Nancy Morrow-Howell

Volunteering in Later Life: Research Frontiers

OBJECTIVES This review summarizes the current knowledge about volunteering in later life and suggests 5 research questions at the forefront of knowledge development. RESULTS Rates of volunteering do not decline significantly until the middle of the 7th decade, and older volunteers commit more hours than younger volunteers. Older adults with more human and social capital tend to volunteer, and there is good evidence of a reciprocal relationship between volunteering and well-being. Program and policy developments in the field are outstripping production of knowledge to support evidence-based practices. DISCUSSION Research on the dynamics of volunteering over the life course as well as the patterns of activities that co-occur with volunteering is needed to guide program development. Research methods and findings from transdisciplinary work on the mechanisms through which psychosocial conditions affect health must be extended to the study of the effects of volunteering on older adults. Finally, we need to engage in more applied social science aimed at improving volunteer management, especially recruitment and retention of older volunteers.

Role Enhancement or Role Strain: Assessing the Impact of Multiple Productive Roles on Older Caregiver Well-Being

Proponents of productive aging claim that occupying productive roles is beneficial to the self and others. The authors use the role enhancement and role strain perspectives to examine the impact of multiple productive roles on the well-being of older caregivers. Using three waves of the America Changing Lives Study, the authors controlled for invariant and time-variant factors to test the effects of occupying multiple productive roles on the three well-being indicators of 270 older caregivers. Older caregivers who worked and/or volunteered reported better self-rated health, supporting the role enhancement hypothesis. No evidence of role strain was found. For caregivers without multiple productive roles, high informal social integration was related with low functional impairment. This study suggests that productive roles may have a positive effect on older caregivers and finds no evidence of any negative effects. The implications of these findings in policy, research, and program development are discussed.

Organizational Support and Volunteering Benefits for Older Adults

PURPOSE This study tested a theoretical model of volunteering benefits and examined the mechanism through which volunteering benefits older adults. DESIGN AND METHODS This is a 2-wave study of 253 older adult volunteers serving in 10 volunteer programs. Older volunteers completed the mailed surveys in 2005 and 2006. Structural equation modeling was used to define the latent variables and to test direct and indirect relationships among organizational support, socioemotional benefits, and self-reported health. RESULTS Organizational support (measured by choice of volunteer activity, training, and ongoing support) had significant direct associations with 2 latent factors of socioemotional benefits, that is, perceived contribution and personal benefits. Perceived contribution was significantly related to mental health. Additionally, older volunteers with lower socioeconomic status (SES) committed more hours and perceived more personal benefits than higher SES peers. IMPLICATIONS These findings suggest that volunteer programs can provide various organizational supports to older volunteers, especially to low-SES volunteers, in order to promote the socioemotional and health benefits of volunteering to older adults. Psychological well-being of older adults can be improved through engagement in meaningful volunteer activities and contribution to others.

Inclusion of Diverse Older Populations in Volunteering: The Importance of Institutional Facilitation

As older adults volunteer in greater numbers, concerns are being expressed about the exclusion of older adults who have historically been marginalized from volunteering. This study identifies the importance of institutional facilitation of older adults in volunteer programs, especially for those of lower socioeconomic status. A questionnaire assessing the importance of institutional facilitation in volunteering was completed by 374 volunteers aged 60 years and older from a national sample. Institutional facilitation was measured by multidimensional items capturing role flexibility, compensation, recognition, and accommodation. Flexibility—especially, choice of activities and ability to set own schedule— was perceived as most important to volunteers. Low-income and non-White volunteers gave more importance to institutional facilitators of engagement. This study suggests that voluntary organizations can facilitate the inclusion of older adults from diverse backgrounds through increasing flexibility, compensation, and recognition.

Engaging Older Adults in Volunteering: Conceptualizing and Measuring Institutional Capacity

Concern exists that organizations are not ready to take advantage of the growing number of older volunteers. This study offers a conceptualization and preliminary measurement strategy to enhance knowledge on the institutional capacity of volunteer programs to engage older adults. Data were collected from 51 program directors to assess 10 dimensions of institutional capacity: specification of role, dissemination of information, role availability, compensation of expenses, in-kind incentive, skill development, role flexibility, role recognition, accommodation, and integration. Eight factors were identified. The subscales were moderately reliable, and dimensions were independent. Programs rated highest on the capacity to recognize volunteers and disseminate information and lowest on their ability to provide cash compensation. Subsequent research on institutional capacity depends on its strong measurement. Future works will assess the extent to which these institutional capacity factors affect the recruitment, retention, and effective utilization of older volunteers.

PATIENT AND FAMILY SATISFACTION WITH DISCHARGE PLANS

This study explored factors affecting patient and family satisfaction with discharge plans, an outcome of discharge planning provided by the hospital department of social work. Adequacy of discharge plans was rated by 126 patients and 130 family members within 24 hours before hospital discharge. Patient ratings of discharge plans were related to their degree of involvement in decisionmaking, social support networks (sex and marital status), and physical condition (diagnosis and functional ability). Three types of factors were important to family members: 1) factors related to the discharge planning process, 2) the patients discharge destination, and 3) length of patient hospital stay. Findings are discussed in terms of their implications on maximizing consumer satisfaction in the cost-conscious environment.

Involvement in Voluntary Organizations: How Older Adults Access Volunteer Roles?

ABSTRACT This study examines how older adults access organizational volunteer roles and what socio-structural factors are associated with the access. Using the data from the Current Population Survey (U.S. Department of Commerce, Bureau of the Census, 2002), bivariate analyses show that there are variations in access to volunteer roles across types of organizations. Results from multinomial logistic regressions indicate that education, income, age, and race are associated with the ways that older adults access volunteer roles. Voluntary organizations are advised to approach older adults directly, use current volunteers to recruit potential ones, publicize their organizational goals, and disseminate relevant information in efforts to improve access of older adults to volunteer roles.

Anticipating relocation: concerns about moving among NORC residents.

Summary Most older adults prefer to live at home as long as possible, requiring supports and services to help them age in place. This study examines the relocation concerns of a group of older adults in a suburban naturally-occurring retirement community (NORC). Twenty-six percent of the 324 residents interviewed expressed concern about having to move in the next few years. Residents who were worried differed from those who did not worry on a number of demographic and biopsychosocial characteristics. Overall, residents present a profile of vulnerability that calls for preemptive action to help them stay in their homes. A NORC is an ideal setting in which to provide supportive services.

Comparing the Congruency of Self-Report and Provider Records of Depressed Elders' Service Use by Provider Type

Background:An accurate accounting of service use is necessary to understand use patterns and outcomes. Yet such an accounting remains challenging, in part because of the reliability and validity of the collection method and sources. Objectives:This study describes 2 methods of data collection: self-report and the retrieval of provider records. We report on the effort, yield, and challenges of retrieving records. Then, we compare the congruency and completeness of 2 methods: self-report and provider records. Finally, we examine the impact of various patients’ characteristics on congruency rates. Method:Our sample of depressed older participants was recruited from an inpatient geropsychiatry unit before they were discharged into the community. We interviewed participants at 3 points during a 6-month period. Provider records were obtained across provider type, based on self-report and snowballing technique. We calculated congruency rates and examined completeness of either data source on 91 participants with completed provider records. Using logistic regression, we examined the differences in congruency by provider type as well as factors related to the congruency. Results:The record retrieval process is labor-intensive and challenging. We found that congruency rates were statistically higher for pharmacy and hospital providers and lower for physicians. We also found higher counts of service use, higher depression levels, and being married were significantly related with lower congruency between self-report of service use and provider records. Discussion:Although we found relatively high congruency rates between self-report and service records, the choice of methods depends on the purpose of the research and breadth of provider types.

Measuring treatment fidelity in a rehabilitation intervention study.

ABSTRACTAttaining and demonstrating treatment fidelity is critical in the development and testing of evidence-based interventions. Treatment fidelity refers to the extent to which an intervention was implemented in clinical testing as it was conceptualized and is clearly differentiable from control or standard-of-care interventions. In clinical research, treatment fidelity is typically attained through intensive training and supervision techniques and demonstrated by measuring therapist adherence and competence to the protocol using external raters. However, in occupational and physical therapy outcomes research, treatment fidelity methods have not been used, which, in our view, is a serious gap that impedes novel treatment development and testing in these rehabilitation fields. In this article, we describe the development of methods to train and supervise therapists to attain adequate treatment fidelity in a treatment development project involving a novel occupational and physical therapy–based intervention. We also present a data-driven model for demonstrating therapist adherence and competence in the new treatment and its differentiation from standard of care. In doing so, we provide an approach that rehabilitation researchers can use to address treatment fidelity in occupational and physical therapy–based interventions. We recommend that all treatment researchers in rehabilitation disciplines use these or similar methods as a vital step in the development and testing of evidence-based rehabilitation interventions.