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?

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 Intervention Primary 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 & Support Generativit 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) % % > 7136% Gender Male18% RaceBlack92% White 8% Married24% EducationHigh school or less82% Health Excellent/very good29% Good60% Fair12%

Change in Blocks Walked Per Week 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-up53%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%) Stronger at follow-up44%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 InterventionPrimary PathwaysMechanismsPrimary Outcomes Causal Pathway Child Outcomes Experience Corps Participation - Generative Role Performance Academic Stimulation Behavioral Management Readiness For Learning

Experience Corps Participation - Generative Role Performance InterventionPrimary PathwaysMechanismsPrimary Outcomes Improved teacher retention Improved aggregate academic performance Improved school climate Causal Pathway Improved volunteer retention Higher 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 resources  Parent participation  Collective efficacy Teacher parameters:  Teacher efficacy  Teacher morale  Time on task Child Parameters:  Literacy Skills  Readiness to learn  Behavioral disruptions School Outcomes Cost Benefits: Children School

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.