1. Social Engagement and Healthy Aging Nancy Morrow-Howell, Ph.D. Ralph and Muriel Pumphrey Professor of Social Work

2. A very old idea excessive individuation individual not bound to social groups little social support or guidance ……….connected to suicide Durkheim (1897)

3. 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.)

4. 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

5. 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)

6. Pathways between social support and health outcomes Social support influences health behaviors Encouraging exercise or help-seeking Social support improves psychological conditions Increasing self-esteem or self-efficacy Social support alters physiologic states Decreasing allostatic load and boosting immune function

7. 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

8. 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?

9. 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)

10. 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

11. 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

12. Modifiable risk factor! Social engagement can be: assessed targeted observed evaluated for change

13. How can we increase the social engagement of older adults?

14. 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

15. 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 of classes and support groups to homebound elders and those who find it difficult to go to a community senior center. You can participate 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!

16. 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).

17. Evaluating a national model

18. 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)

19. Adjusted post-test means correcting for all covariates and the associated effect sizes Health outcome Treatment Adjusted means [SD] Comparison Adjusted means [SD] Program Impact Effect Size Self-rated health 3.56 [0.04]3.44 [0.05]0.12 [0.07] † 0.12 Functional limitations1.79 [0.13]2.67 [0.14]-0.88 [0.19] *** 0.42 Depression4.31[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)

20. Challenges are numerous Participation rates are low Programs in urban areas Access issues: –Transportation –Eligibility –Information

21. 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

22. 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.

23. 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?

24. If you are idle, be not solitary. If you are solitary, be not idle. Samuel Johnson (1709-1784 )