Elizabeth K. Tanner

The Long-Term Relationship Between High-Intensity Volunteering and Physical Activity in Older African American Women

OBJECTIVES Experience Corps (EC) places older volunteers in public elementary schools in 20 cities across the country. The EC program in Baltimore is a health promotion intervention designed to improve the academic outcomes of children and increase older adult volunteer physical activity. We sought to determine if there were sustained increases in physical activity with participation in EC. METHODS Seventy-one African American women volunteers in the Baltimore EC were compared with 150 African American women in the Womens Health and Aging Studies (WHAS) I and II; all were aged 65-86 years with comparable Social Economic Status, frailty, and self-reported health status. Using a regression model, we evaluated physical activity adjusting for a propensity score and time of follow-up over 3 years. RESULTS EC volunteers reported a sustained increase in physical activity as compared with the comparison cohort. Baseline physical activity for individuals with a median propensity score was 420 kcal/wk for both groups. At 36 months, EC volunteers reported 670 kcal/week compared with 410 kcal/week in WHAS (p = .04). Discussion These findings suggest that high-intensity senior service programs that are designed as health promotion interventions could lead to sustained improvements in physical activity in high-risk older adults, while simultaneously addressing important community needs.

Community Aging in Place, Advancing Better Living for Elders:: A Bio-Behavioral-Environmental Intervention to Improve Function and Health-Related Quality of Life in Disabled Older Adults

To determine effect size and acceptability of a multicomponent behavior and home repair intervention for low‐income disabled older adults.

Experience Corps: A dual trial to promote the health of older adults and children's academic success

Background As the population ages, older adults are seeking meaningful, and impactful, post-retirement roles. As a society, improving the health of people throughout longer lives is a major public health goal. This paper presents the design and rationale for an effectiveness trial of Experience Corps™, an intervention created to address both these needs. This trial evaluates (1) whether senior volunteer roles within Experience Corps™ beneficially impact childrens academic achievement and classroom behavior in public elementary schools and (2) impact on the health of volunteers. Methods Dual evaluations of (1) an intention-to-treat trial randomizing eligible adults 60 and older to volunteer service in Experience Corps™, or to a control arm of usual volunteering opportunities, and (2) a comparison of eligible public elementary schools receiving Experience Corps™ to matched, eligible control schools in a 1:1 control:intervention school ratio. Outcomes For older adults, the primary outcome is decreased disability in mobility and Instrumental Activities of Daily Living (IADL). Secondary outcomes are decreased frailty, falls, and memory loss; slowed loss of strength, balance, walking speed, cortical plasticity, and executive function; objective performance of IADLs; and increased social and psychological engagement. For children, primary outcomes are improved reading achievement and classroom behavior in Kindergarten through the 3rd grade; secondary outcomes are improvements in school climate, teacher morale and retention, and teacher perceptions of older adults. Summary This trial incorporates principles and practices of community-based participatory research and evaluates the dual benefit of a single intervention, versus usual opportunities, for two generations: older adults and children.

Invisible Civic Engagement among Older Adults: Valuing the Contributions of Informal Volunteering

There is a growing call for civic engagement, largely in the form of formal volunteering, among older adults in America. This call is a response to the aging of the baby boom population, believed to be the healthiest and wealthiest cohort of older adults to date. It also coincides with the devolution of welfare programs. We argue that current discussions of civic engagement are too narrow and may exclude important informal contributions that older adults make to civic society, and put undue stress on, and devalue those who may not contribute to society due to poor health, poverty or other barriers. We draw on data collected from older adults of lower socio-economic status and diverse ethnic backgrounds in Baltimore City using focus groups to explore their definitions of volunteering and barriers which they face. Through a discussion of existing barriers and motivators for engagement, we critically assess the use of these terms and advance discussions on how to facilitate and value contributions of all older adults. We conclude that civic engagement includes more than formal volunteering and that significant barriers need to be removed to facilitate greater participation of all elders in both formal and informal activities.

Marketing public health through older adult volunteering: Experience Corps as a social marketing intervention.

OBJECTIVES We present a social marketing conceptual framework for Experience Corps Baltimore City (EC) in which the desired health outcome is not the promoted product or behavior. We also demonstrate the feasibility of a social marketing-based recruitment campaign for the first year of the Baltimore Experience Corps Trial (BECT), a randomized, controlled trial of the health benefits of EC participation for older adults. METHODS We recruited older adults from the Baltimore, MD, area. Participants randomized to the intervention were placed in public schools in volunteer roles designed to increase healthy behaviors. We examined the effectiveness of a recruitment message that appealed to generativity (i.e., to make a difference for the next generation), rather than potential health benefits. RESULTS Among the 155 participants recruited in the first year of the BECT, the average age was 69 years; 87% were women and 85% were African American. Participants reported primarily generative motives as their reason for interest in the BECT. CONCLUSIONS Public health interventions embedded in civic engagement have the potential to engage older adults who might not respond to a direct appeal to improve their health.

Impact of the Baltimore Experience Corps Trial on cortical and hippocampal volumes.

There is a substantial interest in identifying interventions that can protect and buffer older adults from atrophy in the cortex and particularly, the hippocampus, a region important to memory. We report the 2‐year effects of a randomized controlled trial of an intergenerational social health promotion program on older mens and womens brain volumes.

Cardiovascular risks and brain function: a functional magnetic resonance imaging study of executive function in older adults

Cardiovascular (CV) risk factors, such as hypertension, diabetes, and hyperlipidemia are associated with cognitive impairment and risk of dementia in older adults. However, the mechanisms linking them are not clear. This study aims to investigate the association between aggregate CV risk, assessed by the Framingham general cardiovascular risk profile, and functional brain activation in a group of community-dwelling older adults. Sixty participants (mean age: 64.6 years) from the Brain Health Study, a nested study of the Baltimore Experience Corps Trial, underwent functional magnetic resonance imaging using the Flanker task. We found that participants with higher CV risk had greater task-related activation in the left inferior parietal region, and this increased activation was associated with poorer task performance. Our results provide insights into the neural systems underlying the relationship between CV risk and executive function. Increased activation of the inferior parietal region may offer a pathway through which CV risk increases risk for cognitive impairment.

Preliminary Data from Community Aging in Place, Advancing Better Living for Elders, a Patient‐Directed, Team‐Based Intervention to Improve Physical Function and Decrease Nursing Home Utilization: The First 100 Individuals to Complete a Centers for Medicare and Medicaid Services Innovation Project

Current medical models frequently overlook functional limitations and the home environment even though they partially determine healthcare usage and quality of life. The Centers for Medicare and Medicaid Services (CMS) Innovation Center funds projects that have potential to affect the “triple aim,” a framework for decreasing costs while improving health and quality of life. This article presents preliminary data from Community Aging in Place, Advancing Better Living for Elders (CAPABLE), a model funded by the CMS Innovation Center and designed to overcome the functional and home environmental barriers of older adults. CAPABLE is a patient‐directed, team‐based intervention comprising an occupational therapist, a registered nurse, and a handyman to decrease hospitalization and nursing home usage of community‐dwelling older adults with functional limitations who are dually eligible for Medicare and Medicaid. Activity of daily living limitations improved in 79% of the first 100 people who completed the intervention. Preliminary findings of this novel intervention may have implications for other older adults with functional limitations.

Can the Wisdom of Aging be Activated and Make a Difference Societally

The Experience Corps®, a community-based intergenerational program, was developed to promote the health of older adults while simultaneously addressing unmet social and academic needs in public elementary schools. The model was designed to draw on, and potentially activate, the wisdom of older adults. This paper explores the nature of wisdom-related knowledge and how older adults may apply such knowledge when tutoring and mentoring young children. It also examines the potential for the intergenerational transmission of wisdom from the older adult volunteers to the school children being mentored by them. Developing an understanding of these issues may provide a basis for the creation of more extensive wisdom-generating opportunities for both older and younger generations.

Experience Corps ® : A Civic Engagement-Based Public Health Intervention in the Public Schools

The Experience Corps® (EC) program is an innovative, community-based model for health promotion for older adults. Incorporating health promotion into new, generative roles for older adults, it brings the time, experience, and wisdom of older adults to bear to improve academic and behavioral outcomes of K-3 grade children in public elementary schools. The EC program is simultaneously designed to be a cost-effective, high-impact literacy support and social capital intervention for young children that doubles as a potentially powerful health promotion model aimed at improving the cognitive, physical, social, and psychological function of older adults and preventing disability and dependency associated with aging. In this program, older adult volunteers are placed in a critical mass in public elementary schools to perform standardized, meaningful roles developed by the program after selection by the schools’ principals as being critical unmet needs. In this chapter, we describe the development and major tenets of the EC model, the science underlying the model and data supporting the effectiveness of this intergenerational intervention for both older adults and children, and policy implications of social engagement programs like Experience Corps for long-term improvements in older adults’ health and well-being and practical guidelines for setting up an EC program in the local community.