Measuring Social Activity and Civic Engagement among Older Americans There is not one…… but there must be one

The current indices Population (6) Numbers, Race/ethnicity, marital status, education, living arrangement, older veterans Economics (6) Poverty, income, income sources, net worth, labor force, housing expenditure Health status (8) Life expectancy, mortality, health conditions, sensory impairments, memory impairment, depressive symptoms, disability, health status Health risks and behaviors (7) Vaccinations, mammography, dietary quality, physical activity, obesity, cigarette smoking, air quality Health Care (10) Use of services, health care expenditures, prescription drugs, sources of health insurance, out-of-pocket expenditures, sources of payment for services, veterans health care, nursing home utilization, residential services, caregiving and assistive devices

Conceptual model Demographics and Economics Health conditions Health behaviors Life expectancy Mortality Self-rated health Disability Impairments Health care utilization Health status

Adding civic engagement, social network, social support Demographics and Economics (some descriptors social network) Health conditions Health behaviors Social engagement Social activity Civic participation Volunteering Life expectancy Mortality Health status Perceived quality of life Disability Impairments Health care utilization Social relationships Social integration

Importance of these concepts Increase accuracy of well-being portrait (shape images of aging; not just costs but benefits of aging society; need to shift national perception) Increase social component of a heavily biomedical portrait Add concepts that are correlated with health outcomes (substantial research) Add intermediate outcomes; targets of interventions to improve health outcomes Vehicle for health promotion, new social equation

Civic engagement (social-purpose work, volunteering, community membership, political involvement; mutual aid) Old deal: we will reward you (or punish you) to stop your productive engagement New deal: if you are willing to contribute longer and use your experience for social benefit, we will make it worth your while (retool, make pathways, give opportunity to use skills) Expressed through: working longer, retooling for social- purpose encore careers, interested in civically- meaningful outcome New stage of life: between leaving career job and retirement; work that is chosen freely “Fiddling with the old” will not work

Civic engagement What people do affects how they age Staying physically, socially, and cognitively active is related to health outcomes Feeling of usefulness is predictive of mortality More engaged communities do better in terms of school participation, crime, disaster assistance, political participation Programs can offer a population approach to health promotion (high intensity/sustained dose); programs can reduce health disparity Civic engagement is essential, not just nice Virtuous circle

Civic engagement: Indicators and Data Paid work: full or part time Volunteering (yes/no just minimal) Stipended volunteering Length of volunteering Types of volunteer activities Settings of activities Level of engagement in activities (number of hours volunteered per year) Regularity of activity Monetary contributions Mutual aid; helping neighbors; informal helping Time living in community Involvement in community organization; clubs Memberships, attendance Voting; civic knowledge Social trust (level of trust in neighbors, not available in US) Time use: commuting, TV watching Costs/benefits of an aging society Purpose in life Usefulness

Social network Social network: web of social relations/ties that surround us Social networks determine/shape health (social isolation related to mortality and if you get the common cold; also cognitive decline) People need all levels of connection: intimate, effective, nominal, and extended connections From networks flow resources (social support, access to resources & information, social engagement, social influence); behaviors mechanisms that are pathways to health Material, emotional, and information resources stem for social networks Some social ties negatively affect health (caregiving, influence of peers with bad health behaviors; not good information shared) Interventions need to be broad and not aimed at high risk groups Dangerous ground if we do not let older adults define what is best Perceive quality of life is critical indicator

Social network: Indicators and data size of network; density number of contacts; frequency of contacts number of contacts with mother, father, grandkids, etc. (face to face or phone) geographic proximity reciprocity intimate ties, informal ties, voluntary associations Informal and formal (group/membership) social integration social influence social isolation social roles (high contact social roles) social connections in a residential area residential characteristics Perceived quality of life Costs of caregiving Needs to be multiple domains Needs to look cross-cultural to understand situation in US (does busy ethic exists in other cultures); international comparability is desirable because of cultural and policy differences that may explain differences in social networks and health outcomes NHANES and GSS have range of network measures

Social support Social network, social support, support quality (broader term social relations) Instrumental aid, affective support, affirmation (information/confirmation) Convoys over the life course Social relationship affects self-efficacy, self esteem; pathways to outcomes SES - health link is influenced by social relationships Measurement is very hard, there are multiples sources of data and methods for gathering; objective vs perceived

Social support: Indicators and Data Community organization membership Religious involvement Confiding in child Giving and receiving (life time; current; perceived, actual) Positive relationship with child Perceived ability to get sick care Perceived ability to get financial help Married people with best friends Network quality; low spouse quality Having a confident Do you receive less support than you provide

Newer HRS measures: combines social network and social support How spend money and time (volunteer hours, hours helping others, times spent attending meetings/clubs) Social participation (still engaged in world) Social network and social support: Who, how many, and quality Close relationship with spouse and how much burden

Social Activity indicator that was eliminated

Current data sources Consumer Expenditure Survey Current Population Survey Health and Retirement Study Medical Expenditure Panel Survey Medicare Current Beneficiary Survey National Health Interview Survey National Health/Nutrition Examination Survey National Long Term Care Survey National Nursing Home Survey National Survey of Veterans, 2001 National Vital Statistics System Panel Study of Income Dynamics Population Projections Survey of the Aged 1963 Survey of Demographic and Economic Characteristics of the Aged, 1968 Survey of Veteran Enrollees’ Health and Reliance upon VA, 2003

Potential data sources Duke EPESE General Social Survey National Social Relation Survey (other data sources were on Dr. Antonucci’s list) New school ….of plastics Cell phones, blackberries Myspace; facebook The sociometer Sensors will do for social-behavioral health sciences what the genome project did for genetics

Research gaps What is “correct dose” of civic involvement to get positive response? What is adequate duration of engagement for positive outcome? How do we ensure inclusion? How work and volunteering work in tandem? How do we change social structure to reduce structural lag? Where is the life course perspective? How do we intervene to improve social network/social connections?

Longer term considerations Health status (ultimate outcomes) could be expanded to include quality of life or life satisfaction Psychological indicators (self efficacy, mastery, etc) as important intermediaries