Volunteering and Health Outcomes Among Older Adults
Formal volunteering is defined as an activity undertaken by an individual that is uncoerced, unpaid (or minimal compensation to offset costs), structured by an organization, and directed toward a community concern (Cnaan, Handy, and Wadsworth 1996), whereas helping others not coordinated by an organization is referred to as informal volunteering.
Volunteering in later life has captured the attention of scholars, social scientists, policymakers, practitioners, and the public due to a growing body of research documenting the health, social, and economic benefits for older adults, families, communities, and society. There are a number of volunteer roles throughout the United States. Older adults volunteer for religious, educational, health-related, or other charitable organizations. In 2012, the Independent Sector (2010) valued volunteer time by adults aged 65+ at $40 billion annually and $62 billion annually for baby boomers. Others have demonstrated that volunteering helps older adults gain employment (Gonzales and Nowell 2016) and may reduce healthcare utilization (Kim and Konrath 2016).
Key Research Findings
The gerontological literature has shown high levels of consistency regarding the many health benefits of volunteering among older adults. Stemming from theories of generativity (Erikson 1986) and role theory (Chambre 1984; Kim and Moen 2002), volunteering offers a sense of purpose, social status, and social resources (Musick and Wilson 2003; Simon and Wang 2002). There is a large and consistent body of research suggesting volunteering yields improvements in psychological well-being (Morrow-Howell et al. 2003; Ho 2017), life satisfaction (Abu-Bader, Rogers and Barusch 2003; Van Willigen 2000), purpose and meaning in life (Heo et al. 2016), positive affect (Greenfield and Marks 2004), self-efficacy (Li 2007), and higher levels of happiness (Baker et al. 2005; Borgonovi 2008). Shen et al. (2013) found that volunteering improved the mental health among African American women caregivers. Jang et al. (2018) also found that volunteering can protect psychological well-being against unplanned events, such as the death of a family member or friend. Research also indicates that volunteers are more likely to be surrounded by a larger social network with access to greater resources, more power, and more prestige (Hunter and Linn 1981; Lum and Lightfoot 2005; Morrow-Howell 2010) which affect mental and emotional health. Li and Ferraro (2005) evaluated the relationship between volunteering and depression, particularly whether depression affects volunteer participation and/or if volunteer participation influences depression levels; and they found that volunteering was a long-term antidote for depression.
The social model for health promotion (Fried et al. 2004) suggests volunteering evokes a generative role for performance and requires older adults to engage in physical activity, social engagement, and cognitive stimulation. Similarly, Matz-Costa et al. (2016) found a synergistic effect of volunteer roles that require the use of body, mind, social interaction, and benefit of others with health outcomes. These theories are supported with research on physical health (Paggi, Jopp, and Hertzog 2016; Varma et al. 2016). Tang (2009) evaluated the longitudinal relationship between volunteering engagement in terms of volunteer status and volunteer hours and trajectories of self-rated health, functional dependency, and number of chronic conditions using data from three waves of data from the Americans’ Changing Lives survey. The results of the study support the relationship between volunteering and improved physical health. The study also offered evidence intensity, and duration of volunteering is associated with self-rated health and functional dependency after controlling for previous levels of health. In a community-based intervention, Hong and Morrow-Howell (2010) evaluated the health outcomes of participating in the Experience Corps volunteer program, using a quasi-experimental two-group pretest-posttest design. The results showed that volunteering did produce increased health outcomes, with intensity of volunteering possibly being an important factor to the quantity of health outcomes (e.g., physical activity, social participations, and cognitive functionality).
In addition to the social model for health promotion and theories on productive engagement (Matz-Costa et al. 2016; Morrow-Howell et al. 2001), others have suggested that intellectually challenging and complex volunteer activities can improve cognitive reserve and brain health (Anderson et al. 2014; Guiney and Machado 2017; Gupta 2018; Infurna, Okun, and Grimm 2016). Proulx, Curl, and Ermer (2017) longitudinal study with Health and Retirement Study data found that formal volunteering improved cognitive functioning over time – working memory and processing, specifically – after controlling for factors that are often associated with cognitive functioning. There is also some evidence from community interventions that volunteering can improve executive functioning and enhance brain plasticity in later life (Carlson et al. 2009).
Research has further shown that volunteering improves self-rated health (Lum and Lightfoot 2005; Ho et al. 2012). Barron et al. (2009) study revealed volunteers who reported being in fair health before participating in the program had greater outcome improvements than those in good health, suggesting that the health outcomes of volunteering can be attained by people in both good and fair health. A quasi-experimental design study using data from the HRS (Gonzales et al. 2018) revealed that volunteers experienced improvements in self-rated health and fewer instrumental activities of daily living (e.g., cleaning and maintaining the house, managing money, preparing meals, shopping for groceries) after moving from one residence to another and that volunteering was particularly beneficial for women and older Whites after relocation.
Volunteering is also associated with a reduced risk in mortality (Lum and Lightfoot 2005; Musick et al. 1999; Oman et al. 1999). Luoh and Herzog (2002) found that older adults who engaged in 100 annual hours or more of volunteering had a significant protective effect against subsequent poor health and death. Interestingly, Konrath et al. (2012) found that those who volunteered for self-oriented reasons had the same mortality risk as non-volunteers, while those who volunteered for other-oriented reasons had significantly reduced mortality risk compared to non-volunteers. In another longitudinal study of 10.5 years from the English Longitudinal Study of Ageing (Rogers et al. 2016), researchers found that volunteering was positively associated with reduced mortality, but upon further analysis this effect was only found to be applicable with volunteers who reported no disabilities, suggesting that volunteering as a catalyst to reduced mortality is more effective with able-bodied volunteers.
Ecological Factors that Shape the Volunteer Experience
There are a number of ecological factors associated with volunteering among older adults. At the individual level, older adults with more formal education, income, baseline health, and religious involvement are more likely to volunteer. Women volunteer at higher rates than men, while Whites volunteer at higher rates than Blacks, Asians, or Hispanics (Bureau of Labor Statistics, U.S. Department of Labor 2013). Inequities in economic and health resources experienced in later life, and often triggered earlier in the life course, may account for these differences (McBride 2007; Tang 2006) as well as structural barriers such as lack of knowledge about volunteer opportunities, lack of skills, time constraints, and role strain with informal caregiving (Center for Health Communication 2004).
At the family level, longitudinal analyses from the Health and Retirement Study reveal that married individuals who liked to spend time with their volunteer spouses were more likely to start to volunteer, volunteer at higher intensities, and less likely to stop volunteering (McNamara and Gonzales 2011). The same study also revealed that caring for a family member with limitations in activities of daily living (e.g., dressing, toileting, getting in and out of bed without assistance) and instrumental activities of daily living limited the number of volunteer hours and increased the odds to cessation. Similarly, Butrica et al. (2004) found that providing care to a parent reduced the likelihood of volunteering.
While most of the research has focused on individual and family characteristics, others have pointed to influential factors in the broader environment (Warburton et al. 2007). At the organizational level, McBride et al. (2011) revealed that a small non-taxed stipend ($2.77/h) reduced the financial barriers associated with volunteering and subsequently expanded volunteer access to non-Caucasian and members with less household income when compared to volunteers without a stipend. Their study also revealed that the stipend served as a social contract in that stipended volunteers served more hours per week (15+ hours per week) and more months (7+ months per year) and were more likely to complete the academic year (80% completion rate), compared to non-stipended volunteers (8 h/week, 5 months/year, 55% completion rate, respectively). Their study was important because it also documented that there were no motivational differences to volunteer between stipended and non-stipended: each group had motivations to help children and teachers improve literacy and give back (68%), while a third (32%) volunteered for self-benefits and material and practical reasons and were attracted to the program. Neighborhood characteristics also act as barriers or facilitators to volunteer. Johnson et al. (2018) revealed that a one-unit increase in neighborhood social cohesion increased the odds of moderate- and high-intensity volunteering. Their study on the importance of neighborhood characters is similar to primary data collection gathered among older adults in St. Louis where Gonzales et al. (2016) found that two dimensions of the quality of neighborhoods (social and built environment) were positively associated with volunteering among older Blacks and African Americans but that only individual characteristics influenced volunteering among older Whites. The number and quality of volunteer roles is expected to increase as more municipalities and counties adopt principles and guidelines of Age-Friendly Cities and Communities (Gonzales and Morrow-Howell 2009; World Health Organization 2007).
Future Directions of Research
Many of the latest studies have offered important nuance to mediating and moderating variables, often uncovering subpopulations that benefit the most from volunteering, while some evidence suggests other populations are unaffected (such as Barron et al. 2009; Gonzales et al. 2016; Gupta 2018; Konrath et al. 2012; Rogers et al. 2016; Shen et al. 2013). Additional research is needed to verify these initial findings before altering public policies and practices. More research is needed to determine the outcomes of volunteering, especially as they relate to cognitive health, neighborhood conditions, organizational practices and policies, and research that incorporates life-course trajectories by social determinants of health such as gender, race, ethnicity, socioeconomic status, occupational status, and family structure and the quality and quantity of the social network. Many of these factors should be tested as moderators and mediators (see Matz-Costa et al. 2016; Fried et al. 2013). These types of research can bring clarity and precision to the volunteer sector. The research on cognitive health is compelling (Karp et al., 2009) but methodologically limited. The essential question is how can volunteering delay, if not prevent, the onset and severity of cognitive impairment including mild cognitive impairment, Alzheimer’s disease and related dementias? While population data have revealed important thresholds to improve various dimensions of health, this will clearly vary on individual circumstances and capacity in the real world. Practitioners should reflect on finding a sweet spot for individual volunteers given their person-environment fit reflected by the environmental press (Lawton 1985; Matz-Costa et al. 2016; Papa et al. 2019). Another area for improvement is to develop qualitative and quantitative research, possibly psychometric measures, that tap multiple dimensions of the volunteer role given the importance of unique and synergistic effects of physical, social, cognitive, and psychological engagement. Most of the extant research relies heavily on a single gross indicator, which is insufficient. For example, in the Health and Retirement Study and sister datasets, there are only a few question related to formal volunteer engagement: “In the past 12 months, have you done volunteer work totaling 100 hours or more for religious or other charitable organizations?” Subsequent queries tap into the intensity and panel data offer the ability to capture duration in years. Clearly, there is much work to be done on exploring the nature and complexity of the volunteer role in linkage with health outcomes at old age.
The evidence on the many health outcomes of volunteering in later life are compelling, and the research underscores formal volunteering as a feasible and meaningful strategy to improve population health and longevity. The scholarship also suggests that not every volunteer role will yield health benefits. Factors such as intensity (hours per week, annual hours), duration (number of weeks, months, years), motivations, and volunteer assignments that are cognitively, socially, emotionally challenging and complex shape mental, emotional, physical, cognitive, and overall health. There are a number of social policies that can expand access to volunteer and improve the quality of the experience to maximize the health outcomes (Gonzales et al. 2015; Morrow-Howell et al. 2001, 2015, 2017), such as reducing barriers to volunteering by providing stipends to offset associated costs; strengthening the volunteer assignments and commitment through social contracts, training, acknowledgement, and supervision; facilitating the transition of retirement to volunteering or enabling the co-occurrence of work and civic engagement; and improving neighborhood conditions such as the social and built environment.
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