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
Health conditions
Health status
Demographics
and
Economics
Disability
Impairments
Health behaviors
Health care utilization
Life expectancy
Mortality
Self-rated health
Adding civic engagement, social network, social support
Health conditions
Demographics
and
Economics
(some descriptors
social network)
Health behaviors
Social engagement
Social activity
Civic participation
Volunteering
Social relationships
Social integration
Health care utilization
Disability
Impairments
Life expectancy
Mortality
Health status
Perceived quality of lif
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 socialpurpose encore careers, interested in civicallymeaningful 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