Transcript PATTERNS OF SERVICE USE AND THEORIES OF HELP …

Practice with Older Adults in
Home and Community Settings
Boston College Graduate School of Social Work
SESSION 3:
SUPPORTING SOCIAL AND PRODUCTIVE
ENGAGEMENT IN LATER LIFE
This PowerPoint presentation is to be used when
teaching Session 3 of Advanced Practice with Older
Adults: Practice in Home and Community Settings.
The course syllabus is available in the Gero-Ed Center
website’s Teaching Infusion Resources section.
Opportunities for Purposeful
Living and Quality Ties to Others
“…(S)ocial inequalities compromise health, not just because they
increase likelihood of negative experience for those in lower
positions, but also because they foreclose opportunities for the
positive. That is, beyond the degradation and misery of abject
poverty, are other, quieter forms of malaise where the essentials of
food, clothing, and shelter are present, but what is lacking are
opportunities for purposeful living and quality ties to others….the
presence of such criterial goods afford protection at underlying
physiological levels. Their absence, in turn, creates vulnerabilities
in mind-body systems, and these are also powerful explanations
for class gradients in morbidity and mortality.”
Source: Ryff, C.D. & Singer, B.H. (1998). The contours of positive human health.
Psychological Inquiry, 9, 1-28.
Entering New Territory
“All of us are now in uncharted
territory, a stage of life not seen before
in human history. And whether
woman or man, whether workingclass or professional, we are all
wondering how we’ll live, what we’ll
do, who we’ll be for the next twenty or
thirty years.”
- Lillian Rubin, Sixty on Up: The Truth
about Aging in America, p. 54
Successful Aging Theory
“…steps taken to avoid disease
and disability, maintain
mental and physical
function, and continued
engagement with life”
Source: Rowe, J.D. & Kahn, R. (1998) Successful Aging. New York: Delacorte Press., p. 51
2002 World Health Organization Active Ageing Framework
“Active ageing”—a process that aims to extend healthy life expectancy and quality
of life for all people as they age. In this framework, PARTICIPATION in social,
economic, cultural, spiritual and civic affairs is positioned as one of the three pillars
of active ageing in addition to health and security.
Source: World Health Organization. (2002). Active ageing: A policy framework. Geneva, Switzerland: World Health
Organization. Retrieved from http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf?ua=1
Social Engagement
Source: Prohaska, T.R., Anderson, L.A., Binstock, R.H. (Eds.) (2012). Public Health for an Aging
Society. Baltimore, MD: The Johns Hopkins University Press.
Productive Engagement
 Usually refers to activities that produce goods or services,
or develop the capacity to produce them whether they are
paid or not.
Paid
employment
Caregiving (e.g.,
grand-parenting,
eldercare)
Productive
Engagement
Volunteering
(formal and
informal)
Careerrelated
education
Source: Bass, S.A., Caro, F.G., & Chen, Y.P. (Eds.) (1993). Achieving a productive aging society.
Westport, CT: Auburn House.
Productive Aging
Places an emphasis on
approaching older persons from
a premise that continued
engagement in paid or unpaid
activities—including, but not
limited to, paid work,
volunteerism, civic engagement
and caregiving—supports a
sense of meaning, purpose, and
value in later life.
Source: Morrow-Howell, N., Hinterlong, J. & Sherraden, M. (2001). Productive Aging: Concepts and Challenges.
Baltimore: Johns Hopkins University Press.
Why support engagement?
Both empirical research and
theory tell us that supporting
the continued engagement of
older adults in social and
productive activities that are
personally valued is beneficial
not only to individuals, but to
families, communities, and to
society-at-large.
Society-atlarge
Communities
Families
Individual
health and
well-being
Source: Morrow-Howell, N., Hinterlong, J. & Sherraden, M. (2001). Productive Aging: Concepts and Challenges.
Baltimore: Johns Hopkins University Press.
Individual Level: Health and Well-being
 Health effects of both social and productive
engagement in later life.
 Relationship is likely to have a mutual
influence: participation fosters an older person’s
physical, cognitive, and psychological well-being and
older person’s well-being also increases the
likelihood of preserving participation in old age.
Bio-Psychosocial Pathways??
Social and Productive
Engagement
Potential
Pathways
- Healthy behaviors?
- Self-esteem?
- Purpose in life?
Better Health and
Well-being for Older
Adults
These pathways through which participation can exert its
health-promoting effects are important because they
represent intervention points!
Families, Communities & Society
 Some have argued that those in the third age
represent an enormous untapped natural resource—
older adults can be seen as bevy of experience,
knowledge and human capital that could be
leveraged to the benefit of families, communities,
and society.
Involvement in Productive Activity by Older Adults (age 55+)
Overall, eight in ten older adults are engaged in one of these
activities, and over half are engaged in multiple activities.
Source: Zedlewski, S. R., & Schaner, S. G. (2005). Older adults’ engagement should be recognized and
encouraged. The retirement project: Perspectives on productive aging.
http://www.urban.org/UploadedPDF/311201_Perspectives1.pdf
Significant Value to the Economy
 The Urban Institute also estimates that unpaid activities by
older adults accounted for 162 billion dollars of economic
value or $27,000 per person on average.
 Caregiving accounts for about 100 billion of this total, with
61 billion in value created by those caring for older people
who are sick or disabled, and 39 billion created by those
providing child care.
 And this is all in addition to the 768 billion dollars in paid
work among this population.
Source: Johnson, R. W., & Schaner, S. G. (2005). Value of unpaid activities by older
Americans tops $160 billion per year. Washington, DC: The Urban Institute.
Additional Implications
 Policies and programs that support engagement can
support older adult’s ability to remain living independently
in the community as they age.
 Leveraging older adults’ skills, knowledge and experience
through continued engagement in the community can be
seen as a cost-effective strategy to revitalize and enhance
communities.
 Social justice?: To what extent should all citizens--
regardless of age -- have the ability and choice to
participate in all phases of economic and social activities?
Criticisms of Productive Aging
 Highlighting that the concept could engender an expectation that older
adults must be “productive,” and that this emphasis could serve to
marginalize and discount segments of the older adult population.
(e.g., Estes & Mahakian, 2001; Holstein, 1992, 1993; Minkler & Holstein, 2008; Moody, 2001).
 Involvement in activities that are considered “productive” should not be
pushed upon older adults and public policies, workplace policies, or
prevailing attitudes should be careful not to support an expectation that
older adults should work, volunteer, or give care in older age.
 Instead:
1) work to be sure that there are ample opportunities for continued
engagement for those who choose this route, and
2) that barriers that may serve to disincentivize or detract from
engagement in these activities are identified and removed.
5 Core Principles that Should Guide Productive
Aging Policies and Programs
 Choice vs Coercion
 Opportunity vs Obligation
 Tapping growing human capital vs Exploiting older
adults
 Intergenerationism vs intergenerational conflict
 Inclusion vs Elitism
Source: Morrow-Howell, N., & Wang, Y. (2013). Productive engagement of older adults:
Elements of a cross-cultural research agenda. Ageing International, 38(2), 159-170.
Ageist Attitudes
 Ageist attitudes and outdated social structures limit
participation of older adults in these important social
roles as well as prevent the optimization of outcomes
for older adults, families and society.
Challenges for Social Work
 changing work environments and employment
policies to enable people to work longer,
 restructuring educational institutions so that
individuals can educate themselves across the life
course,
 enabling older adults to engage in volunteer and
service work; and
 supporting caregiving to facilitate involvement and
reduce negative effects.
Source: Morrow-Howell, N., Gonzales, E., Matz-Costa, C., & Greenfield, E.A. (2014). Grand Challenge: Increasing productive
engagement in later life for the good of society and older adults themselves . Concept paper accepted as a grand challenge in social
work by the American Academy of Social Work and Social Welfare.