Episode 9: Volunteering and Healthy Aging with guest Dr. Nicole Anderson
On today’s episode of the BrainShape podcast, we’re talking about the health benefits associated with volunteering, including better self-reported health status, less depression, and more life satisfaction. There is even evidence that shows that volunteering can impact your cognition or mental functions. Today we're talking with Dr. Nicole Anderson - an Associate Professor in the Departments of Psychology and Psychiatry at the University of Toronto, as well as a Senior Scientist at the Rotman Research Institute (Baycrest). Her research focuses on cognitive interventions for healthy older adults, older adults with Mild Cognitive Impairment (MCI) or adults recovering from a stroke or traumatic brain injury. Dr. Anderson tells us about the research on the positive impacts that volunteering can have on your health and well-being and shares the very insightful findings from her BRAVO (or Baycrest Research about Volunteering Among Older Adults) study.
How is "volunteering" defined?
People generally make a distinction between formal volunteering and informal volunteering.
Informal volunteering is when seniors, for example, grandparents, help to babysit their grandchildren or people who help to take care of a loved one. This is a form of volunteering for sure, but it is distinct from formal volunteering.
Formal volunteering is where people go to a specific organization and lend their time. Formal volunteering is completely voluntary. Nobody's telling you, you have to go volunteer at a hospital or at a school. It doesn't matter how many hours people volunteer or what organization they volunteer for. It is simply people who are voluntarily giving up their time to an organization - large or small. That's what Dr. Nicole Anderson means by “volunteering”.
While there is a little bit out there on the benefits of informal volunteering, most of the research has looked at the benefits of formal volunteering.
So, in this episode, when Dr. Nicole Anderson is talking about volunteering, she’s talking about formal volunteering.
Research on volunteering
In 2014, Dr. Nicole Anderson and her team looked at the studies that had been published to date, and they reviewed every piece of evidence that they could find out there. So, this ranged from qualitative studies where they interviewed volunteers, this included cross-sectional studies where they just compared volunteers and non-volunteers, and it included what is called prospective studies, where they followed people over time and looked at how volunteers and non-volunteers change over time.
And then finally, there was one randomized control trial that existed at the time where they randomly assigned people to either volunteer in elementary schools or to not volunteer. Dr. Anderson and her team put all of this evidence together to try to find: what were the strongest pieces of evidence for the health benefits of volunteering in the physical, the cognitive, and the psychosocial domains. What they found was that there was quite a lot of evidence for physical and psychosocial benefits of volunteering.
Side note: psychosocial generally refers to your well-being. It's kind of an umbrella term that would include your levels of depression or happiness, your outlook on life, life satisfaction, feelings of self-esteem, etc. The term “psychosocial” refers to all of these things that contribute to your sense of well-being.
So, for example, volunteers compared to non-volunteers, not only do they start out healthier and less depressed, so that is that generally speaking, people who are healthier and less depressed tend to volunteer compared to people who tend not to volunteer. But, if the research participants are followed over time, volunteers tend to self report their health as being better. They report having fewer functional limitations over time. They report less depression over time, more life satisfaction, and volunteers live longer than non-volunteers do.
These findings are a great motivation to volunteer.
In 2014, the cognitive benefits of volunteering had only been examined in a handful of studies at that time.
How much time do you have to volunteer to see these benefits?
The research shows that it doesn't take much. The benefits start to emerge with as little as about three hours of volunteering a month. What the research also shows is that, in general, the benefits of volunteering, especially in terms of psychosocial well-being and depression, increases the more hours people volunteer - but only up to a point. That point (across studies) seems to be around 100 annual hours, which works out to about two and a half, three hours a week of volunteering. That's when people see maximal benefits.
Beyond that, volunteering more than 100 hours per year, either there are no further benefits or in a couple of cases, the benefits start to decline again. The 100 annual hours does seem to be kind of a sweet spot where people get the greatest benefit.
Who benefits the most from volunteering?
The research on this is quite mixed. But, one domain that has the strongest evidence is that older adults who feel appreciated or needed, as a volunteer, seem to have the biggest psychosocial benefits – e.g., depression, life satisfaction, and general overall psychological well-being.
One study found that people who had a recent negative life event (e.g., divorce or loss of a loved one) benefited the most, but that's one study. So, really in Dr. Anderson’s review, they tried to look for what has consistently replicated findings and the one thing that stood out was feeling needed and appreciated. That was the one thing that seemed to relate to the biggest benefits.
What does the research say about volunteering & dementia prevention?
Since 2014, one study followed people over time and found that the volunteers, when they're followed over time, tend to have less cognitive decline than non-volunteers. And of course, cognitive decline is a precursor or necessary component of dementia. Of note, Dr. Anderson is not a big fan of the research that showed volunteering would help to lower dementia risk, because the researchers tried to say who had dementia and who didn't based on medication prescriptions from a big database. So, if the participant was prescribed a drug like Aricept, the study authors said the participant had dementia. Also, it was a really young sample, average age of 67, which is not when the numbers of people with dementia really go up. So, in Dr. Anderson’s mind, it was a really weak study (although the authors did find that people who volunteered were less likely to be prescribed these medications). Dr. Anderson is personally waiting for a more substantial study to come out to make the link between volunteering and dementia risk.
About the Baycrest Research About Volunteering Among Older Adults (BRAVO) study
Dr. Anderson’s research was interested in examining the mechanisms by which volunteering is beneficial, and one area that previous research had really missed was the complexity of the volunteer work.
To back up a little bit, there's a whole other literature showing that the complexity of our paid occupations in mid-life relates to dementia risk and risk of cognitive decline in late life, such that occupations that are more cognitively complex (e.g., you have to think harder on the job or that are more socially complex), are related to better cognitive functioning and lower dementia risk in late life.
It occurred to Dr. Anderson and her team that volunteer jobs are like occupations – because an occupation is just a meaningful activity. Furthermore, volunteer jobs vary in complexity. For example, somebody who's stuffing envelopes, is not engaged in a very complex volunteer job (either physically, cognitively, or socially), But, if somebody’s volunteer position requires that they lead an exercise class, that is obviously more physically challenging and complex, and also more socially and cognitively complex, because you have to come up with the routines that you're going to teach, and gauge people's reactions to those exercises: Are the exercises too difficult? Does the instructor need to adjust them?
In the BRAVO study, Dr. Anderson and her team recruited people who are age 55 and older who were interested in volunteering at Baycrest. They assessed them before they started to volunteer and at two six-month intervals, so after six months and after 12 months. They examined their physical, cognitive and psychosocial functioning as it related to how many hours they volunteered.
Dr. Anderson and her team wanted to see whether there was the same sweet spot of about 100 annual hours of volunteering, but also as a function of the complexity of the volunteer roles that they held, so the physical, cognitive, and psychosocial complexity or social complexity of their volunteer roles.
BRAVO Study Research Findings
Dr. Anderson and her team predicted that people who would volunteer more hours would benefit more from the study and that people who volunteered in more complex rules would benefit more from volunteering. Dr. Anderson and her team were surprised to find that that wasn't the case. Over the course of a year of volunteering, they didn't find any changes in physical functioning, which really isn't that surprising because when we analyze the physical complexity of the volunteer roles that people chose, they were by and large predominantly sedentary. So, Dr. Anderson and her team would argue that if we want to improve physical functioning, you need to take on opportunities that are more physically challenging in the context of your volunteer roles.
Dr. Anderson and her team also didn't see any changes in psychosocial or social well-being over time, which stands out as different from all of the other evidence that they reviewed, but their participants were in pretty good psychosocial health to begin with; so that might have dampened their ability to see any changes in that regard. They did, however, see cognitive improvements in all of the participants. The area that really showed this pattern was in terms of memory: verbal memory, and non-verbal memory, and working memory improved in general over the course of the year of volunteering, which is fabulous. But memory improved more among people who volunteered fewer hours than those who volunteered more hours. And what's interesting with that one was that when they statistically put perceived stress into the model, that went away. This suggests that volunteering too many hours might be just too stressful for people to have bigger cognitive benefits. So, it might be the case and the point at which that happened was around this 100 annual hour mark, that people volunteering more than that had fewer cognitive benefits than people who volunteered fewer than about 100 hours in a year.
In terms of the volunteer complexity, Dr. Anderson and her team found that people who volunteered in less complex volunteer roles showed the biggest cognitive benefits, compared to people who volunteered in more complex volunteer roles. This finding was not expected at all. And with the BRAVO study data that they have, they can't explain it. But there might be something here that suggests volunteering and paid occupations are different. Specifically, for paid occupations, it's important to have complex occupations in terms of dementia risk and cognitive health in late life, but maybe that’s not the case in later life volunteering. Perhaps in order to maintain cognitive functioning in later life, we may just need to fill volunteer roles that are not too complex in order to help maintain cognitive functioning.
Social capital, volunteering and dementia risk
It is fairly new to be speaking about social capital in the context of dementia risk. There's not a whole lot of people who have thought this way. But, the idea of social capital goes back a long way - back to the 1900s, but it's really started a resurgence in the last 50, 60 years or so. Generally, it's just trying to tap into the value of social relationships and benefiting society, but also benefiting people.
So, if you think about people who are socially connected with other people and with society at large, they have more trust in society and they just feel more empowered if they're connected. Dr. Anderson is starting to think about the benefits of social capital on people's cognitive health and dementia risk. Perhaps volunteering is one way to help people stay socially connected to their community. Of note - there are many ways that people can get that kind of social capital and volunteerism as one key one, but it is not the only way.
Interested in volunteer opportunities?
If you’re interested in exploring opportunities to volunteer, a good place to start is by visiting Volunteer Canada at www.volunteer.ca.
Also, Dr. Anderson suggests that you just spend a bit of time thinking about what it is that you want to do. What level do you want to volunteer at? People really need to reflect on, what is it that they want to give and in what capacity, rather than just taking whatever volunteer opportunity first pops up.
In addition, you can look into organizations like CESO (Canadian Executive Service Organization) that can help place people and connect their professional area of expertise to a volunteer role (click here to learn more). For example, if somebody is an accountant, they might go to Thailand and help small businesses get going or help them with their books, etc.
Other people want to help people a bit more directly, so volunteering in a hospital or at an elementary school might be more appropriate.
What can organizations do to enhance volunteer opportunities for seniors?
Organizations should really reflect on and think about the value of volunteerism and the levels at which volunteers can contribute, so that they incorporate volunteerism into the whole fabric of their organization. We have this whole Baby Boomer generation retiring and they are fabulously capable and have such rich histories and can really contribute at high levels to various organizations. So, for organizations to go back and really reflect on how they can incorporate older volunteers at every level of the organization would be very beneficial and powerful. For example, Baycrest is developing a new memory care model with the intention of incorporating volunteers at every level of planning and its full implementation.
Interesting statistics: According to Statistics Canada, individuals over the age of 55 are among the most active of the volunteer age group. Interesting, this is true globally (Canada, United States, Europe) - among those seniors who do volunteer, they volunteer way more hours than young people.
Dr. Anderson’s additional research projects
One of her main research focuses is on trying to prevent cognitive decline and dementia. Along these lines, Dr. Anderson has two studies going on that are part of the Canadian Consortium on Neurodegeneration and Aging (CCNA). This is a study going on across Canada with over 450 researchers all trying to tackle issues related to dementia.
In Toronto, specifically, Dr. Anderson is involved in two non-pharmacological clinical trials where they are recruiting people who are concerned that their cognition is declining, but they haven't had any kind of diagnosis of cognitive decline. They are focusing on people who are noticing cognitive changes and they're bothered by it, but they're still functioning very well and scoring within normal ranges (on cognitive assessments). Dr. Anderson and her team are enrolling these types of individuals in two trials:
1. One study is focused on this idea that social and cognitive engagement is beneficial for cognitive health and reduces dementia risk. In this research, they will be teaching people Spanish, or they’re teaching them music, or they're getting them involved in documentary discussion groups and looking at how their cognition and brain health is maintained by doing these various activities.
2. In the other study, again, they are interested in recruiting people who have concerns about their cognition and they have two or more cardiovascular risk factors. In this study, the participants will be exposed to an exercise and nutrition intervention. This evaluation will consist of a six-month intervention, where they're going to get them really super physically fit and eating well, and again, hoping that this will impact the maintenance of cognitive functioning and good brain health.
To learn more about the research that Dr. Nicole Anderson is working on and to inquire about getting involved, you can call her research assistant Kaljani Mahalingam at 416-785-2500 x3315.