Measuring Social Activity and Civic Engagement among Older Americans

1
Measuring Social Activity and Civic Engagement
among Older Americans

• There is not one
• but there must be one

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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

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

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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

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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

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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

9
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

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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

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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

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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

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Newer HRS measurescombines 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

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Social Activity indicator that was eliminated
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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

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Potential data sources

• Duke EPESE
• General Social Survey
• National Social Relation Survey
• (other data sources were on Dr. Antonuccis
  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

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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?

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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