and applying them to community needs. Currently, there are

approximately 360,000 older adults taking advantage of these programs, but due to budget

cutbacks in the federal government, the funds for these programs and others are shrinking every

year. Another issue is that many older adults are not aware these programs even exist, and

minorities are vastly underrepresented. There needs to be a push to get older adults, especially

minorities and those who are a part of a disadvantaged group involved and active in these

programs that are federally funded. If the government sees that people are not utilizing the

services, they will have no qualms about continuing to cut funding.

According to James, Boyle, Buchman, and Bennett (2011) “social activity has long been

recognized as an essential component of healthy aging and is associated with a decreased risk of

adverse health outcomes including depression, cognitive decline, dementia, motor decline, and

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mortality.” This is important because older adults who may need help with activities of daily

living or instrumental activities of daily living may not realize or want to admit they need help,

and without social interaction they may never receive the help they need. It may also be harder

for those who have started experiencing some of these issues to change their lives, but by putting

policies in place to give them affordable option for help, those in power can start make a

significant change for the better.

Women make up the largest group of older adults, and so it is of interest to see how

widowhood affects them and their levels of social engagement. They are also less likely than

men to remarry, so they may experience worse outcomes as they age. Widows do tend to

socialize less right before their husbands die, and more after their husbands pass. This is

important because it may mean that they are compensating for their loss through social

engagement, and if awareness of social engagement as a protective factor against poor health and

grief could be encouraged, more people may have better health outcomes as they age (Utz, Carr,

Nesse, & Wortman, 2002). This may be a group that could be specifically targeted for an

intervention to get them engaged and involved after widowhood.

It is also important to look at all different groups of older adults, from community

dwelling to those in institutions. Just because someone moves in an assisted living facility or

nursing home does not mean they still do not need engagement activities. Findings have revealed

how complex social engagement can be for older adults and were organized around the “the

characteristics of desired social relationships, the perspective of time and loss, barriers to and

resources for social engagement, and strategies to develop or modify relationships.” Assisted

living providers could make concerted efforts to develop practices to provide residents with more

social and emotional experiences and help them engage in meaningful social interactions, as well

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as help create public policies to enhance these interactions (Park, Zimmerman, Kinslow, Shin, &

Roff, 2012).

CONCLUSION

According to the National Council on Aging (NCOA, 2015), there is currently an

emphasis being placed on reauthorizing the Older Americans Act for at least three years. This act

will place greater importance on modernizing senior centers, which will increase the activities

available at those centers for older adults to engage in. We also know that older adults are

productive contributors to society through their skills, abilities, and knowledge, and we need to

continue to address the demands of the aging population, and create more policies to facilitate

their participation. Policies that facilitate participation of older adults, and policies that build

capacity across the life course, will help with this increasing burden. Given the demographic

trends, public and private sector needs, and long-term care demands of an aging society, now is

the time to strengthen policies and programs to support the productive engagement of older

adults (Gonzales, Matz-Costa, and Morrow-Howell, 2015). We all as whole need to come

together and establish and implement policy that will affect older adults now, as well as in the

future, because budgetary difficulties are not going to go away any time soon, and with a

burgeoning older adult population, the healthier people are, the fewer costs that are associated

with their care. One way to keep people healthy is through adequate social engagement

opportunities.

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REFERENCES

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Bitzan, J.E. & Kruzich, J.M. (1990). Interpersonal relationships of nursing-home residents. The Gerontologist, 30, 385-90. doi: 10.1093/geront/30.3.385

Boudiny, K. (2013). ‘Active ageing’: From empty rhetoric to effective policy tool. Ageing and Society, 33(06), 1077-1098. doi: 10.1017/S0144686X1200030X

de Leon, C. F. M. (2005). Social engagement and successful aging. European Journal of Ageing, 2(1), 64-66. doi: 10.1007/s10433-005-0020-y

Glass, T. A., de Leon, C. M., Marottoli, R. A., & Berkman, L. F. (1999). Population based study of social and productive activities as predictors of survival among elderly Americans. Bmj, 319(7208), 478-483. doi: 10.1136/bmj.319.7208.478

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National Council on Aging (January 15, 2015). Senate Moves Swiftly on OAA Reauthorization in Anniversary Year. Retrieved from http://www.ncoa.org/public-policy-action/policy-news/senate-moves-swiftly-on-oaa.html

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