Social Engagement and Healthy Aging

Nancy Morrow-Howell, Ph.D.

Ralph and Muriel Pumphrey Professor of Social Work

A very old idea

• excessive individuation• individual not bound to

social groups• little social support or

guidance

……….connected to suicide

Durkheim (1897)

Good friends are good medicine

Social contact predicts mortality

(Berkman, L. & Syme, L. 1979. Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology 109, 186-204.)

30 years of research……

Social support

Social networks

Social relationships

Social participation

Social engagement

Social capital

Mortality

Heart disease

Physical health

Functional ability

Mental health

Life satisfaction

Cognitive function

A closer look at social engagement

participation in formal and informal social groups – church-connected groups– non-profit organizations– youth groups or community centers– civic, business, political, or neighborhood organizations– professional groups– involvement in social or leisure activities, including clubs,

sports teams, or weekly social gatherings with friends.

2 central concepts: • activity engagement• social context (with at least one other person)

Pathways between social support and health outcomes

Social support influences health behaviorsEncouraging exercise or help-seeking

Social support improves psychological conditionsIncreasing self-esteem or self-efficacy

Social support alters physiologic statesDecreasing allostatic load and boosting immune function

Beyond social support

• Physical and cognitive activity, and bodily systems may be stimulated

• Effective coping strategy, especially in the face of loss or declining health.

• Reinforce role identities

• Purpose/meaning

Need for more understanding

What aspects are health-producing: the content of the activity or the social context?

What are relative effects of different types or combination of activities--- for example, social versus physical or altruistic versus not?

When is social engagement detrimental for a person?

Under what conditions is social engagement the most health-producing?

Assessment of Social Engagement

• contact with immediate household

• contact with extended families

• contact with friends • contact with

neighbors• social contact with

workmates • adult learning

activities

• organized community activities

• voluntary sector activity

• active interest in current affairs

• community activism• religious observation

Berry, Rodgers, and Dear

(2007)

20% leisure engaged

23% productively engaged

50% less socially engaged

5% less socially engaged caregivers

2% socially engaged caregivers

Croezen, Haveman-Nies, Alvarado, Van’T Veer,

and De Groot (2009)

Patterns of social engagement

Factors associated with engagement

Increased engagement:Female

Married

Higher education

Higher income

Better health

Conducive physical environments

Decreased engagement:Sensory impairment

Fall history

Loss of spouse/friends

Modifiable risk factor!

Social engagement can be:assessedtargetedobservedevaluated for change

How can we increase the

social engagement of older adults?

Programming for social engagement

Senior centers

Congregate meal sites

Friendly visitors

Telephone reassurance

Life long learning programs

Support groups

Peer-to-peer counseling

Activity programs in residential facilities

Adult day care

Senior Center without Walls

Free group activities by telephone for homebound elders in California, Sponsored

by Episcopal Senior Communities

Brain Aerobics? On the telephone? Yes!

Or if you prefer, how about Play Reading,Bird Watching, or a Vision Support Group?

Senior Center Without Walls offers activities,friendly conversation, and an assortment ofclasses and support groups to homeboundelders and those who find it difficult to go to

a community senior center. You canparticipate from the comfort of your own

home through telephone conference calls.No special equipment is needed and the

calls are completely free.

We even have parties on the phone!

Volunteering as a social engagement intervention

Activity

Social

Altruistic

Meaningful

Older adults are motivated to participate to be “generative and make valued contributions to society,” not to participate in a health promotion program per se (Carlson et al., 2008).

Evaluating a national model

Research Aim

• To examine whether older adults who participate in the Experience Corps® program for two years experience more positive health outcomes than comparable older adults who do not participate in the EC program

• Three health outcomes were compared before and after participating in the EC program over two years between two groups (participants vs. non-participants): – Depression (CES-D), Functional limitation (NAGI

Scale), & Self-rated Health (Likert –type scale)

Adjusted post-test means correcting for all covariates and the associated effect sizes

Health outcomeTreatment

Adjusted means [SD]

ComparisonAdjusted means

[SD]

Program Impact

Effect Size

Self-rated health 3.56 [0.04] 3.44 [0.05] 0.12 [0.07] † 0.12

Functional limitations 1.79 [0.13] 2.67 [0.14] -0.88 [0.19] *** 0.42

Depression 4.31[0.18] 6.42 [0.16] -2.11 [0.26] *** 0.73

Note. An effect size of .50 on health-related quality of life measures translates to clinically important differences (Norman, Sloan, & Wyrwich, 2003)

Challenges are numerous

Participation rates are low

Programs in urban areas

Access issues:– Transportation– Eligibility– Information

Newest directions

Redesigning communities to maximize informal social connections

Internet technologies to keep people connected

Design of residential facilities

Policies to promote volunteering and life-long education

Social engagement receives less formal attention as a health-promoting intervention compared to physical or cognitive activity, despite evidence of

its effects on health and quality of life.

Intervening on social engagement

How can practitioners more systematically target social engagement in treatment planning?

Can we “prescribe” social engagement?

How can develop social programs that are more widely used and effective in promoting health?

How can informal social relations be promoted?

Can we “program” for friendship?

How can we prevent decrease in social engagement in later life?

If you are idle, be not solitary.

If you are solitary, be not idle.

Samuel Johnson (1709-1784)