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

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial

OBJECTIVE

To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients.

MEASUREMENT

The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period.

RESULTS

Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants.

CONCLUSIONS

The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation.

SUMMARY

This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

Study protocol of the 'HEAL-HOA' dual randomized controlled trial: Testing the effects of volunteering on loneliness, social, and mental health in older adults

Background

Interventions to reduce loneliness in older adults usually do not show sustained effects. One potential way to combat loneliness is to offer meaningful social activities. Volunteering has been suggested as one such activity - however, its effects on loneliness remain to be tested in randomized controlled trials (RCT).

Methods

This planned Dual-RCT aims to recruit older adults experiencing loneliness, with subsequent randomization to either a volunteering condition (6 weeks of training before delivering one of three tele-based loneliness interventions to older intervention recipients twice a week for 6 months) or to an active control condition (psycho-education with social gatherings for six months). Power analyses require the recruitment of N = 256 older adults to detect differences between the volunteering and the active control condition (128 in each) on the primary outcome of loneliness (UCLA Loneliness Scale). Secondary outcomes comprise social network engagement, perceived social support, anxiety and depressive symptoms, self-rated health, cognitive health, perceived stress, sleep quality, and diurnal cortisol (1/3 of the sample). The main analyses will comprise condition (volunteering vs. no-volunteering) × time (baseline, 6-, 12-, 18-, 24-months follow-ups) interactions to test the effects of volunteering on loneliness and secondary outcomes. Effects are expected to be mediated via frequency, time and involvement in volunteering.

Discussion

If our trial can show that volunteers delivering one of the three telephone-based interventions to lonely intervention recipients benefit from volunteer work themselves, this might encourage more older adults to volunteer, helping to solve some of the societal issues involved with rapid demographic changes.

Facilitating Volunteer Engagement Among Older Adults in Social Services: A Case Study of an Innovative Timebank Program in a Chinese Society

BACKGROUND AND OBJECTIVES

Exploring the roles of older adults as volunteers in social care settings has attracted wide attention to facilitate healthy aging and tackle care workforce constraints. However, there is little knowledge of the mechanism of engaging older adults as volunteers in the social care sector.

RESEARCH DESIGN AND METHODS

The study applies a case study to describe the features of an innovative timebank project, Good Hands, and explore the underlying mechanism of engaging older adults as volunteers in the social care sector. Three focus groups were conducted with 12 older adult volunteers and 6 advisory group members. Thematic analysis was applied to code and analyze the content of the focus group interviews.

RESULTS

Three emergent themes were identified as critical components: strong cross-sector collaboration, meaningfulness in voluntary work comprising 4 subthemes (including capacity optimization, care capacity enhancement, cultivating belonging, and value recognition), and a coproducing environment.

DISCUSSION AND IMPLICATIONS

Volunteer engagement of older adults in the provision of welfare for community-based care for frail peers is discussed, and practice implications are presented.

Types of Voluntary Work and Influence of Participation for Older Volunteers: A Systematic Review of Qualitative Studies

This systematic review synthesized findings on socio-demographic characteristics of older adults who engaged in formal volunteering, types of voluntary work for engagement, and the outcomes resulting from different types of voluntary work participation. Studies published in peer-reviewed journals were identified from six electronic databases. Studies were included if they: (1) involved a study sample of adults aged 65 and older or had a mean age of 65 , (2) reported any type of formal voluntary work at any setting, and (3) reported at least one influence of voluntary work on volunteers. Older adults who were female, married, retired, and have a higher education, fair health, and more volunteering experience participated in voluntary work. The majority of older volunteers preferred to volunteer in a community setting, and they most commonly participated in healthcare or social care related voluntary work. The older volunteers perceived positive influences mostly related to health-relatedoutcomes or helping knowledge and skills.

Civic Activities and Mental Health in Later Life: The Moderating Role of Generative Concerns

This study examined the moderating mechanisms of generative concerns (perception of making contributions to others) between generative civic activities and mental health among middle-aged and older adults. A total of 1,109 community-dwelling adults aged over 45 were recruited through an online survey. Generative civic activities (political participation and volunteering), generative concerns (the Loyola Generativity Scale), and two outcomes of mental health (depressive symptoms and mental wellbeing) were measured. Linear regression models and simple slope analyses were used to probe the moderating effects of generative concerns, stratified by age (45-64 years and 65+). Generative activities, but not concerns, were associated with lower depressive symptoms among middle-aged and older adults. Generative concerns and activities were related to better mental wellbeing among middle-aged adults. Generative concerns moderated the associations between civic activities and depressive symptoms. Those with higher generative concerns but lower civic activities had higher depression scores. Conversely, a stronger reduction in depressive symptoms by engaging in civic activities was found only when individuals had greater concerns. No moderating effect was found on mental wellbeing. The positive effect of civic engagement on reducing depressive symptoms depends on generative concerns, particularly among older people and those with greater concerns. Bridging the gap between perceived generative concerns and actual civic actions may improve later-life mental health.

The Relationship Between Volunteering and the Occurrence of Loneliness Among Older Adults: A Longitudinal Study with 12 Years of Follow-Up

Informed by the social model of health promotion, this study examined the association between formal volunteering and the occurrence of loneliness among older adults over 12 years of follow-up and whether the association differs by gender. Data came from the Health and Retirement Study (2006-2018). The study sample included 5,000 individuals aged 60 and over who did not experience loneliness in 2006. Self-reported participation in formal volunteer work was classified into three levels: (0) no volunteering, (1) less than 100 hours of volunteering per year, and (2) more than 100 hours of volunteering per year. Cox regression was used to examine the relationship between volunteering level and the onset of loneliness during the 12 years of follow-up. Volunteering more than 100 hours per year was associated with a lower risk of loneliness compared to non-volunteers (HR = 0.55, p = .008). This protective effect was not observed for those who volunteered less than 100 hours per year (HR = 0.84, p = .246). The benefits of volunteering in mitigating loneliness did not differ by gender. Engagement in moderate to high levels of volunteering can protect against loneliness. More volunteering programs can be offered to older adults to reduce loneliness in later life.

A review of different types of volunteer programs for older adults with and without cognitive impairment

Theoretical models and empirical evidence suggest an association between volunteering and health outcomes in older adults. However, less is known about existing programs that involve older adults engaging in formal volunteering, especially programs for older volunteers with cognitive impairment. In this review, we summarized and evaluated different types of volunteering-based programs involving older volunteers with and without cognitive impairment. After a non-systematic literature search, we presented eight example volunteer programs. Older volunteers participate in the programs in person or remotely. In five of the programs, older volunteers without cognitive impairment participate in intergenerational engagement, support and referral, home visiting, and dementia care services. The other three programs specifically recruit older volunteers with cognitive impairment and provide intergenerational engagement and individualized volunteer activities. Both strengths and challenges identified in the programs were discussed. Different types of volunteering-based programs are available for engaging older volunteers. For volunteers to remain active during the pandemic or for volunteers who live with cognitive impairment, remote programs can be a valuable alternative. Program effects on older volunteers need to be tested in more rigorously designed studies.

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

OBJECTIVES

The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.

METHODS

Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

RESULTS

Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.

CONCLUSIONS

Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

Exploring the Effects of Volunteering on the Social, Mental, and Physical Health and Well-being of Volunteers: An Umbrella Review

Volunteering provides unique benefits to organisations, recipients, and potentially the volunteers themselves. This umbrella review examined the benefits of volunteering and their potential moderators. Eleven databases were searched for systematic reviews on the social, mental, physical, or general health benefits of volunteering, published up to July 2022. AMSTAR 2 was used to assess quality and overlap of included primary studies was calculated. Twenty-eight reviews were included; participants were mainly older adults based in the USA. Although overlap between reviews was low, quality was generally poor. Benefits were found in all three domains, with reduced mortality and increased functioning exerting the largest effects. Older age, reflection, religious volunteering, and altruistic motivations increased benefits most consistently. Referral of social prescribing clients to volunteering is recommended. Limitations include the need to align results to research conducted after the COVID-19 pandemic. (PROSPERO registration number: CRD42022349703).

Supplementary Information

The online version contains supplementary material available at 10.1007/s11266-023-00573-z.

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.

Volunteer Engagement in a Stroke Self-Management Program: Qualitative Analysis of a Hybrid Team of Healthcare Providers and Trained Volunteers

Stroke recovery is a complex, multidimensional and heterogeneous process. Volunteer engagement improves the delivery of interventions in stroke rehabilitation programs but is under-utilized due to poor role clarity and other program-related concerns. We evaluated healthcare providers’ and volunteers’ perceptions of volunteer engagement in an 8-week self-management program that provided self-management support for community-dwelling stroke survivors. Using a qualitative design, we conducted individual, semi-structured interviews with a purposive sample of 5 trained healthcare providers and 18 volunteers. The participants shared their experiences of supporting survivors, perceptions of volunteer engagement, and areas of improvement to optimize volunteer support. Three main themes and six subthemes emerged: bilateral exchange between healthcare providers/volunteers and survivors; adoption of individualized approaches; and suggestions for optimizing volunteer contributions. Volunteer engagement can be optimized by developing well-designed programs with sufficient role clarity, strengthened collaborations with healthcare providers and adequate training. Our findings highlighted the contributions of trained volunteers in supporting stroke survivors’ self-management. Future research should evaluate the use of peer and healthcare professional volunteers in such programs and build community capacity to support stroke survivors’ recovery.

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.

Neighborhood built environment and late-life depression: A multilevel path analysis in a Chinese society

OBJECTIVE

Neighborhood built environments (BEs) are increasingly recognized as being associated with late-life depression. However, their pathways are still understudied. This study investigates the mediating effects of physical, social activities (PA & SA) and functional ability (FA) in the relationships between BEs and late-life depression.

METHOD

We conducted a cross-sectional analysis with data from 2,081 community-dwellers aged 65 years and above in Hong Kong in 2014. Two road-network-based service area buffers (200- and 500-meter buffers) adjusted by terrain and slope from participants' residences were created to define the scope of neighborhoods. BEs comprised population density in District Council Constituency Areas (DCCAs), urban greenness, land use diversity, and neighborhood facilities within 200- and 500-meter buffers. Multilevel path analysis models were used.

RESULTS

More urban greenness within both buffers and more commercial facilities within a 500-meter buffer were directly associated with fewer depressive symptoms. SA mediated the relationship between the number of community facilities and depressive symptoms within a 200-meter buffer. Neighborhood urban greenness and the number of commercial facilities had indirect associations on depressive symptoms within a 500-meter buffer, which were mediated by FA.

CONCLUSION

Our findings have implications for the ecological model of aging. The mediating effects of SA and FA underscore the importance of promoting active social lifestyles and maintaining FA for older adults' mental health in high-density cities. Policy implications on how to build age-friendly communities are discussed.