Ageing: is volunteerism the answer to social exclusion? Jean Woo Department of Medicine & Therapeutics The Chinese University of Hong Kong

Positive ageing Social network and continuing societal contribution Health Adequate 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) (70%)* (72%)* (72%)* (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of exclusion Relationship between the feeling of worthlessness and 4 year non-suicide mortality [Wong SYS et al, unpublished results] 1999 men aged 65 years and over recruited from all over Hong Kong as part of a health survey, followed for 5 years.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 ],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.

Chau PH & Woo J. How well are seniors in Hong Kong doing? An international comparison HKJC Cadenza Project 2008

Models based on Eriksons 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 childrens 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.