Sources of well-being and cardiovascular health: A mixed methods investigation from the MIDUS study

OBJECTIVE

Using mixed methods, we investigated whether different sources of well-being were associated with better cardiovascular health.

METHODS

Data came from adults (55% women; 19% Black, 75% White) with biomarker data from the Midlife in the United States (MIDUS) Study. At the second wave and in a refresher cohort, participants answered the question "What do you do to make your life go well?" Judges evaluated each response for the presence of 12 sources of well-being (e.g., positive relationships, faith, health maintenance). Participants were also assessed on 8 components of cardiovascular health at two waves, an average of 12 years apart. Concurrent (N = 2036) and longitudinal (N = 650) linear regressions examined the association between each well-being source in unadjusted models and models adjusted for sociodemographic factors and word count.

RESULTS

Adults who wrote about positive relationships, positive attitudes, enjoyment, coping, health maintenance, and planning tended to have better cardiovascular health in unadjusted models concurrently and longitudinally. In fully adjusted models, health maintenance (p < .001) and planning and organization (p = .004) were associated with better cardiovascular health concurrently. Additionally, health maintenance (p = .03) and work (p = .04) were associated with better cardiovascular health longitudinally.

CONCLUSIONS

Individuals who endorsed maintaining their health as central to well-being showed healthier cardiovascular outcomes 12 years later. Combining qualitative assessments of sources of well-being with clinically assessed measures of cardiovascular health highlights unique contributors of well-being that are relevant for health and may not be evident with conventional self-report measures.

The effect of social exclusion on the cognitive health of middle-aged and older adults: A systematic review

This systematic review aimed to evaluate the independent and joint effects of social exclusion in three specific domains-economic, social relations, and civic participation-on the cognitive health of middle-aged and older adults. Longitudinal studies from January 2000 to October 2023 were identified via Web of Science, Scopus, and PubMed, with sixty-five studies meeting inclusion criteria. The quality of the studies was assessed with Newcastle-Otawa Scale. Analysis revealed a strong association between economic exclusion and cognitive decline, with most studies indicating a significant negative impact. Ten studies found a positive link between volunteering and cognitive health for civic participation, while eight did not, showing mixed evidence. In social relations, most studies connected loneliness, social isolation, smaller social networks, reduced contact with family and friends, lower engagement in activities, and negative social interactions with cognitive decline. Notably, one study found that older adults experiencing social exclusion in multiple domains simultaneously face even greater cognitive decline. In summary, this review shows that social exclusion in economic, social relations, and civic participation and all together domains is associated with greater cognitive decline in older adults.

Volunteering and Risk of Heart Attack in Later Life: The Moderating Role of Purpose in Life?

Objectives: We investigate whether volunteering is associated with a reduced risk of first heart attack in later life and whether purpose in life moderates this relationship. Methods: Cox proportional hazards were used to examine seven waves of data (2006-2018) from the Health and Retirement Study-a nationally representative survey of adults 50 years and older (N = 5,079). Results: Volunteering a moderate number of hours was associated with a 46% lower risk of heart attack compared to non-volunteers. The association between high time-commitment volunteering and heart attack risk was contingent on level of purpose in life: compared to non-volunteers, people with high purpose in life who volunteered 100 + hours had the lowest risk of heart attack. Discussion: Meaningful volunteer activities may be one way for older adults to reduce their risk of heart attack.

Does volunteering reduce epigenetic age acceleration among retired and working older adults? Results from the Health and Retirement Study

OBJECTIVES

The current study aims to explore the relationship between the frequency of volunteering and biological aging, as measured by epigenetic age acceleration. It also investigates whether this relationship differs between retired and working older adults. Understanding this connection could inform interventions promoting healthy aging and reducing age-related chronic health conditions.

METHOD

Data were derived from the Health and Retirement Study (HRS), including pre-treatment covariates (2012), volunteer frequency and work status (2014), and five DNA methylation measures (2016) (N = 2,605). Generalized linear models were estimated to examine the relationship between volunteering and epigenetic age acceleration, stratified by retirement status. The analyses adjusted for relevant covariates and utilized energy balancing weights to account for selection into volunteering.

RESULTS

Findings show that volunteering, especially for 1-49 h per year and 200+ hours per year, was linked to less epigenetic age acceleration, with significant effects on DNA methylation measures PhenoAge, GrimAge, and DunedinPACE clocks. Among retired individuals, moderate volunteering was significantly associated with decelerated epigenetic age acceleration, indicating greater benefits for retirees compared to working individuals.

CONCLUSIONS

The study found that frequent volunteering may lead to decelerated epigenetic aging, potentially offering a public health intervention to enhance health and quality of life among older adults. Further research is needed to confirm these findings and to understand how volunteering might differentially impact retired and working individuals. Such insights could guide the development of targeted strategies to promote healthy aging and address age-related health disparities.

Helping and Volunteering During COVID-19: Associations With Well-Being and Psychological Distress

INTRODUCTION

Salutogenic effects of volunteering and helping activities have been well recognized in the pre-COVID-19 era. This study examines associations between helping others as well as additional volunteer activities during the first wave of the COVID-19 pandemic and 6 psychological distress and well-being outcomes one year later.

METHODS

Longitudinal data collected between 2019 and 2021 were used. Analyses were based on data from 42,005 middle-aged and older adults from 27 European countries who participated in the Survey of Health, Ageing, and Retirement in Europe (SHARE) and two SHARE Corona Surveys. Prospective associations were examined using generalized estimating equations. A series of secondary analyses and the sensitivity of the associations to unmeasured confounding provided evidence for the robustness of results. All analyses were conducted in December 2022.

RESULTS

Helping others outside one's home in the first wave of COVID-19 was associated with subsequent increased risks of depression and anxiety. It was concurrently associated with an increased probability of an uplifting, hope, and happiness-inducing experience. Engagement in volunteer activities conducted in addition to helping was found to be prospectively associated with higher probability of an uplifting experience, but not with depression and anxiety. These associations were independent of demographic and socioeconomic characteristics, personality traits, prior quality of life and health history as well as pre-COVID-19 engagement in altruistic activities.

CONCLUSIONS

Helping and volunteering during the COVID-19 pandemic likely led to positive experiences. However, a negative impact on psychological distress of the same activities was also noted.

Associations between dimensions of the social environment and cardiometabolic risk factors: Systematic review and meta-analysis

Aim

The social environment (SE), including social contacts, norms and support, is an understudied element of the living environment which impacts health. We aim to comprehensively summarize the evidence on the association between the SE and risk factors of cardiometabolic disease (CMD).

Methods

We performed a systematic review and meta-analysis based on studies published in PubMed, Scopus and Web of Science Core Collection from inception to 16 February 2021. Studies that used a risk factor of CMD, e.g., HbA1c or blood pressure, as outcome and social environmental factors such as area-level deprivation or social network size as independent variables were included. Titles and abstracts were screened in duplicate. Study quality was assessed using the Newcastle-Ottawa Scale. Data appraisal and extraction were based on the study protocol published in PROSPERO. Data were synthesized through vote counting and meta-analyses.

Results

From the 7521 records screened, 168 studies reported 1050 associations were included in this review. Four meta-analyses based on 24 associations suggested that an unfavorable social environment was associated with increased risk of cardiometabolic risk factors, with three of them being statistically significant. For example, individuals that experienced more economic and social disadvantage had a higher "CVD risk scores" (OR = 1.54, 95%CI: 1.35 to 1.84). Of the 458 associations included in the vote counting, 323 (71%) pointed towards unfavorable social environments being associated with higher CMD risk.

Conclusion

Higher economic and social disadvantage seem to contribute to unfavorable CMD risk factor profiles, while evidence for other dimensions of the social environment is limited.

Association between workplace social capital and systolic blood pressure among 23 173 workers at 367 small-sized and medium-sized enterprises in Japan: a cross-sectional study

OBJECTIVES

Social capital (SC) has been shown to be inversely associated with elevated blood pressure. While SC in the workplace may also be associated with blood pressure, it has not been extensively studied. We aimed to investigate the association between workplace SC and systolic blood pressure (SBP).

DESIGN

A cross-sectional study.

SETTING

367 small-sized and medium-sized companies in Japan.

PARTICIPANTS

A total of 23 173 participants (15 991 males and 7182 females) aged ≥18 years.

EXPOSURE OF INTEREST

SC was assessed using individual responses to eight 4-point Likert questions used in the Brief Job Stress Questionnaire. Workplace SC was assessed as the mean of individual-level responses to the SC questions from those working in the same company.

OUTCOME MEASURE

Systolic blood pressure (SBP) RESULTS: A multilevel linear regression model revealed that higher workplace-level SC was linked with lower SBP (coef.=-0.53 per 1SD increment in workplace SC, 95% CI=-1.02 to -0.05) among females in the age-adjusted model, which remained statistically significant after adjusting for other covariates. After adjusting for individual-level SC, this association was attenuated and became non-significant (coef.=-0.41, 95% CI=-0.87 to 0.05), while individual-level SC was inversely associated with SBP (coef.=-0.43, 95% CI=-0.73 to -0.13). Among males, we did not find any evidence of significant inverse associations either in relation to workplace SC (coef.=-0.12, 95% CI=-0.46 to 0.21) or individual-level SC (coef.=0.19, 95% CI=-0.01 to 0.39).

CONCLUSIONS

Our study findings suggested that workplace-level SC can affect SBP differently by sex.

Social participation and self-reported depression during the COVID-19 pandemic among older adults

OBJECTIVES

The COVID-19 pandemic has increased depressive symptoms and disrupted activities that might typically mitigate depressive symptoms. Pandemic restrictions to social participation that supports well-being in older adults may contribute to worse mental health outcomes, but how participation relates to pandemic depressive symptoms is unclear.

METHODS

Using longitudinal data from the nationally representative National Health and Aging Trends Study (N = 3181), we assessed whether older adults' pandemic depressive symptoms were associated with participation in paid work, volunteering, religious services, and other organized activities during the pandemic, as well as changes in participation in these activities compared to pre-pandemic engagement.

RESULTS

Of participation during the pandemic, only attending religious services predicted pandemic depression, with religious attendance associated with higher risk of mild pandemic depressive symptoms. However, for changes in participation, stopping paid work during the pandemic predicted higher risk of moderate/severe pandemic depressive levels, while stopping attending religious services predicted lower risk of mild pandemic depression.

CONCLUSION

This work demonstrates the importance of social participation for mental health and indicates what types of disruptions may reduce integration to increase older adults' vulnerability to depressive symptoms during a global pandemic.

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.

Physical multimorbidity, depressive symptoms, and social participation in adults over 50 years of age: findings from the English Longitudinal Study of Ageing

OBJECTIVES

The aim of the current study was to identify specific patterns of physical multimorbidity and examine how these patterns associated with changes in social participation over time.

METHODS

We used latent class analysis to identify clusters of physical multimorbidity in 11,391 older adults. Mixed effects regression models were used to assess associations between physical multimorbidity clusters and changes in social participation over 15 years.

RESULTS

Four clusters of physical multimorbidity were identified. All physical multimorbidity clusters were associated with a reduction in cultural engagement (e.g. visits to theatre, cinema, museums) over time, with the strongest association seen in the complex/multisystem cluster (β = -0.26, 95% CI = -0.38 to -0.15). Similar results emerged for leisure activities. Adjusting for depressive symptoms fully attenuated some associations. All physical multimorbidity clusters were associated with an increase in civic participation over time.

CONCLUSIONS

Physical multimorbidity reduced some aspects of social participation over time, with specific combinations of conditions having increased risk of reductions.

Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2021.2017847.

Changes in Volunteering of Older Adults in the Time of the COVID-19 Pandemic: The Role of Motivations

This paper elucidates the relationship between possible changes in volunteering experienced by older people during the COVID-19 pandemic, and their motivation to volunteer, as well as the direct or indirect experience of COVID-19 symptoms. Given the well-known positive benefits of volunteering in older age both for individuals (in terms of improved health and wellbeing) and society at large, there is a paucity of studies on older volunteers in the time of COVID-19. In this context, older people's volunteering was highly challenged due to age-based physical and social restrictions put in place by national governments, which have been considered as ageist by a large part of the gerontological scientific community. This study was carried out on a sample of 240 Italian older volunteers. The results suggest that during the COVID-19 pandemic, especially older volunteers driven by social goals (e.g., opportunities to have relationships with others) were able to continue volunteer activities without needing to change them. The study also clarified that having directly or indirectly experienced COVID-19 symptoms did not influence changes in voluntary activities of older people. These results have important policy implications, given the indication that through volunteering, older individuals may try to counter the undesired calls by the governments for self-isolation and physical distancing. It is important that in emergency situations involving older people, policy makers should not treat them as only recipients of health and social care, but also as useful providers of help in the community.

Experimental effects of social behavior on well-being

Subjective well-being is characterized by relatively frequent positive emotions, relatively infrequent negative emotions, and high life satisfaction. Although myriad research topics related to subjective well-being have been explored - from how it should be measured to how it affects physical health - a key finding is that social connections are crucial. Researchers are therefore increasingly exploring whether subjective well-being can be improved through interventions that encourage specific types of social behaviors, including prosociality, gratitude, extraversion, and brief social interactions. We review this recent work, highlighting potential behavioral and psychological mechanisms underlying the effectiveness of such interventions, along with their boundary conditions.

The genomic impact of kindness to self vs. others: A randomized controlled trial

OBJECTIVE

Prosocial behavior has been linked to improved physical health, but the biological mechanisms involved remain unclear. This study tested whether a 4-week kindness intervention could reduce expression of a stress-related immune response gene signature known as the Conserved Transcriptional Response to Adversity (CTRA).

METHODS

In a diverse sample of community adults (N = 182), study participants were randomly assigned to perform 3 kind acts for other people, to perform 3 kind acts for themselves, or to list daily activities (control), on one day per week over 4 weeks. CTRA gene expression was measured by RNA sequencing of dried blood spots (DBS) collected at baseline and 5 weeks later (1 week after completing study assignments). Participants' descriptions of their kind acts were coded for protocol adherence and act content.

RESULTS

Participants who were randomized to perform kind acts for others showed significant reductions in CTRA gene expression relative to controls. Participants who were randomized to perform kind acts for themselves also showed significant reductions in CTRA gene expression relative to controls, but this pattern emerged only for those who failed to perform the requested self-kind acts (protocol non-adherent). Those who fully adhered to the self-kindness protocol showed no change in CTRA gene expression and did not differ from controls. Act content analyses implicated self-stress-reducing behavior in the paradoxical effects of self-kindness and the physical presence of others in the effects of prosocial behavior.

CONCLUSIONS

Prosocial engagement-doing something kind for others rather than oneself-reduces CTRA gene expression. The nature of kind acts and their intended recipient plays a key role in shaping the genomic impact of kindness.

Identifying pathways to increased volunteering in older US adults

While growing evidence documents strong associations between volunteering and improved health and well-being outcomes, less is known about the health and well-being factors that lead to increased volunteering. Using data from 13,771 participants in the Health and Retirement Study (HRS)—a diverse, longitudinal, and national sample of older adults in the United States—we evaluated a large range of candidate predictors of volunteering. Specifically, using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 61 predictors spanning physical health, health behaviors, and psychosocial well-being (over a 4-year follow-up between t₀; 2006/2008 and t₁; 2010/2012) were associated with volunteer activity four years later (t₂; 2014/2016). After adjusting for a rich set of covariates, certain changes in some health behaviors (e.g., physical activity ≥ 1x/week), physical health conditions (e.g., physical functioning limitations, cognitive impairment), and psychosocial factors (e.g., purpose in life, constraints, contact with friends, etc.) were associated with increased volunteering four years later. However, there was little evidence that other factors were associated with subsequent volunteering. Changes in several indicators of physical health, health behaviors, and psychosocial well-being may predict increased volunteering, and these factors may be novel targets for interventions and policies aiming to increase volunteering in older adults.

Volunteer Engagement and Systemic Inflammation: Does Helping Others Benefit Oneself?

BACKGROUND AND OBJECTIVES

Although research on the health benefits of volunteering has proliferated, most studies are cross-sectional and rely on self-reported measures of health. Drawing from role theory, the objectives of this study are to examine if (a) volunteering engagement is related to systemic inflammation in later life, as measured by C-reactive protein (CRP); (b) the effect of volunteering varies by age; and (c) volunteering is related to change in CRP over time.

RESEARCH DESIGN AND METHODS

This study uses 4 waves of data from the Health and Retirement Study, a nationally representative survey of adults 50 years or older. Nested linear regression models were used to examine the relationship between volunteer engagement and CRP concentration in later life. Residualized regression models were used to examine the effects of volunteer engagement on change in CRP.

RESULTS

Results revealed that volunteering is modestly associated with lower CRP concentration, but only for respondents 65+. Highly engaged volunteers had lower CRP than both mid-level and nonvolunteers. Longitudinal analyses revealed a leveling of the beneficial effect of volunteering by age, indicative of reduced returns among the oldest respondents in our sample.

DISCUSSION AND IMPLICATIONS

These results support previous studies that volunteering, and doing so at a high engagement level, is associated with slightly lower levels of CRP. Leaders in medicine, public health, and social services should consider implementing volunteering programs for older adults.

Volunteering Experience among Older Adults with End-stage Renal Disease (ESRD)

Living with End-stage Renal Disease (ESRD) can be stressful and associated with long-term psychological effects on older adults, especially when they have to undergo a lifetime treatment. Previous studies have documented numerous positive effects of volunteering as a potential intervention on health and well-being among older adults. However, there is limited understanding of the experience of older adults in volunteering while having ESRD. This study aimed to explore the experience often older adults with ESRD volunteering while battling with their illness. Several themes emerged from the data analysis regarding the experience of volunteerism among the older adult ESRD patients. The themes are pre-volunteerism experience, enriching and inspiring experience, volunteering experience as sources of support system, improvement of health and wellbeing experience, experience in discovering meaning in life, experience in repaying the good deed, and challenges in volunteerism participation. This study contributes to the literature and practices through the illumination of innovative intervention through volunteering for older adults with ESRD.

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.

Having hobbies and the risk of cardiovascular disease incidence: A Japan public health center-based study

BACKGROUND AND AIMS

The role of hobbies as a protective factor against cardiovascular diseases (CVD) has gained increasing attention; however, no large-scale studies were performed to confirm this. We aimed to examine the association between having hobbies and the risk of total CVD, coronary heart disease (CHD), and stroke in a large Japanese cohort.

METHODS

A total of 56,381 adults aged 45-74 years were divided into the non-hobby, having a hobby, and having many hobbies groups. We performed Cox proportional hazard models to estimate the hazard ratio (HRs) for incident CVD, CHD, and stroke after adjusting for potential confounding factors.

RESULTS

We identified 3685 incident CVDs (940 CHDs and 2839 strokes) during a median follow-up of 16.3 years. After multivariable adjustment, compared to the non-hobby group, participants having a hobby and many hobbies had a 10% (HR = 0.90 [0.83, 0.97]) and 20% (HR = 0.80 [0.69, 0.93]) lower risk of CVD incidence, respectively. The risk of CHD was lower in those with many hobbies, but the association between having many hobbies and CHD risk was not statistically significant. We also found a similar inverse association for stroke. Compared to the non-hobby group, participants having a hobby and many hobbies had a 13% (HR = 0.87 [0.80, 0.96]) and 20% (HR = 0.80 [0.68, 0.94]) lower risk of stroke.

CONCLUSIONS

Having hobbies was associated with a lower risk of CVD. Engagement in hobbies may emerge as an important target for healthy lifestyle promotion for the primary prevention of CVD.

Associations between Volunteering and Mental Health during COVID-19 among Chinese Older Adults

Evidence about the association between volunteering and the mental health of older adults during COVID-19 remains underexplored. This study investigated (1) patterns of volunteering among older adults in Hong Kong during COVID-19; (2) associations between volunteering and mental health of older adults during COVID-19; and (3) associations between key psychological resources (e.g., self-efficacy and self-esteem) and volunteering among older adults during COVID-19. This study applied a cross-sectional design with data collected from 128 older adults in June 2020, who were trained as volunteers in a volunteer program that began before COVID-19. The study found that older adults continued to actively contribute to their communities by engaging in volunteering during COVID-19. The specific type of volunteering activities was linked to few depressive and anxiety symptoms. Older adults with increased self-esteem prior to COVID-19 were more likely to participate in volunteering activities related to COVID-19. Our study suggested that encouraging older adults to volunteer during the pandemic is a key pathway to maintain mental health. Social workers are encouraged to engage older adults in volunteerism regularly to offset the risk of depression and anxiety symptoms in times of crisis.

Volunteering and self-reported health outcomes among older people living in the community: the Yilan study, Taiwan

PURPOSE

This study aimed to explore associations between volunteering and various self-reported health outcomes among older people, including subjective physical and mental health, self-rated health, and self-rated happiness.

METHODS

This questionnaire survey was conducted in Yilan, Taiwan. By convenient sampling, a total of 3692 older people living in the community were recruited from 2012 to 2016. Participants' engagement in community volunteer activities in the past month was recorded. Subjective physical and mental health were evaluated using the Short Form-12 version2 Health Survey physical and mental component summary scores. Self-rated health and happiness were each evaluated by a single question. Participants' demographic information and comorbidities were also recorded. We conducted multiple linear regression analyses adjusted for age, sex, marital status, body mass index, educational level, living status, comorbidities, smoking status, and status of alcohol drinking.

RESULTSS

After adjusting for covariates, volunteering was significantly associated with better subjective physical health, self-rated health, and self-rated happiness scores (B = 2.41, 95% confidence interval [CI] (1.56, 3.26); B = 3.46, 95% CI (2.66, 4.66), and B = 4.62, 95% CI (3.18, 6.05), respectively). The strength of the relationships between volunteering and various self-reported health outcomes differed.

CONCLUSIONS

Volunteering has positive associations on subjective physical health, self-rated health, and happiness for older people living in the community in Yilan, Taiwan. Further follow-up studies are needed to examine the mechanisms of associations between volunteering and various self-reported health outcomes, and clarify the differences in the strength of their associations.

Stress-Buffering Effects of Volunteering on Daily Well-Being: Evidence From the National Study of Daily Experiences

OBJECTIVES

Building on theoretical frameworks and empirical evidence linking volunteering and well-being in later life, we investigated the associations between daily engagement in formal volunteering, stressors, and negative and positive affect, focusing on the stress-buffering effect of volunteering.

METHODS

We used 8 days of daily diary data from the second wave of the National Study of Daily Experiences (NSDE II), a national survey of middle-aged and older adults (participant N = 1,320; participant-day observation N = 8,277). A series of multilevel models were estimated to assess the within-person associations between daily volunteering, stressors, and affect.

RESULTS

A direct link between daily volunteering and affect was not discovered. However, we found that the association between daily stressors and negative affect (but not positive affect) was weaker on days when volunteering was performed compared to days volunteering was not performed.

DISCUSSION

Our findings suggested that the stress-buffering effect of volunteering contributes to improved emotional well-being for participants who volunteered on a daily basis. Future studies should investigate whether such stress-buffering effects are present for other forms of helping behaviors.

Helping Amid the Pandemic: Daily Affective and Social Implications of COVID-19-Related Prosocial Activities

BACKGROUND AND OBJECTIVES

The novel coronavirus disease 2019 (COVID-19) pandemic may have prompted more engagement in prosocial activities, such as volunteering and support transactions. The day-to-day affective and social implications of these activities for adults of different ages are unknown. The current study examined associations of daily prosocial activities with affective and social well-being, and whether these associations varied by age.

RESEARCH DESIGN AND METHODS

Participants ages 18-91 in Canada and the United States (N = 1,028) completed surveys for 7 consecutive evenings about their daily experiences of COVID-19-related prosocial activities (formal volunteering, support provision, support receipt), positive and negative affect, and satisfaction with social activities and relationships. Analyses were conducted using multilevel modeling and accounted for a range of potential confounding factors (e.g., sociodemographics, work, family, caregiving, daily stressors).

RESULTS

Older age predicted more frequent formal volunteering, as well as more support provision and support receipt due to COVID-19. In particular, middle-aged and older adults provided more emotional support than younger adults, middle-aged adults provided the most tangible support, and older adults received the most emotional support. All three types of prosocial activities were associated with higher positive affect and greater social satisfaction on days when they occurred. Providing COVID-19-related support further predicted lower same-day negative affect. Age did not significantly moderate these associations.

DISCUSSION AND IMPLICATIONS

Older age was related to more frequent engagement in prosocial activities during the COVID-19 crisis. These activities were associated with improved daily affective and social well-being for adults of all ages.

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.

Pandemic policy making: the health and wellbeing effects of the cessation of volunteering on older adults during the COVID-19 pandemic

Purpose

This policy-orientated commentary aims to provide a perspective on the effects of policy changes designed to reduce the risk of infection as a result of COVID-19. The example of the abrupt cessation of volunteering activities is used to consider the policy and practice implications that need to be acknowledged in new public service research to deal with the on-going implications of the COVID-19 pandemic and for future preparedness.

Design/methodology/approach

The paper will provide a critical challenge to English pandemic health policy making, in particular, the national instruction “to stop non-essential contact with others” without a strategy on how to remedy the serious side effects of this instruction, in particular on older adults.

Findings

The abrupt cessation of volunteering activities of and for older people because of the COVID-19 pandemic is highly likely to have negative health and wellbeing effects on older adults with long-term and far-reaching policy implications.

Originality/value

The paper combines existing knowledge volunteering of and for older adults with early pandemic practice evidence to situate an emerging health and wellbeing crisis for older adults. It emphasises the importance of immediate further detailed research to provide evidence for policy and practice following the lifting of COVID-19 related restrictions and in preparation for future crises.

Being a trained volunteer Peer Supporter for carers of people living with dementia in Norway: Reciprocal benefits and challenges

This qualitative, exploratory study aimed to investigate the perception of benefits and the challenges of Peer Support services to carers of people with dementia. Four focus group interviews were conducted with volunteer Peer Supporters (n = 40)-all former carers-on their experience of supporting such carers. One overriding theme was of making the carers' path smoother by giving the possibility for free time and reflection, and three themes summarised their experience: 'filling the gap between health care and everyday life challenges', 'importance of mutual and unique experience based on skills and knowledge' and 'the importance of setting limits'. The findings showed that voluntary work is valuable to both carers and Peer Supporters. Peer Supporters' experiences as former carers are valuable. They offer the opportunity to engage in mutually supportive relationships with carers based on shared experience and similar interests by contributing to a better management of everyday life. Being able to see positive changes in carers' lives, guarding their privacy and providing them with free time were important for volunteers in gaining enjoyment and satisfaction over time. Enabling recovery and reflection might be crucial for carers to avoid burnout. How to recruit, support Peer Supporters and incorporate them in the formal healthcare system will be of great interest in the future.

Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach

INTRODUCTION

Growing evidence documents strong associations between volunteering and favorable health and well-being outcomes. However, epidemiological studies have not evaluated whether changes in volunteering are associated with subsequent health and well-being outcomes.

METHODS

Data were from 12,998 participants in the Health and Retirement Study-a large, diverse, prospective, and nationally representative cohort of U.S. adults aged >50 years. Using multiple logistic, linear, and generalized linear regression models, this study evaluated if changes in volunteering (between t₀, 2006/2008 and t₁, 2010/2012) were associated with 34 indicators of physical health, health behaviors, and psychosocial well-being (in t₂, 2014/2016). Models adjusted for sociodemographics, physical health, health behaviors, psychosocial factors, and personality, as well as volunteering and all outcomes in the prebaseline wave (t₀, 2006/2008). Results accounted for multiple testing and data were analyzed in 2019.

RESULTS

During the 4-year follow-up period, participants who volunteered ≥100 hours/year (versus 0 hours/year) had a reduced risk of mortality and physical functioning limitations, higher physical activity, and better psychosocial outcomes (higher: positive affect, optimism, and purpose in life; lower: depressive symptoms, hopelessness, loneliness, and infrequent contact with friends). Volunteering was not associated with other physical health outcomes (diabetes, hypertension, stroke, cancer, heart disease, lung disease, arthritis, overweight/obesity, cognitive impairment, and chronic pain), health behaviors (binge drinking, smoking, and sleep problems), or psychosocial outcomes (life satisfaction, mastery, health/financial mastery, depression, negative affect, perceived constraints, and contact with other family/children).

CONCLUSIONS

With further research, volunteering is an activity that physicians might suggest to their willing and able patients as a way of simultaneously enhancing health and society.

Volunteering, polygenic risk for Alzheimer's disease, and cognitive functioning among older adults

OBJECTIVE

In the context of the public health burden posed by increases in Alzheimer's Disease (AD) prevalence around the globe and the related research efforts to identify modifiable risk factors for the disease, we sought to provide an empirical test of earlier claims that volunteering may be considered as a health intervention that could help to prevent or delay the onset of AD.

METHOD

Using nine waves of panel data from the U.S. Health and Retirement Study (n=9,697), we examined whether volunteering conferred cognitive health benefits in later life and whether volunteering served a gene-regulatory function to help alleviate cognitive decline associated with polygenic risk for AD. Multilevel models were used to estimate associations between volunteering, polygenic risk for AD, and cognitive functioning over time.

RESULTS

We found robust within-person associations between volunteering (assessed as volunteer status and time commitment) and cognitive functioning over time, such that volunteering was associated with higher levels of cognitive functioning and slower cognitive decline. The findings also provided evidence that the within-person associations for volunteering and cognitive decline were more pronounced for older adults at higher genetic risk for developing AD.

CONCLUSIONS

Our findings are in line with a growing body of theoretical frameworks and empirical evidence suggesting that prosocial behaviors are directly associated with biological systems and may modify gene regulation to confer health benefits. The analytic approach taken in this study also provided a useful framework for investigating the effectiveness of other modifiable risk factors that vary over time in the context of cognitive decline related to genetic risk for AD.

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

BACKGROUND

Volunteering among older people has the potential to deliver health benefits to the individual, along with economic and social benefits to society. However, it is not clear whether healthier people are more likely to engage in volunteering, whether volunteering improves health, or the extent to which the relationship may be reciprocal. There is an identified need for longitudinal work, especially in the form of randomized controlled trials, to establish causality.

AIMS

To assess the effects of commencing volunteering among older non-volunteers utilizing a randomized controlled trial approach involving per-protocol and pragmatic analyses.

METHODS

Of the 445 Australians aged 60 + years who participated in the study, 201 were assigned to an intervention arm that required them to participate in a minimum of 1 h/week of formal volunteering in a position of their choice. The remaining participants were assigned to a control condition and asked to continue their lives as usual, but were not discouraged from commencing volunteering.

RESULTS

Across the assessed physical, psychological, and social variables, a significant difference in sit-to-stand scores was found in both the per-protocol and pragmatic analyses, and a further significant difference in the fast pace walk was identified in the pragmatic analyses.

CONCLUSION

The results provide some support for policies and programs designed to encourage older people to engage in volunteering to maintain or improve their health.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12615000091505.

Volunteerism and Cardiovascular Health: The HCHS/SOL Sociocultural Ancillary Study

OBJECTIVES

The objective of this study was to examine the association between volunteerism and favorable cardiovascular health (CVH) among Hispanics/Latinos living in the US.

METHODS

Data from the Hispanic Community Health Study/Study of Latinos (2008-2011) Sociocultural Ancillary Study were used (N = 4,926; ages 18-74 years). Favorable CVH was defined as positive profiles of all major CVD risk factors: low total serum cholesterol, blood pressure, and body mass index; not having diabetes; and not smoking. Survey-weighted logistic regression models were adjusted for sociodemographic, lifestyle, and psychological factors. In secondary analyses, we tested whether the volunteerism-CVH association was modified by sex, age, or years lived in the US (<10 vs. ≥10 years; a proxy acculturation measure).

RESULTS

Prevalence of volunteerism was 14.5%. Compared to non-volunteers, volunteers had 1.67 higher odds of favorable CVH in the fully-adjusted model (Odds Ratio [OR] = 1.67, 95% Confidence Interval [CI] = 1.11, 2.52). There was evidence of effect modification by acculturation; only volunteers who had lived in the US ≥10 years had 2.41 higher odds of favorable CVH (OR = 2.41, 95% CI=1.53, 3.80). There was no evidence of effect modification by sex or age.

CONCLUSIONS

Volunteerism was associated with favorable CVH among US Hispanics/Latinos.

Precision Medicine in Lifestyle Medicine: The Way of the Future?

Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.

Factors associated with formal volunteering among retirees

The present study developed and tested a comprehensive multivariate model designed to assess the relative importance of various factors found or proposed in previous research to be associated with engagement in volunteering among 799 fully retired Australian older adults (62% female; mean age = 71.92 years (SD = 6.69)). Engagement in volunteering in the 12 months preceding the study and a range of sociodemographic, psychological, physical, social, and attitudinal variables were measured. Respondents' perceived personal responsibility to volunteer was found to be especially important in the tested model. This variable was directly associated with engagement in volunteering and acted as an important mediator between the following variables and volunteering engagement: personal growth, social connectedness, religious attendance, self-rated health, and depression. Efforts to increase volunteering engagement among older adults may therefore need to target perceptions of their responsibility to volunteer. Especially important focus areas for future strategies may include increasing social connectedness, facilitating personal growth, and improving self-rated health.

Improving Attitudes to Volunteering Among Older Adults: A Randomized Trial Approach

Promoting engagement in formal volunteering represents a potential means of facilitating healthy aging. Given reluctance to participate in volunteering has been partially attributed to negative perceptions of various aspects of this activity, this study assessed whether trialing volunteering can improve perceptions among older people. Using a parallel-group design, Australians aged 60+ years ( n = 445) were randomly assigned to one of two conditions, one in which they were encouraged to trial volunteering and one in which they were asked to continue their usual activities. Perceptions and attitudes among those in the volunteering condition became significantly more favorable over 6 months relative to those in the control condition, with this change predicted by several aspects of the volunteering experience (e.g., acquisition of skills, increased social connectedness). Providing access to roles that cater to the learning and social needs of older adults appears to be important for improving attitudes toward engaging in volunteer work.

Volunteer peer support and befriending for carers of people living with dementia: An exploration of volunteers' experiences

With ageing populations and greater reliance on the voluntary sector, the number of volunteer-led peer support and befriending services for carers of people with dementia in England is set to increase. However, little is known about the experiences of the volunteers who deliver these interventions, many of whom are former carers. Using in-depth semi-structured interviews with 10 volunteer peer supporters and befrienders, this exploratory study investigated volunteers' experiences of delivering the support, the types of relationships they form with carers and their perceptions of its impact upon them and on carers. Data were analysed using framework analysis. Findings showed that volunteers benefitted from their role due to the 'two-way' flow of support. Experiential similarity and having common interests with carers were considered important to the development of mutually beneficial relationships. Volunteers perceived that carers gained emotional and social support, which in turn improved the carers' coping ability. Being able to see positive changes to carers' lives was important for volunteers to gain enjoyment and satisfaction from their role. However, volunteers also identified challenges with their role, such as dealing with carers' emotions. Future research should investigate ways of reducing potential burden on volunteers and explore the impact of volunteering specifically on former carers of people with dementia.

Stress-buffering effects of volunteering on salivary cortisol: Results from a daily diary study

Based on the theoretical foundations of the caregiving system model, which holds that prosocial behavior can be conceptualized in relation to a neurobiological stress-buffering mechanism, we addressed the question of whether daily volunteering yields buffering effects in terms of suppressing a neuroendocrine response (i.e., salivary cortisol) to daily stressors. We used daily diary data from the second wave of the National Study of Daily Experiences (NSDE II), which is part of the Midlife in the United States study (MIDUS II), a nationally representative survey of middle-aged and older adults. Analyzing a sample of volunteers (N = 340), we tested the buffering role of daily volunteer work for the same day stressors-salivary cortisol response relationship (person-day observations, N = 1,042). Findings from multilevel models indicated that the relationship between daily stressors and cortisol output was attenuated on days when volunteering was performed compared to days volunteering was not performed. Our findings are suggestive of a unique, but unobserved, neurobiological mechanism underlying the link between volunteering and better health. Volunteer programs designed to help others in need may be considered as an intervention strategy for individuals living under stressful conditions.

Kindness in the blood: A randomized controlled trial of the gene regulatory impact of prosocial behavior

CONTEXT

Prosocial behavior is linked to longevity, but few studies have experimentally manipulated prosocial behavior to identify the causal mechanisms underlying this association. One possible mediating pathway involves changes in gene expression that may subsequently influence disease development or resistance.

DESIGN, SETTING, PARTICIPANTS

In the current study, we examined changes in a leukocyte gene expression profile known as the Conserved Transcriptional Response to Adversity (CTRA) in 159 adults who were randomly assigned for 4 weeks to engage in prosocial behavior directed towards specific others, prosocial behavior directed towards the world in general, self-focused kindness, or a neutral control task.

RESULTS

Those randomized to prosocial behavior towards specific others demonstrated improvements (i.e., reductions) in leukocyte expression of CTRA indicator genes. No significant changes in CTRA gene expression were observed in the other 3 conditions.

CONCLUSION

These findings suggest that prosocial behavior can causally impact leukocyte gene expression profiles in ways that might potentially help explain the previously observed health advantages associated with social ties.

Social Activities, Incident Cardiovascular Disease, and Mortality

Objective: This study examined the relationships between social activities, incident cardiovascular disease (CVD), and non-CVD mortality among older adults in the United States. Method: Data from the Health and Retirement Study (2006-2010) were employed. Two measures of social engagement, volunteering and informal helping, along with two measures of social participation, attendance at religious services and social group meetings, were included. Mediation models for health behaviors were estimated. Results: Multinomial logistic regression models demonstrated that volunteering provided the most consistent results in terms of a lower risk of incident CVD and mortality. Furthermore, volunteering at higher time commitments is related to lower CVD incidence and death; informally helping others at a modest time commitment is related to lower risk of death only. Health behaviors mediated the relationships. Social participation was not related to either CVD or mortality. Discussion: Social activity is a modifiable behavior that may be considered a potential health intervention.