Ageing: is volunteerism the answer to social exclusion?
Jean WooDepartment of Medicine &
TherapeuticsThe Chinese University of
Hong Kong
Positive ageing
Social network and continuing societal contribution
HealthAdequate 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)
40-49 873 609 (70%)*
50-59 811 584 (72%)*
60-69 771 553 (72%)*
70-74 515 374 (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Relationship between the feeling of worthlessness and 4 year non-suicide mortality [Wong SYS et al, unpublished results]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 1..01-1.72],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.
Figure 3. Voluntary works participation rate among people aged 65 or above
4%
27%
4%
40%
24%
32%
0%
10%
20%
30%
40%
50%
Hong Kong (2001-2002)
Japan (2001)
Singapore (2004)
Australia (2004)
U.S. (2003)
England & Wales(2001)
Per
cent
age
Chau PH & Woo J.How well are seniors in Hong Kong doing?An international comparison
HKJC Cadenza Project 2008
Models based on Erikson’s 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 children’s 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’.