A randomized controlled trial and pragmatic analysis of the effects of volunteering on the health and well-being of older people

Social coaching: applying Keyes' Model of Social Wellbeing to audiological support for older adults with hearing loss

OBJECTIVE

To propose the application of Keyes's Model of Social Wellbeing to guide hearing care professionals (HCPs) in providing social coaching to address the impact of hearing loss on social wellbeing in older adults.

DESIGN

A discussion paper introducing Keyes's Model of Social Wellbeing and its application in enhancing the social wellbeing of older adults with hearing loss. Qualitative insights and evidence from various studies are provided to support the application of the proposed model. Examples of how HCPs can use social coaching to help address the effects of hearing loss on social coherence, integration, acceptance, contribution, and actualisation are provided.

STUDY SAMPLE

N/A.

RESULTS

Hearing loss significantly impacts all five constructs of Keyes's Model of Social Wellbeing, leading to challenges in social coherence, integration, acceptance, contribution, and actualisation. Effective social coaching by HCPs can mitigate these impacts by providing tailored support, enhancing communication skills, and fostering a sense of belonging and purpose.

CONCLUSIONS

Integrating social coaching into audiology practice and policy, guided by Keyes's Model, can improve social wellbeing for older adults with hearing loss. This person-centred approach requires HCPs to understand the social implications of hearing loss and deliver targeted interventions to support their clients' social and emotional needs.

The effects of volunteering on loneliness among lonely older adults: the HEAL-HOA dual randomised controlled trial

BACKGROUND

Previous randomised controlled trials have largely relied on self-reported volunteer work to assess the effects of volunteering and have rarely provided structured volunteering activities during the intervention period. The present study aimed to investigate the effects of social volunteering work over 12 months on loneliness among older adults during the COVID-19 pandemic.

METHODS

A dual randomised controlled trial was done in Hong Kong to investigate the long-term effects of telephone-delivered psychosocial interventions by older Chinese volunteers who were screened as lonely, for older adult recipients who had low income, lived alone, felt lonely, and were digitally excluded. Participants were included if they were aged 50-70 years; had provided consent to be trained and serve as a volunteer for at least 2 h per week for 6 months; had at least 3 years of secondary school education; had no severe self-reported physical, mental, or cognitive health problems; were not working full or part-time; had engaged in formal volunteering fewer than four times within the past year; and were lonely (ie, had a score of at least 6 on the three-item UCLA Loneliness Scale). Participants were allocated into either the volunteering or control group (psychoeducation programme) using a random number method. The details of group allocation were concealed as the research assistant responsible for randomisation was different to the research assistants responsible for recruitment and assessments (who were masked to the condition). Following a 6-week training, the volunteers delivered a psychosocial intervention to older intervention recipients for 6 months. The primary outcome was loneliness measured with the 20-item UCLA Loneliness Scale and the De Jong Gierveld (DJG) Loneliness Scales at 6 months and 12 months. Assessments were performed before training (baseline; T1), at 6 months (T2), and at 12 months after training (T3). The intention-to-treat principle was used to compare the effects of volunteering between the two groups. The trial was registered in the Clinical Trials Registry of the University of Hong Kong Clinical Trials Centre (HKUCTR-2929). This trial has completed.

FINDINGS

Between May 3, 2021, and Oct 6, 2022, a total of 375 individuals were recruited to the trial, including 84 males (22%) and 291 females (78%). 185 were randomly assigned to the volunteering group (56 to deliver a mindfulness intervention, 65 to deliver a behavioural activation intervention, and 64 to deliver a befriending intervention) and 190 were assigned to the control group. 311 (83%) of 375 participants were 60 years or older (median 64 years [SD 4·86]). Participants in the volunteering group reported a significantly lower level of loneliness at T2 (dppc2 ranged from -0·41 to -0·70) compared with T1 than participants in the control condition. There was a significant decrease in loneliness measured using the UCLA Loneliness Scale at T2 in the volunteering group but such a decline was not shown in the control group (condition × time interaction, estimate 0·19 [95% CI 0·08 to 0·29], p=0·00058, dppc2=-0·41). Similarly, when measured with the DJG Loneliness Scale, there was a significantly greater decrease in loneliness in the volunteering group compared with the control group at T2, including a medium to large effect size on total DJG scores (estimate 1·34 [95% CI 0·83 to 1·84], p<0·0001, dppc2=-0·70) and a medium effect size on emotional (estimate 0·63 [0·35 to 0·90], p<0·0001, dppc2=-0·59) and social subscales (estimate 0·71 [95% CI 0·37 to 1·05], p<0·0001, dppc2=-0·58). Although most of the positive effects of volunteering were not sustained at T3, the volunteers who continued to volunteer for more than 2 h per week at T3 reported lower levels of loneliness than those who did not maintain volunteering.

INTERPRETATION

This randomised controlled trial demonstrates the beneficial effect of volunteering on reducing loneliness in older adults who feel lonely, and that this benefit can be maintained through continued participation in voluntary work. Future intervention programmes should strengthen older adults' commitment to volunteer.

FUNDING

Research Grants Committee of the Hong Kong Special Administrative Region, China.

Evaluating the Well-Being Benefits and Social Value of Volunteer Gardening: Health Economics Meets Behavioral Science

Multidisciplinary collaboration is key to strengthening the evidence base for multifaceted illness prevention interventions. We bring together health economics and behavioral science to explore the well-being benefits and social cost-benefit of volunteer gardening at an accredited botanic garden, Wales, UK. A health economics-informed social return on investment (SROI) evaluation was combined with the assessment of volunteers' basic psychological needs (autonomy, competence, and relatedness), connection to nature, and their interrelatedness in this innovative nature-based intervention study. Pre- and post-volunteering outcome data were collected using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), the ICEpop CAPability measure for Adults (ICECAP-A), the 12-item diary version of the Basic Psychological Need Satisfaction and Frustration Scale (BPNSNF), the Nature Connection Index (NCI), and a bespoke Client Service Receipt Inventory (CSRI). Results indicate that volunteer gardening can provide well-being benefits to participants and cost savings to the NHS. The well-being benefits observed were estimated to generate social value in the range of GBP 4.02 to GBP 5.43 for every GBP 1 invested. This study contributes to the evidence base that simple nature-based interventions such as volunteer gardening could offer low-cost supportive environments that deliver significant well-being benefits and associated social value to local communities, including a reduced burden on overstretched local healthcare services.

Volunteering and Its Association with Depression, Loneliness, and Lifestyle of Older Adults: Insights from a Japanese Cross-Sectional Study

Background/Objectives: Volunteering has been widely recognized as beneficial to the well-being of older adults, providing health benefits, increased social engagement, and a sense of purpose. This study aimed to explore the associations between volunteering and physical and mental health measures among older adults in Japan. Methods: Using an online survey conducted during the COVID-19 pandemic, 500 participants aged 65 and older were divided into volunteer and non-volunteer groups. Demographic, lifestyle, and health characteristics were comprehensively assessed using a series of reliable and validated instruments. Logistic regression analysis was used to explore the associations between volunteering and health outcomes. Results: The findings revealed that while there were no significant differences in physical health indicators and undertreatment of most diseases (with the exception of cataracts), volunteers reported significantly lower levels of depression and loneliness compared to non-volunteers. The volunteer group also showed greater engagement in social activities and hobbies, which may have contributed to their improved mental health outcomes. Conclusions: The results of this study add to the growing body of evidence suggesting that volunteering may be an effective, low-cost intervention for promoting mental health and social engagement among older adults.

Cultural contexts differentially shape parents' loneliness and wellbeing during the empty nest period

The coming decades will see a substantial increase in the population of older adults, accompanied by significant demographic and family structure changes worldwide. As a result, the empty nest period-the postparental phase in parents' lives when their children have left home and they are no longer engaged in childrearing-is becoming an increasingly common experience in Western and Asian cultures. The current theoretical review examines the psychological consequences of the empty nest period on loneliness and well-being across cultures, emphasizing the impact of cultural factors on these experiences. By synthesizing research from Western and Asian contexts, we explore two primary theoretical mechanisms-role loss and role strain relief-that shape the postparental phase's psychological outcomes. Our review reveals that while some parents experience reduced well-being due to role loss, others benefit from role strain relief and increased social engagement. We highlight how cultural differences in familial roles, gender roles, social expectations regarding nest-leaving, and social participation patterns moderate these mechanisms. We propose a comprehensive cultural framework, along with a discussion of culturally sensitive interventions to enhance the well-being of empty nesters globally.

Combined effects of loneliness and diabetes mellitus on disability incidence among older Japanese adults

BACKGROUND

Developed countries worldwide face the challenge of aging populations in which loneliness is problematic, leading to mental and physical health issues. Diabetes mellitus (DM) can cause decreased physical activity, reduced functioning, and depressive symptoms. However, how interactions between loneliness and DM influence health outcomes remains unclear. We aimed to determine the effects of loneliness and DM-related complications on the incidence of disability among older individuals.

METHODS

We analyzed data from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes for community-dwelling adults aged ≥65 years without initial long-term care needs. Loneliness was assessed using the University of California Los Angeles Loneliness Scale, and DM status was determined based on medical history obtained through face-to-face interviews. Disability incidence was identified by monthly tracking of certifications under the Japanese long-term care insurance system. The combined effect of DM and loneliness on care needs was examined using Cox proportional hazard regression models.

RESULTS

Among 5,160 participants, 298 (5.8 %) developed incident disabilities within 24 months. Cox models adjusted for potential confounders revealed a significantly increased disability risk among persons with DM and loneliness. Having DM without loneliness and vice versa were not significant risk factors for disability incidence compared with having neither.

CONCLUSIONS

The combination of loneliness with DM was a risk factor for disability development among community-dwelling older adults. Loneliness and DM might be interrelated and associated with disability development, suggesting that support along with assessments of mental health and illness might help to avoid disability in this population.

The Effects of High versus Low Levels of Altruism and Volunteering on the 4-Year Follow-Up Cognitive Performance of Community-Dwelling Older Adults

OBJECTIVES

Currently, there is a growing interest on the benefits of volunteering. Nevertheless, there is scarce evidence for non-volunteering altruistic behaviors. This study aims to investigate the role of both altruism and volunteering on the cognitive performance of older individuals followed for four years.

METHODS

This was cohort study carried out in 180 Brazilian older adults assessed in three different timepoints (baseline [2015-2016], 2 years of follow-up [2017-2018] and 4 years of follow-up [2019-2020]). Composite cognitive score was calculated based on the Mini-Mental State Examination, Verbal Fluency, Clock-Drawing test, and CERAD Word-List. Altruism was assessed through the Self-reported Altruism Scale and self-reported volunteering status. Mixed ANCOVAS were performed.

RESULTS

For altruism, there were significant differences in all time points (Baseline, 2 years and 4 years) favoring higher cognitive scores for higher levels of altruism. However, no differences were observed for volunteering in all time points.

CONCLUSIONS

Having higher levels of altruism was significantly associated with better cognitive scores.

CLINICAL IMPLICATIONS

Altruism, even without volunteering, seem to have positive effects on the cognitive functioning of older adults. Health professionals who take care of older adults might take account of the presence or absence of altruistic behaviors of their patients in their formulations and recommendations.

Longitudinal impact of volunteering on the cognitive functioning of older adults: A secondary analysis from the US Health and Retirement Study

Objectives

To examine the relationship of volunteering with cognitive activity, social activity, and physical activity among older adults and, ultimately, with later cognitive functioning across different time periods.

Methods

We used individual responding to three waves of the US Health and Retirement Study panel data from 2008, 2012, and 2016 (n = 2,862). Self-reported questionnaires were used to assess annual volunteering frequency (non volunteering, volunteering <100 h and ≥100 h), and an adapted version of the Telephone Interview for Cognitive Status (TICS) was used to assess memory, mental processing, knowledge, language, and orientation. A structural equation model was estimated to assess effects on cognitive functioning throughout waves.

Results

Those participants that were part of volunteering activities in 2012 showed an increase between 2008 and 2012 in moderate physical activity (β = 0.19, P < 0.001 for those volunteering less than 100 h and β = 0.21, P < 0.001 for those volunteering at least 100 h), increase in social activity (β = 0.10, P = 0.052 for those volunteering less than 100 h and β = 0.12, P = 0.018 for those volunteering at least 100 h) and increase in higher cognitive activity (β = 0.13, P < 0.001 for those volunteering at least 100 h), compared to participants who did not volunteer. Higher levels of cognitive activity in 2008 and 2012 were associated with higher cognitive functioning on the following waves (β = 0.66 and β = 0.60, P < 0.001, respectively).

Discussion

Volunteering is a modifiable activity that can be increased to bolster cognitive functioning in older adulthood, primarily mediated by increased cognitive activity.

Volunteering and Changes in Cardiovascular Biomarkers: Longitudinal Evidence From the Health and Retirement Study

Background and Objectives

Growing body of research shows that volunteering is beneficial for those served, the volunteers, and the larger communities. However, major challenges remain that hinder the practical implications for volunteer activity as a public health intervention, including potential selection effects, lack of longitudinal studies that adjust for baseline characteristics, and a paucity of studies that consider multiple physical health outcomes in a single model.

Research Design and Methods

Data from 2006 to 2016 waves of the Health and Retirement Study (2006-2016) were used (N = 18,847). Outcome-wide analyses were utilized to evaluate if changes in volunteering between 2006/2008 (t0) and 2010/2012 (t1) were associated with 7 cardiovascular disease biomarkers 4 years later (2014/2016, t2). These models were adjusted for demographic factors, socioeconomic status, health behaviors, chronic conditions, baseline biomarkers, and volunteering. Additionally, selection into volunteering and attrition were taken into account.

Results

Compared with nonvolunteers, volunteering more than 200 hr a year was associated with a lower risk for clinically high diastolic blood pressure. In addition, increased volunteering effort (change from 1 to 99 hr at t0 to >100 hr at t1) was associated with a lower likelihood of clinically high systolic and diastolic blood pressure levels. Sustained high volunteering (>100 hr at both t0 and t1) was associated with lower diastolic blood pressure.

Discussion and Implications

The current study adds to the evidence on the health benefits of volunteering for adults 50 and older by inferring a potential causal link between high-intensity volunteering and reduced blood pressure.

Life Satisfaction and Self-Esteem in Older Adults Engaging in Formal Volunteering: A Cross-Sectional Study in Taiwan

Previous research has reported an association between life satisfaction, self-esteem, and volunteering. However, it is unclear whether self-esteem is associated with life satisfaction in older adults who are already engaged in volunteering. Therefore, the present study aimed to investigate the association between life satisfaction and self-esteem in older adults who were formally volunteering at a non-governmental organization in Taiwan. A cross-sectional study was conducted on 186 formal volunteers aged ≥ 65 years who were recruited from the Keelung chapter of the Buddhist Compassion Relief Tzu Chi Foundation in Taiwan. A hierarchical stepwise linear regression was used to examine the association between scores on the Satisfaction With Life Scale (SWLS) with the Rosenberg Self-Esteem Scale (RSES) and the Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale. The results showed that SWLS was significantly associated with RSES score (standardized beta (std. β) = 0.199, p = 0.003), the eudaimonic subscale score of the HEMA-R (std. β = 0.353, p < 0.001), a vegetarian diet (std. β = 0.143, p = 0.027), and volunteering for five days or more a week (std. β = 0.161, p = 0.011). In conclusion, improving self-esteem and promoting eudaimonic motives in older adults who are formally volunteering could be effective strategies for enhancing their levels of life satisfaction.

Volunteering and political participation are differentially associated with eudaimonic and social well-being across age groups and European countries

Voluntary participation is thought to promote the well-being of engaged individuals, especially in old age, but prior evidence on this link is mixed. In the present studies, we used the cross-sectional data from Round 6 (2012) of the European Social Survey (ESS) to investigate the variation in the associations between voluntary participation and eudaimonic (e.g., sense of direction) and social (e.g., perceived social support) well-being across types of participation (nonpolitical volunteering vs. political participation), age groups, and European countries. Study 1 addressed individual-level associations and age differences therein (preregistered at https://osf.io/2p9sz and https://osf.io/6twqe). Two-level multiple regression with an extensive set of control variables showed that at the within-country level, the associations between voluntary participation and well-being indicators were small on average. Nonpolitical volunteering had significantly more positive effects than did political participation, whereas few significant age differences emerged. Study 2 focused on the country-level variables that might explain the substantial cross-national variation in the main effects of voluntary participation (preregistered at https://osf.io/mq3dx). Only GDP per capita was a significant moderator at the country level: The associations of nonpolitical volunteering with eudaimonic well-being were more positive in the European countries with lower GDP. Other country-level variables (Gini coefficient, social welfare spending, and democracy indices) yielded no consistent moderation effects. Study 3 considered potential country-level explanations for the substantial cross-national variation in whether younger or older adults appeared to benefit more (preregistered at https://osf.io/7ks45). None of the country-level variables considered (effective retirement age in men, life expectancy at 65, average age of members of the national parliament and cabinet, and youth unemployment rate) could account for this variation. We conclude that, given the large cross-national variation in the effects of voluntary participation on well-being and in age differences therein, more attention to national specifics is warranted.

"Our focus is on illness and loneliness": Volunteer work engagement, compassion satisfaction, compassion fatigue, self-care and motivations to volunteer

They are participating as a volunteer implies active personal positioning accompanying others. Evidence supports that experiences of those who experience an illness, who are hospitalised or feel lonely, impact the volunteers: positive emotions like engagement and Compassion Satisfaction (CS) or, the reverse, Compassion Fatigue (CF). Motivations help us understand why volunteers spend their time on these activities. And self-care practices will be a challenge to counteract the exhausting emotions of volunteering. This research presents a mixed, exploratory and sequential design study on the island of Majorca (Spain). The first phase (n = 216) was quantitative, gathering data from November 2018 to April 2019. Then, the second phase (two focus groups) started with qualitative data collection (July 2019). Firstly, the study determines CS and work engagement levels and examines the relationship between self-care, CF and motivations. Secondly, the study finds out how they recognise their positive and negative emotions, their relationship with self-care and what motivates them to be volunteers. The results show that the volunteers report highly positive feelings associated with their volunteering (CS and engagement) and are backed up by a good level of personal Self-Care. The Understanding and Enhancement motivational functions generate even more positive feelings for the volunteers themselves, who attach a positive value to their experience of caring for others. Despite the positive results collected, we must not ignore the phenomenon of CF in relational volunteering and pain support because it occurs. After all, that could lead to abandonment by volunteers.

Social Inclusion and Communality of Volunteering: A Focus Group Study of Older People’s Experiences

The aim of this qualitative study was to describe the factors that motivate older people to volunteer and how volunteering influences their social inclusion and communality. Data were collected using focus group interviews in 2020–2021 from older people aged 65–81 years (n = 38) who had experience of volunteering in the community. The data were analyzed using inductive content analysis. Based on the results, the experiences described by older people who participate in volunteering consisted of factors encouraging older people to volunteer and depended on the activation, support, and motivation of volunteer operators. The support provided by the health care services and volunteer action organization for volunteers was a key factor in encouraging older people to participate in volunteering. Moreover, volunteering impacted the communality of volunteers in several ways, influencing social capital. The sense of communality was enhanced by the way in which volunteering was carried out, including collaboration with health care services and associations. In order to strengthen the importance of volunteering in society, there is a need for close collaboration between voluntary organizations and health care service providers to develop volunteering because health care organizations cannot respond to all of the challenges faced by the ageing population.

The health advantage of volunteering is larger for older and less healthy volunteers in Europe: a mega-analysis

There is a vast literature on the health benefits associated with volunteering for volunteers. Such health advantages are likely to vary across groups of volunteers with different characteristics. The current paper aims to examine the health advantages of volunteering for European volunteers and explore heterogeneity in the association between volunteering and health. We carry out a mega-analysis on microdata from six panel surveys, covering 952,026 observations from 267,212 respondents in 22 European countries. We provide open access to the code we developed for data harmonization. We use ordinary least squares, fixed effects, first difference, and fixed effect quantile regressions to estimate how volunteering activities and changes therein are related to self-rated health for different groups. Our results indicate a small but consistently positive association between changes in volunteering and changes in health within individuals. This association is stronger for older adults. For respondents 60 years and older, within-person changes in volunteering are significantly related to changes in self-rated health. Additionally, the health advantage of volunteering is larger for respondents in worse health. The advantage is largest at the lowest decile and gradually declines along the health distribution. The magnitude of the association at the first decile is about twice the magnitude of the association at the ninth decile. These results suggest that volunteering may be more beneficial for the health of specific groups in society. With small health advantages from year to year, volunteering may protect older and less healthy adults from health decline in the long run.

Longitudinal associations between formal volunteering and well-being among retired older people: follow-up results from a randomized controlled trial

Volunteering has been identified as a potential mechanism for improving the psychosocial health of older adults. Utilizing a randomized controlled trial approach, the present study assessed the extent to which commencing volunteering can improve psychosocial health outcomes for older people. Fully retired Australian adults aged 60+ years (N= 445) were assessed at baseline and allocated to either the intervention or control arms of the trial. Those in the intervention condition were asked to participate in at least 60 min of formal volunteering per week for 6 months. Per-protocol analyses were conducted comparing psychosocial outcomes for those who complied with the intervention condition (n= 73) to outcomes for those who complied with the control condition (n= 112). Those who complied with the intervention condition demonstrated significant improvements in life satisfaction, purpose in life, and personal growth scores over a 12-month period relative to those in the control condition who did no volunteering. Findings provide evidence of a causal relationship between commencing volunteering and improvements in psychosocial health among older adults and indicate that encouraging participation in this activity could constitute an effective healthy aging intervention.

Nature-Based Citizen Science as a Mechanism to Improve Human Health in Urban Areas

The world is becoming increasingly urbanised, impacting human interactions with natural environments (NEs). NEs take a number of forms, ranging from pristine, modified, to built NEs, which are common in many urban areas. NEs may include nature-based solutions, such as introducing nature elements and biological processes into cities that are used to solve problems created by urbanisation. Whilst urbanisation has negative impacts on human health, impacting mental and physical wellbeing through a number of mechanisms, exposure to NEs may improve human health and wellbeing. Here, we review the mechanisms by which health can be improved by exposure to NEs, as explained by Stress Reduction Theory, Attention Restoration Theory, and the 'Old Friends'/biodiversity hypothesis. Such exposures may have physiological and immunological benefits, mediated through endocrine pathways and altered microbiota. Citizen Science, which often causes exposure to NEs and social activity, is being increasingly used to not only collect scientific data but also to engage individuals and communities. Despite being a named component of scientific and environmental strategies of governments, to our knowledge, the intrinsic health benefits of Citizen Science in NEs do not form part of public health policy. We contend that Citizen Science programs that facilitate exposure to NEs in urban areas may represent an important public health policy advance.

The Potential Win-win Strategy for Healthy Aging and Environmental Protection: Environmental Volunteering

PURPOSE

To explore the physical activity level of community environmental volunteering (CEV) participants and the differences in physical functions and daily activity patterns between the older adults who engaged in intensive CEV (≥15 hours/week) and non-intensive CEV (<15 hours/week) groups.

DESIGN

Cross-sectional study.

SETTING

Three recycling stations in Taiwan.

SAMPLE

In total, 113 community-dwelling older adults who regularly participated in CEV. The response rate was 53%.

MEASURES

The ActiGraph wGT3x-BT accelerometer for the percentage of sedentary, light, and moderate to vigorous physical activity (MVPA) of CEV time and awaken time; the Jamar hand dynamometer for grip strength; and the MicroFET3 muscle testing dynamometer for knee extension strength.

ANALYSIS

Analysis of covariance with the baseline characteristics as covariates.

RESULTS

Overall, MVPA, light, and sedentary activities accounted for 53.73%, 41.10%, and 5.23% of CEV time, respectively. The intensive group (n = 61) displayed greater dominant handgrip strength (P = .004) and higher MVPA percentage in daily life (P = .044) than the non-intensive group (n = 52).

CONCLUSION

CEV provides sufficient opportunities for older adults to perform physical activity. Intensive CEV is related to greater handgrip strength but not lower limb strength. Further study is needed to establish the causal relationship between CEV and health variates.

Aspects of formal volunteering that contribute to favourable psychological outcomes in older adults

Although there is a large body of evidence documenting the benefits of engagement in formal volunteering among older people, research assessing the specific aspects of the volunteering experience that are associated with these benefits is limited. Accordingly, the objective of this study was to (i) examine the aspects of volunteering that predict improvements or declines in older people's psychological outcomes over time and (ii) assess the extent to which demographic characteristics and time spent engaging in informal volunteering moderate the relationship between aspects of volunteering and potential outcomes. At Time 1, non-volunteering Australian older adults completed measures assessing their subjective well-being, eudemonic well-being, and psychological resources and were asked to commence volunteering. At Time 2 (six months later), participants completed the same measures and reported on their volunteering experiences. Among the 108 older adults who provided usable data at both time points (average age = 69.86 years, 64% women), the degree to which participants felt overwhelmed by their volunteer work significantly predicted declines in subjective well-being and psychological resources. The perceived importance of the cause for which participants reported volunteering and the perceived meaningfulness of the specific activities undertaken predicted improvements in these outcomes. Volunteering roles for older adults that (i) are not considered overwhelming, (ii) fulfil their desire to volunteer for a cause about which they are genuinely concerned, and (iii) involve activities perceived to be meaningful are likely to produce the favourable psychological outcomes.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10433-021-00618-6.

Voluntary work for the physical and mental health of older volunteers: A systematic review

Background

The increasing imbalance between the number of older adults not working and the number of adults in the age range of labour force participation (age range 20-64) has long been a fundamental public policy challenge in the Organization for Economic Co-operation and Development member countries. At a societal level, this growing imbalance raises serious concerns about the viability and funding of social security, pensions and health programmes. At an individual level, the concern is probably more that of aging well with the prospect of many years in retirement. Some research suggests that retiring for some carries the risk of a fast decline in health. Volunteering can play a significant role in people's lives as they transition from work to retirement, as it offers a "structured" means of making a meaningful contribution in society once the opportunity to do so through work has been cut off. Some older people consider voluntary work as a way to replicate aspects of paid work lost upon retirement, such as organisational structure and time discipline. In many countries, volunteering of the older adults is increasing and programmes designed specifically for this subpopulation are emerging. Volunteering may contribute to both individuals aging well and society aging well, as volunteering by the older adults at the same time relieves the societal burden if it helps maintain health and functionality for those who volunteer. It thus remains to be established to what extent volunteering impacts on the physical and mental health of those who volunteer.

Objectives

The main objective of this review is to answer the following research question: what are the effects of volunteering on the physical and mental health of people aged 65 years or older?

Search Strategy

Relevant studies were identified through electronic searches of bibliographic databases, governmental and grey literature repositories, hand search in specific targeted journals, citation tracking, contact to international experts and internet search engines. The database searches were carried out to December 2018 and other resources were searched in September 2019 and October 2019. We searched to identify both published and unpublished literature. The searches were international in scope. Reference lists of included studies and relevant reviews were also searched.

Selection Criteria

The intervention of interest was formal volunteering which can be described as voluntary, on-going, planned, helping behaviour that intend to increase the well-being of strangers, offers no monetary compensation and typically occurs within an organisational context. We included older people aged 65 or over who are engaged in formal voluntary work. The primary focus was on measures of physical and mental health. All study designs that used a well-defined control group were eligible for inclusion. Studies that utilised qualitative approaches were not included.

Data Collection and Analysis

The total number of potential relevant studies constituted 17,046 hits. A total of 90 studies, met the inclusion criteria and were critically appraised by the review authors. The 90 studies analysed 47 different populations. Only 26 studies (analysing 19 different populations) could be used in the data synthesis. Forty-six studies could not be used in the data synthesis as they were judged to have too high risk of bias and, in accordance with the protocol, were excluded from the meta-analysis on the basis that they would be more likely to mislead than inform. Eighteen studies did not provide enough information enabling us to calculate an effects size and standard error or did not provide results in a form enabling us to use it in the data synthesis. Finally, of the 26 studies that could be used in the data synthesis, two pairs of studies used the same two data sets and reported on the same outcome(s), thus in addition two studies were not used in the data synthesis.Meta-analysis of both physical health outcomes and mental health outcomes were conducted on each metric separately. All analyses were inverse variance weighted using random effects statistical models that incorporate both the sampling variance and between study variance components into the study level weights. Random effects weighted mean effect sizes were calculated using 95% confidence intervals (CIs).Sensitivity analysis was carried out by restricting the meta-analysis to a subset of all studies included in the original meta-analysis and was used to evaluate whether the pooled effect sizes were robust across components of risk of bias.

Results

The 24 studies (analysing 19 different populations), used for meta analysis were from Australia, Ireland, Israel, Japan, Korea and United States, three were a randomised controlled trial and 21 were NRS. The baseline time period (the year the voluntary work that was analysed was measured) spanned by the included studies is 30 years, from 1984 to 2014 and on average the baseline year was 2001. On average the number of follow up years was 5, although with great variation from 0 to 25 years. The average number of volunteers analysed (not reported in four studies) was 2,369, ranging from 15 to 27,131 and the average number of controls was 13,581, ranging from 13 to 217.297. In total the average number of participants analysed was 14,566, ranging from 28 to 244.428.Ten studies analysed the effect of voluntary work on mortality, however, eight studies reported a hazard ratio and two studies reported an odds ratio. We analysed these two types of effect sizes separately. A hazard ratio <1 indicates that the treated, the volunteers is favoured. That is, the conditional mortality rate is lower for volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.91. The random effects weighted mean hazard ratio was 0.76 (95% CI, 0.72-0.80) and statistically significant. The two studies that reported odds ratios of mortality supported this result. There was no heterogeneity between the studies in either of the meta analyses.Three studies analysed the effect of voluntary work on incident functional disability, using a hazard ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.70-0.99. The random effects weighted mean hazard ratio was 0.83 (95% CI, 0.72-0.97) and statistically significant. There was a small amount of heterogeneity between the studies.Two studies analysed the effect of voluntary work on decline in instrumental activities of daily living, using an odds ratio as effect measure. Both reported results indicated an effect favouring the volunteers (0.63 and 0.83). The random effects weighted mean odds ratio was 0.73 (95% CI, 0.53-1.01) and not statistically significant. There is no heterogeneity between the two studies.Three studies analysed the effect of voluntary work on maintenance of functional competence, using an odds ratio as effect measure. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.67-0.83. The random effects weighted mean odds ratio was 0.81 (95% CI, 0.70-0.94) and statistically significant. There is no heterogeneity between the studies.In addition a number of other physical outcomes were reported in a single study only.Three studies analysed the effect of voluntary work on depression, and reported results that enabled the calculation of standardised mean difference (SMD) and variance. The effect sizes are measured such that a positive effect size favours the volunteers. All reported results indicated an effect favouring the volunteers, primary study effect sizes lied in the range 0.05-0.66. The random effects weighted SMD was 0.12 (95% CI, 0.00-0.23) and statistically significant. There is a very small amount of heterogeneity between the studies.In addition, a number of other mental health outcomes were reported in a single study only.We did not find any adverse effects.There were no appreciable changes in the results across components of risk of bias as indicated by the sensitivity analysis.

Authors' Conclusions

The review aimed to examine effects on all types of physical and mental health outcomes. With the exception of mortality, there was insufficient evidence available. The available evidence, however, does suggest that there is an effect on the mortality of volunteers, although the effect is small. We found evidence that voluntary work reduces the mortality hazard of the volunteers aged 65 and above. The effect corresponds to a 43% chance of the volunteers dying first which should be compared to a fifty-fifty chance (50%) of dying first if the intervention had no effect. The evidence seems robust in the sense that we did not find any heterogeneity between the studies. As the intervention, unlike most other interventions in the social welfare area, is not costly, it could be prescribed to more older adults. In fact as the intervention in contrary to carrying a cost is a productive activity contributing directly to community well-being and has a positive effect on the volunteers it probably should be prescribed universally. However, due to the very nature of the intervention, it is voluntary and it cannot be prescribed. But more people could be encouraged to take up voluntary work if the opportunity was immediately available and visible.

Patterns of older Australians’ engagement in health-promoting activities: a latent profile analysis

Being active in later life is key to remaining physically and mentally healthy, and health in turn influences individuals’ ability to remain active. Activity prevalence figures can disguise the existence of clusters of older people who are very active due to regular participation in multiple categories of activity versus those who are sedentary. The aim of this study was to conduct segmentation analyses based on retired seniors’ engagement in various activities (walking, active sport/exercise, gardening and volunteering) to identify groups characterised by varying patterns of participation. The sample comprised 746 Western Australians aged 60+ years (range 60–95 years, average age 71.66 years, standard deviation = 6.57), 61 per cent of whom were female. Using latent profile analysis, four distinct segments emerged. Those respondents classified as belonging to the most active group exhibited moderate to high levels of participation across all four forms of activity, and tended to be older and more educated than other respondents. Those allocated to the least active group had very low levels of participation across most of the assessed activities and the least favourable physical and mental health scores. Overall, the results indicate the existence of highly divergent segments within the older population in terms of participation across various combinations of health-promoting activities. Segment membership appears to be more closely associated with physical and psychological factors than socio-demographic characteristics.