Running head: POLICY PAPER

Policy Paper: Social Engagement in Older Adults

Kari M. Nilsen
Wichita State University

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ABSTRACT

Social engagement in older adults is of vital importance because of the links between
social isolation and loneliness with physical and mental health outcomes. Older adults who are
not socially engaged tend to make fewer healthy choices than those who are socially engaged,
and they tend to die sooner with fewer social contacts. This has significant impact for the health
care system because the more people engage in unhealthy behaviors; the more they require a
doctors care, or being placed into long term care settings. Lawmakers, caregivers, social
organizations, and families can help diminish the effects of social isolation and loneliness by
implementing policy that is specifically targeted towards social isolation in older adults. There
are many programs that currently work, but due to budget and awareness issues, they are not
being utilized by those who may need them the most. The Reauthorization of the Older
Americans Act in 2015 will hopefully help with these problems, as one of the tenants of the act is
to give more money to senior centers, which will help get more programs and awareness out to
the public regarding the importance of social engagement in older adults.

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INTRODUCTION

There has been a recent change in the Medicaid system, both nationally and in the State
of Kansas, to take people out of institutions and place them back into their communities. There
are several reasons for this advance. Most notably are the financial implications involved. In the
State of Kansas, $438 million in Medicaid dollars are being spent on Kansass nursing homes
annually, and this rate is rising by the year. The Kansas solution includes changes to system by
aiding the transition away from institutional care and towards services that can be provided in
individuals homes and communities. About 9,900 Medicaid nursing home residents, more than
55 percent of the total, rely on Medicaid because they cannot afford the $3,600 a month it costs
to stay in the average nursing home, and 5.2 percent of Kansans 65 and older live in nursing
homes, far more than the national average of 3.8 percent. Nearly one in five Kansas nursing
home residents have low care needs that could be served in less expensive, alternate
community settings (Smith, OKeefe, Carpenter, Doty, & Kennedy, 2008).
Many older adults who live alone are at a risk of being placed in LTC settings against
their will due to inadequate social support (Steinbach, 1992). People who live alone, who are not
very socially engaged, or who do not have many social interactions, run the risk of being viewed
by the outside world as socially isolated, lonely, or depressed (Shankar, McMunn, Banks, &
Steptoe, 2011), but this is not necessarily true. The expectation of social encounters can also
impact isolation and loneliness levels positively or negatively. Being able to maintain quality
social relationships are important to older adults as they age (Bitzan & Kruzich, 1990).
Although their families do not typically abandon nursing home residents, the lost of a
caregiver or close family often results in the placement in a nursing home. This placement then
can lead to the loss of personal relationships with significant others outside of the home. New

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relationships inside the nursing home may develop, especially among the very old who suffered
from a lack of access to social activities and friends outside of the care setting. However, for
those who are not able to develop new relationships or engage in social activities, their physical
and mental health may decline at much quicker rates than those who are still able to engage in
meaningful encounters with others (Bitzan & Kruzich, 1990).
Social isolation and loneliness are believed to impact healthy behaviors. These health
behaviors can be aided through positive social cues and support, or negatively through a lack of
these social cues from others. Social isolation and loneliness have been related to a greater
probability for lack of medical adherence, unhealthy behaviors such as smoking and lack of
physical exercise, and not paying attention to ones own physical or mental changes (Shankar,
McMunn, Banks, & Steptoe, 2011). Social engagement is also an important influence on well
being, both emotionally and psychologically, for people as they age (Hubbard, Tester, & Downs,
2003).
Several studies have shown that older adults with severe disengagement, poor social
networks, and few social ties had an increased risk of subsequent cognitive decline, such as
Alzheimers and Parkinsons disease (Stoykova, Matharan, Dartigues, & Amieva, 2011).
Encouraging and developing ways to increase the social networks of older adults could lead to
increased independence and better health outcomes, which could lead to fewer costs associated
with hospital and doctor visits.
Very few people are doing work to lower rates of social isolation and increase social
engagement in older adults, even though we know these are important areas to focus on. There
are few viable interventions in the literature, but policy could begin to take an active role in
giving people options and increasing awareness, especially in the area of public health policy

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(Nicholson, 2012). If this matter is not addressed in a timely manner, especially with the
increasing number of older adults in America, the number of Medicaid recipients using federal
funds to pay for nursing home, or similar, care will continue to be a drain on an already unsteady
system. Adequate social support for older adults, especially those in LTC settings, will lead to
more satisfied older adults who can contribute more to their communities, and in turn, lead
healthier lives.
Social Engagement in Older Adults
Older adults are often an unrecognized source of social and civic engagement in our
society. They give back in many ways, such as through time spent in paid work, formal and
informal volunteering, and through caregiving activities. Seeing as many older adults are free of
child-rearing duties, and some free from job responsibilities, they tend to have more free time to
give back to their community and other organizations than younger adults do. Data from the
2002 Health and Retirement Study (HRS) is typically used to define what social engagement
looks like in the older adult population (Zedlewski & Schaner, 2005).
According to the HRS study, older adults stay busy as they age, even though social
engagement starts to decline as they get older. They also remain engaged in a variety of
activities, with the younger old more likely to be employed in a paid work setting and only 10%
of those 75 and older are still employed. Thirty percent of adults over the age of 65 provide
formal volunteering, however, and this number stays consistent as we move up the life span.
Fifty percent report being involved in informal volunteering, and almost 40% say they provide
caregiving for family and friends. Caregiving rates tend to decline over time also, as family
members and friends pass away or move.
An active lifestyle is widely accepted as a way to live a long life with better health. Older

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adults with disabilities tend to be less socially engaged, which can lead to more negative health
effects due to the lack of others around. When other people are around, they notice when we are
looking ill or that we are not taking care of ourselves. When there is no one around, these things
can be overlooked. These effects are not limited to race, gender, or socioeconomic status either.
Remaining socially engaged is important for all older adults, regardless of their background (de
Leon, 2005).
Social engagement is important because those that volunteer, work, or provide care tend
to reflect those that are more physically or cognitively able to do so. Health does prohibit being
socially engaged, but not being socially engaged can also lead to more declines in physical and
mental health. By remaining active and providing knowledge and skills to others, older adults
can get mental and physical exercise that many help halt some declines of age. Also, by
becoming more socially engaged, older adults may help stop some of the negative stereotypes of
aging, such as not being a worthwhile member of society after retirement.
There is also research being conducted on how older adults can age gracefully by
remaining socially engaged by simply using the computer. Using the computer can help those
with dementias to decrease the rate at which their dementias progress, as well as the amount of
depression they experience as a result. Ways to remain socially engaged suggested are to nurture
social networks and remain in contact with friends and family, play mind games, find a part-time
job, join a club, volunteer, or offer assistance to family members. These activities can help older
adults stay socially and intellectually engaged, and lead to fewer health declines (McCoy, 2013).
These articles have implications for policy because they point out that older adults are
productive members of society who are an untapped resource. The problem may be that they are
not being utilized effectively, and by those who could really benefit from their skills and

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knowledge base. Many low-income older adults may not have the ability or resources that
higher-income adults do, and finding ways that they could also remain engaged is important.
They are not drains on our resources, and can actually contribute in ways that could save time
and money for others. They actually want to give back, but policy needs to be written as to how
that could happen, and where these sources should come from. Also, by remaining healthy and
active, they could potentially have fewer health issues that would require less financial payout
for themselves, their families, and the insurance system. It could also help them to remain
independent longer, leading to less strain on families and the nursing home system.
The idea of aging in place is one that has many definitions, some which may be
maladaptive to successful aging for older adults. It refers to the ability to age in your home
while still being physically, mentally, and cognitively healthy. This can be maladaptive because it
implies that if you are disabled, have any cognitive issues, or suffer from dementias, you are not
aging successfully. It is more important to stress that even with all the natural problems that
occur with aging, social engagement can help people lower to effects of any of these more
negative effects. By remaining socially engaged, older adults can compensate for losses by
becoming more proficient at other skills. For example, if they are less mobile and are not able to
get out of the house, they can learn to use the computer to stay connected with the world and
other people. Old age can be freeing, especially when people become unburdened through
retirement and when children move out, but if people do not remain connected to other people
and activities, older adults can become the burden on others that they do not want to be
(Boudiny, 2013).
Policy Prevalence
The policy I am proposing to increase social engagement in the older adult population

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will affect primarily adults aged 65 and over. It could also potentially help caregivers, family
members, and medical staff as well, however, due to the fact that social engagement has been
shown to help lower rates of cognitive decline and dementias (Stoykova, Matharan, Dartigues, &
Amieva, 2011). Encouraging and developing ways to increase the social networks of older adults
could lead to increased independence and better health outcomes, which could lead to lowered
costs associated with hospital and doctor visits. This can also take some of the burden off of
family members and caregivers when they are trying to care for their clients and loved ones.
In 2012, there were 41.4 million people aged 65 and older in the United States (Administration
on Aging, 2012). This is an 18% increase in the past decade, and the number continues to grow.
Twenty-eight percent (11.8 million) live alone, and they are at the greatest risk for social
isolation and loneliness, and would be the most likely people to benefit from a social engagement
policy change, but others would as well. The median income for this group is $27,707 for men
and $15,362 for females, which indicates that they tend to be in a lower socioeconomic status
(SES) than most, but SES does not change who is affected by diminished social engagement.
Even those who are in a high SES can experience negative health and mental health effects from
being isolation or lonely. Also of importance is to note that is social engagement can be done by
anyone, especially those who have mobile limitations. In a study of the benefit of social
engagement done at Harvard, more active older adults lived longer than less active ones. Social
and productive activities were found to be just as beneficial to the aging process as physical
activities (Glass, de Leon, Marottoli, & Berkman, 1999).
There is the potential for an economic impact with a policy shift regarding social
engagement. If this matter is not addressed in a timely manner, especially with the increasing
number of older adults in America, the number of Medicaid recipients using federal funds to pay

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for nursing home, or similar, care will continue to be a drain on an already unsteady system.
Adequate social support for older adults, especially those in long term care settings, will lead to
more satisfied older adults who can contribute more to their communities, and in turn, lead
healthier lives.
Those that could impact the rates of social engagement through public policy are
lawmakers, by passing the Reauthorization of the Older Americans Act (National Council on
Aging, 2015), which will place a greater importance on healthy aging and social engagement for
older adults, as well as doctors, caregivers, researchers, social organizations, and senior centers.
These key players can begin with small steps and by showing the older adults they work with the
results of positive social engagement. Many people are afraid of developing dementias or being
placed in a nursing home, and it will be important to stress the preventative measures that can be
put in place to combat these issues, among them healthy social engagement. This is not an
exhaustive list, and families and the older adults themselves are also going to have to begin to
recognize the importance of social engagement on their physical and mental health outcomes.
Solutions
There are many solutions that are available for the increasing of social support for older
adults. The most important may be increasing funding that goes to volunteer and employment
opportunities for older adults, as well as the funding that goes into senior centers. By increasing
the social engagement opportunities for older adults, especially those that may be more at risk
due to a lack of social support, there is a chance that this would help them age in more healthy
ways, and not require the types of care that many currently need through the Medicaid system.
Other solutions include a revamping of the long term care system in America, and encouraging
more physical activities in the residents. For those who are nursing home eligible, but chose to

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stay in their own homes, there should be more community support such as social organizations
and engagement opportunities. We as a nation can get back to a place where we age in ways that
are less isolated and restricted, and where we look out for our neighbors, and in order to do this,
policy changes in how we deal with older adults are needed.
It can be very hard to just create social engagement opportunities for older adults, even
though we know they need these opportunities. There are many agencies and organizations that
are actively working to create these opportunities. This is a great way for policy changes to come
in and help to instigate and encourage change in the ways we provide these opportunities
(Gonzales, Matz-Costa, & Morrow-Howell, 2015). Generally, nonprofit organizations that utilize
volunteers have largely disregarded older adults, despite numerous calls-to-action. The federal
government has programs such as Senior Corps, Retired Senior Volunteer Program, Foster
Grandparent Program, and Senior Companion Program. These programs work by using the skills
and abilities of the older adult and applying them to community needs. Currently, there are
approximately 360,000 older adults taking advantage of these programs, but due to budget
cutbacks in the federal government, the funds for these programs and others are shrinking every
year. Another issue is that many older adults are not aware these programs even exist, and
minorities are vastly underrepresented. There needs to be a push to get older adults, especially
minorities and those who are a part of a disadvantaged group involved and active in these
programs that are federally funded. If the government sees that people are not utilizing the
services, they will have no qualms about continuing to cut funding.
According to James, Boyle, Buchman, and Bennett (2011) social activity has long been
recognized as an essential component of healthy aging and is associated with a decreased risk of
adverse health outcomes including depression, cognitive decline, dementia, motor decline, and

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mortality. This is important because older adults who may need help with activities of daily
living or instrumental activities of daily living may not realize or want to admit they need help,
and without social interaction they may never receive the help they need. It may also be harder
for those who have started experiencing some of these issues to change their lives, but by putting
policies in place to give them affordable option for help, those in power can start make a
significant change for the better.
Women make up the largest group of older adults, and so it is of interest to see how
widowhood affects them and their levels of social engagement. They are also less likely than
men to remarry, so they may experience worse outcomes as they age. Widows do tend to
socialize less right before their husbands die, and more after their husbands pass. This is
important because it may mean that they are compensating for their loss through social
engagement, and if awareness of social engagement as a protective factor against poor health and
grief could be encouraged, more people may have better health outcomes as they age (Utz, Carr,
Nesse, & Wortman, 2002). This may be a group that could be specifically targeted for an
intervention to get them engaged and involved after widowhood.
It is also important to look at all different groups of older adults, from community
dwelling to those in institutions. Just because someone moves in an assisted living facility or
nursing home does not mean they still do not need engagement activities. Findings have revealed
how complex social engagement can be for older adults and were organized around the the
characteristics of desired social relationships, the perspective of time and loss, barriers to and
resources for social engagement, and strategies to develop or modify relationships. Assisted
living providers could make concerted efforts to develop practices to provide residents with more
social and emotional experiences and help them engage in meaningful social interactions, as well

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as help create public policies to enhance these interactions (Park, Zimmerman, Kinslow, Shin, &
Roff, 2012).
CONCLUSION
According to the National Council on Aging (NCOA, 2015), there is currently an
emphasis being placed on reauthorizing the Older Americans Act for at least three years. This act
will place greater importance on modernizing senior centers, which will increase the activities
available at those centers for older adults to engage in. We also know that older adults are
productive contributors to society through their skills, abilities, and knowledge, and we need to
continue to address the demands of the aging population, and create more policies to facilitate
their participation. Policies that facilitate participation of older adults, and policies that build
capacity across the life course, will help with this increasing burden. Given the demographic
trends, public and private sector needs, and long-term care demands of an aging society, now is
the time to strengthen policies and programs to support the productive engagement of older
adults (Gonzales, Matz-Costa, and Morrow-Howell, 2015). We all as whole need to come
together and establish and implement policy that will affect older adults now, as well as in the
future, because budgetary difficulties are not going to go away any time soon, and with a
burgeoning older adult population, the healthier people are, the fewer costs that are associated
with their care. One way to keep people healthy is through adequate social engagement
opportunities.

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REFERENCES

Administration on Aging (2012). A profile of older Americans: 2012. Administration for

Community Living, U.S. Department of Health and Human Services.
Bitzan, J.E. & Kruzich, J.M. (1990). Interpersonal relationships of nursing-home residents. The
Gerontologist, 30, 385-90. doi: 10.1093/geront/30.3.385
Boudiny, K. (2013). Active ageing: From empty rhetoric to effective policy tool. Ageing and
Society, 33(06), 1077-1098. doi: 10.1017/S0144686X1200030X
de Leon, C. F. M. (2005). Social engagement and successful aging. European Journal of Ageing,
2(1), 64-66. doi: 10.1007/s10433-005-0020-y
Glass, T. A., de Leon, C. M., Marottoli, R. A., & Berkman, L. F. (1999). Population based study
of social and productive activities as predictors of survival among elderly Americans.
Bmj, 319(7208), 478-483. doi: 10.1136/bmj.319.7208.478
Gonzales, E., Matz-Costa, C., & Morrow-Howell, N. (2015). Increasing opportunities for the
productive engagement of older adults: A response to population aging. The
Gerontologist, 1-7. doi: 10.1093/geront/gnu176
Hubbard, G., Tester, S., & Downs, M.G. (2003). Meaningful social interactions between older
people in institutional care settings. Ageing & Society, 23, 99-114.
doi: 10.1017/S0144686X02008991
James, B. D., Boyle, P. A., Buchman, A. S., & Bennett, D. A. (2011). Relation of late-life social
activity with incident disability among community-dwelling older adults. The Journals of
Gerontology Series A: Biological Sciences and Medical Sciences, 1-7.
doi: 10.1093/gerona/glq231
McCoy, T. (April 16, 2013). How to stay socially engaged as you age. Retrieved from
http://www.everydayhealth.com/senior-health/enhancing-your-life.aspx.
National Council on Aging (January 15, 2015). Senate Moves Swiftly on OAA Reauthorization
in Anniversary Year. Retrieved from http://www.ncoa.org/public-policy-action/policynews/senate-moves-swiftly-on-oaa.html
Nicholson, N. R. (2012). A review of social isolation: An important but underassessed condition
in older adults. The Journal of Primary Prevention, 33(2-3), 137-152.
doi: 10.1007/s10935-012-0271-2
Park, N. S., Zimmerman, S., Kinslow, K., Shin, H. J., & Roff, L. L. (2012). Social
engagement in assisted living and implications for practice. Journal of Applied
Gerontology, 31(2), 215-238. doi: 10.1177/0733464810384480

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Shankar, A., McMunn, A., Banks, J., & Steptoe, A. (2011). Loneliness, social isolation, and
behavioral and biological health indicators in older adults. Health Psychology, 30, 377385. doi: 10.1037/a0022826
Steinbach, U. (1992). Social networks, institutionalization, and mortality among elderly people
in the United States. Journal of Gerontology, 47, S183- S190.
doi: 10.1093/geronj/47.4.S183
Stoykova, R., Matharan, F., Dartigues, J., & Amieva, H. (2011). Impact of social network on
cognitive performances and age-related cognitive decline across a 20-year follow-up.
International Psychogeriatrics, 23(9), 1405-1412. doi: 10.1017/S1041610211001165
Utz, R. L., Carr, D., Nesse, R., & Wortman, C. B. (2002). The effect of widowhood on older
adults' social participation: An evaluation of activity, disengagement, and continuity
theories. The Gerontologist, 42(4), 522-533. doi: 10.1093/geront/42.4.522
Zedlewski, S.R., & Schaner, S.G. (2005). Older adults engagement should be recognized and
encouraged. Perspectives on Productive Aging, 1. Retrieved from
http://www.urban.org/publications/311201.html.