Lifecourse Epi Lecture 9

Question 1

Case Study: Aging and Volunteerism/Group Activities

Answer 1

An intervention to encourage volunteering and physical activity, Baltimore (Tan)
Participation in traditional basho-fu weaving, Okinawa (Wilcox)
Productive roles and improved health outcomes amongst older adults

Question 2

Case Study: Background

Answer 2

Volunteering by older people seen as a cornerstone to productive aging
Reduces the risk of disability and mortality
Formal volunteering
Provides ‘social capital’ (or social relations with productive benefits) to the community
Improves mental and physical health
Improvement affects longevity
Volunteering at an earlier time in life leads to increased functional ability later in life
Social scientists explain relationship between volunteering and health using the concept of “role enhancement”
Volunteering offers more social resources, a larger social network, more power, and more prestige, and leads to better physical and mental health
Too much volunteering: “role strain”
Limited or no physical and mental health benefits of over-volunteering

Question 3

Case background: Conceptual Basis

Answer 3

Activity Theory
Claims that successful aging can be achieved by maintaining or replacing roles and relationships.
Criticized for neglecting issues of power, inequality, and conflict between age groups.

Disengagement Theory
Argues that the gradual withdrawal of a person from functionally important social roles is good for both the individual and society.
opens up these roles for others and promotes social equilibrium.
also advantageous for the individual because allows a person with diminishing energy to adapt to aging and impending death.

Question 4

Case Study: Conceptual model

Answer 4

“Successful aging” has drawn from ‘activity theory’ (Rowe & Kahn, 1997)
Argues that impact of physiological changes of aging are determined by attitude of a person as he/she ages.
Maintaining high cognitive and physical capacity leads to:
Low probability of disease and disability
Active engagement with life

Question 5

Volunteering and Physical Activity in Older African American Women

Answer 5

Background
Physical inactivity leading cause of preventable death
53% of Americans >65 years report no regular physical activity
Groups at risk of low activity levels: Older women, African Americans, Hispanics, people with disabilities, lower incomes, and less education (Healthy People 2010)
Need to develop, implement, and evaluate community-based approaches for physically active lifestyle for all older adults
Experience Corps (EC) program
Older adult public health intervention
Embedded in community-based volunteer program
Places older adults in the public elementary schools in support of improved academic outcomes for children
Based on 3 – 5 days of service a week during the school year (for a minimum of 15 hrs a week)
The EC program first volunteer program to demonstrate short-term increases in physical activity

Question 6

Case Study: Methodology (Experience Corps)

Answer 6

Data from the Baltimore EC Extended Pilot Study
Comparison group: similar women from the Baltimore Women’s Health and Aging Study
Eligibility requirements for Baltimore EC Study:
age ≥ 60 years,
Receive Mini-Mental State Examination score >24 (or 20 – 23 among those with a high school education or less)
minimum fifth-grade reading level
passing a criminal background check conducted by the Baltimore City Public School System
Data collected included:
Self-reported age, race, education level, income, fatigue, physical activity, mobility difficulty, and health status
Self-reports of a physician diagnosis
Objective measures of strength, walking speed, MMSE, height, weight, frailty, and fatigue

The primary outcome, physical activity, was measured at baseline and follow-up using the modified Minnesota leisure time physical activity questionnaire (LTA)

Question 7

Case Study: Results (Experience Corps)

Answer 7

At 36 months of follow-up:
Statistically significant increase in physical activity in the EC group as compared with WHAS group

Conclusion:
A high-intensity senior service program can lead to significant long-term improvements in the level of physical activity in high-risk older adults

Question 8

Case Study: Limitations (Experience Corps)

Answer 8

Comparison between two observational studies and involved a small sample size

Older adults enrolled in the Baltimore EC program had higher rates of physical activity at baseline as compared with the WHAS cohort (a random sample of older women in Baltimore City and the surrounding counties)

Question 9

Case Study: Implications (Experience Corps)

Answer 9

Increased access to national and community service :
Addresses important social needs and disparities
Creates a sustainable intergenerational social contract

Question 10

Case Study Background: The Cultural Construction of Successful Aging in Japan

Answer 10

Successful aging, with focus on productive activity, salient in modern Japan

Demographic changes in Japan impacted the lifestyle, family relationships, and expectations of older Japanese

Particularly true for aging women in Japan: Japanese women are now the world’s longest living, with an average life expectancy more than 85 years

Question 11

Case Study: Japan’s Response to Aging Population

Answer 11

Focus on health maintenance and promotion

Worlds highest longevity and post-retirement security help build new pathways to ‘self-actualization’ (such as adult education, sports activities, and artistic efforts)

Idealized pictures of aging in Japan as based on family care, increasingly individually managed living arrangements

Question 12

Case Study: Basho-fu among Older Okinawan Women

Answer 12

Basho-fu weaving traditionally played a major role in lives of villagers

Different age groups taking on different roles throughout the production process

For older Okinawan women, weaving a way to maintain their status as active and productive in rapidly changing social milieu.

Question 13

Case Study: Older persons and Symbolic Capital

Answer 13

Social recognition of persons who have contributed to society throughout their lifetimes

Older persons build credit through self-maintenance of health

Continued engagement with society

Pursuit of productive activity and building further credit by engagement in activity, reciprocal obligations

Question 14

Case Study: Methodology

Answer 14

Fieldwork took place during a 4-year period (1997–2001
Participant observation data collection
Village Census and supplemental information
Conducted semi-structured interviews with 40 villagers and eight public officials, focusing on the role of Basho-fu weaving in the lives of elderly women.

Question 15

Case Study: Results

Answer 15

Okinawan weavers lived longer
Low rates of diseases relating to aging process
High rates of functionality
Contributes to symbolic capital
Creation of a socially valued product.
Japanese values originate in Confucian ideas about selfcultivation over the life course, reinforce these social processes

Question 16

Summing Up of Case

Answer 16

The value of staying productive a “cultural universal”
Stage of aging process, health status, ethnicity, gender and social organization are critical to engaging in productive activity in later life
Social relationship quality neglected in research
Older adults a heterogeneous group
Future of volunteering with baby boomers

Question 17

Aging in the Lifecourse: Continuities and Change

Answer 17

Continuities
Social, emotional functioning mostly constant
Need to feel embedded in larger social group
Fears of isolation
Intense, strong emotions in youth and old age
Personality traits remain stable
Negative emotions affect physiological functioning
Changes
Social and emotional life changes
Social networks narrow
Experienced emotions are more predictable
Social roles change quantitatively and qualitatively
Compromised physical functioning
Sensory losses strain interaction
Physiological functioning is regulated less efficiently
Decreased physical reserves

Question 18

Aging: Challenges

Answer 18

Strain pension and social security systems
Increase demand for acute and primary health care
Require a larger and better trained health workforce
Preserving quality of life in face of chronic disablements ( e.g Alzheimer’s and long term care)
Challenge for informal networks of family and friends

Question 19

Aging: Opportunities

Answer 19

Older people’s social capital: Underutilized talent, misperceptions about abilities
Older people a resource for families, communities
A resource in formal or informal workforce
Act as repositories of knowledge
“If we can ensure older people live healthier as well as longer lives, if we can make sure that we are stretching life in the middle and not just at the end, these extra years can be as productive as any others”

Question 20

Population Aging: A Global Phenomena

Answer 20

The world population is rapidly aging
Low- and middle-income countries will experience the most rapid and dramatic demographic change
By 2050, 80% of older people will live in what are now low- or middle-income countries, and nations like China and Brazil will have a greater proportion of older people than the USA
Globally the population of older persons is growing at a rate of 2.6 per cent per year
The pace of population aging is faster in developing countries than in developed countries

Question 21

What Does Global Aging Imply?

Answer 21

By 2050, nearly 1.2 billion of the expected 1.5 billion people age 65 or older will reside in today’s less developed regions.
Just 22 percent of the world’s older people will live in what we today call more developed countries. This demographic transformation will profoundly affect the health and socioeconomic development of all nations. ( Kinsella,2005)
Does longevity means an extension of healthy active lives or an extension of morbidity?

Question 22

Longevity Revolution: Need for Lifecourse Approaches

Answer 22

To better understand biopsychosocial changes from young adulthood through the end of life
To better understand influence of social structural factors and social institutions on lives on adult lives
To build productive engagement and participation of older adults in occupational, family, and civic realms

Question 23

Aging and Vulnerabilities

Answer 23

Gains and losses inherent in all developmental stages
Understand vulnerabilities to better plan aging societies
Normal aging associated with slowed cognitive processing, memory impairment and difficulty concentrating

Question 24

Cognitive Decline

Answer 24

Cognitive decline or ‘inevitability’:
Neurological decline: For e.g general process of neurological decline and cognitive and sensory changes ( Horn and Davidson, 1980; Baltes, 1997)
Chronic disease related decline: Cognitive decline due to chronic diseases and dementia: cognitive change linked to a number of chronic disease conditions, including cardiovascular disease (Geroldi et al., 2003)
Social context related decline in cognition: Role of social ,cultural and historical factors—contextual factors—interact with processes of cognitive aging

Question 25

Looking Beyond Decline and Aging: Building on Strengths

Answer 25

Cognitive decline: Timing and nature still debated
-heterogeneity in cognitive functioning
-substantial evidence in some cognitive capabilities for stability and even growth ( e.g in areas of expertise)
Variability in physical, emotional, cognitive capacity: such as, frailty
Educated and affluent have less functional disability, exercise more and have less cognitive decline
Social class makes for variable trajectories
Old age needs parsing into different stages, and contexts and different age based policy levels needed ( e.g early, middle, late old age)

Question 26

Frailty: Variability in Older Adults

Answer 26

Frailty: An emerging geriatric syndrome, aggregate expression of risks and vulnerability ( Fried’s method to measure 5 frailty variables)
Associations: Falls, disability, morbidity, mortality and excess healthcare costs
e.g in US amongst adults 65 and older only (7% to 10% of those in any given community) are frail, disabled (20% or less with difficulty or dependency in managing households and/or basic self care, or in need of long-term care (5% to 10%).

Question 27

Building Age-friendly Societies: Commitments at Three Levels

Answer 27

Micro level:
Changes in lifestyle, continued fitness and updated learning programs
Mezzo level:
Workplace environment, community support, civic volunteering
Macro level:
Employment conditions, health system reform , rethink business practices

Question 28

Summing Up: Healthy Aging Approaches

Answer 28

Healthy aging not simply to avoid disease and disability but also to improve care and autonomy
Needs to understand biopsychosocial changes from young adulthood through the end of life
To analyze influence of social structural factors and social institutions on lives of adults
Aging experience and ‘successful aging’ needs to recognize
Differences between the young-old and the oldest old
Gender differences
Ethnic differences
Differences in experiences of life events and coping mechanisms, such as resilience
Differences between researchers ‘and older adults’ views of what makes for a successful aging experience
Population aging will transform the global community, the key question is will it also improve societies and lead us to modify the lifecourse? i.e to build on strengths and anticipate vulnerabilities