By Ellen Feldman, MD
Altru Health System, Grand Forks, ND
Dr. Feldman reports no financial relationships relevant to this field of study.
• This observational study utilized data from 12,998 respondents from the Health and Retirement Study (a periodic survey of more than 20,000 nationally representative adults aged older than 50 years) to investigate changes in volunteering and its association with any of 34 indicators of physical and emotional health.
• At baseline from 2006 to 2008, psychosocial and medical factors were collected via self- report. Participation in volunteer hours was assessed four years later, and in the subsequent four years, the 34 health outcomes were examined.
• When controlled for multiple variables and compared with 0 hours volunteering yearly, participants who volunteered ≥ 100 hours/year had a significant difference in decreased risk of mortality, better self-rated health status, positive affect, purpose in life, and contact with friends.
• When controlled for multiple variables and compared with 0 hours volunteering yearly, participants who volunteered ≥ 100 hours/year had no significant difference in other health outcomes, including number of chronic conditions, obesity, chronic pain, binge drinking, smoking, sleep problems, and contact with children.
SYNOPSIS: This large, observational study of U.S. adults aged older than 50 years found that volunteering ≥ 100 hours yearly is associated with a reduced risk of mortality and several favorable psychosocial outcomes when compared with peers reporting 0 volunteer hours yearly.
SOURCE: Kim ES, Whillans AV, Lee MT, Chen Y. Volunteering and subsequent health and well-being in older adults: An outcome-wide longitudinal approach. Am J Prev Med 2020;59:176-186.
Intertwined with history and development in the United States, volunteering dates back to the founding of this country. In 1736, Benjamin Franklin cofounded the first all-volunteer firehouse, which became a model for communities across the newly formed nation. In the 1800s, the rise of organizations such as the United Way and Red Cross helped expand the reach of volunteer services. Although the rate of volunteering has waxed and waned over the subsequent years, a record high was recorded in 2017 , with more than 77 million adults reporting 9.9 billion hours dedicated to volunteering in the United States.1
Volunteering has benefits beyond contributing to the health of a community. Many medical studies have shown a link between volunteering and improved personal health measures, but such studies have been inconsistent in methodology and conclusions. Thus, definitive statements regarding this relationship have remained elusive.2
Kim et al approached this problem by narrowly defining the scope of work to an observational study with a specific age group and period of time. Using the data from the Health and Retirement Study (HRS), a longitudinal study beginning in 1992 and encompassing a nationally representative group of people older than age 55 years, enabled a large number of diverse participants.3 HRS participants are surveyed in staggered groups of four years regarding a variety of psychosocial and health measures. For the purposes of this study, respondents in the years 2006 and 2008 were considered “prebaseline”; data from this wave were used to establish covariates, such as gender, age, marital status, household income, geographical location, and education.
In 2010 and 2012, HRS respondents were asked about volunteer hours. These were divided into four quartiles from 0 hours to ≥ 100 hours (or two hours/week). In 2014 and 2016, Kim et al evaluated 34 participant health outcomes, including mortality, number of chronic conditions, obesity, diabetes, hypertension, stroke, cancer, physical function limitations, health behaviors (binge drinking, smoking, sleep problems), psychological well-being and/or distress, and social factors. These outcomes were compared across the volunteer quartile categories.
Using an innovative statistical analytic approach, and controlling for a number of factors, including levels of volunteering during the prebaseline period, Kim et al described being able to isolate the effect of change in volunteer hours on each of these outcomes. The demographics at prebaseline included a group of 12,998 participants with an average age of 66 years. Of the participants, 59% were women and 66% were married. When comparing health outcomes during the four-year follow-up period, and controlling for multiple variables, the results of the group reporting ≥ 100 volunteer hours yearly vs. those who reported 0 hours of volunteer work showed significant differences in the following measures:
- 44% reduced risk of mortality (95% confidence interval [CI], 0.44 -0.71); P < 0.05
- 86% greater healt self-rating (95% CI, 0.08-0.19); P < 0.05
- 87% higher reporting of positive affect (95% CI, 0.08-0.19); P < 0.05
- 89% higher purpose in life (95% CI, 0.05-0.16); P < 0.05
- 29% less likely to describe loss of contact with friends (95% CI, 0.62-0.80); P < 0.05
Several other measures (e.g., an increased likelihood of frequent physical activity, lower depressive symptoms, lower loneliness, and lower hopelessness) in the group reporting ≥ 100 hours volunteering yearly vs. those reporting 0 hours volunteering yearly appeared to be significantly different. However, these differences were no longer significant after applying the Bonferroni correction, a statistical calculation that, in effect, raises the bar on significance when analyzing a sample with multiple comparisons.4
There were no noticeable differences between the two groups in development of the remaining health outcomes, including the number of chronic conditions, obesity, cognitive impairment, chronic pain, sleep problems, binge drinking, life satisfaction, and negative affect.
COMMENTARY
Lifespan is increasing in the United States as the baby boomer generation of the 1950s drives a population explosion of older Americans at an unprecedented rate. In 2018, there were 52 million Americans older than age 65 years; by 2060, this number is projected to reach 95 million, representing a shift from 16% to 23% of the total U.S. population.5 Kim et al, looking specifically at this demographic, brings us important information — not only about volunteering and health outcomes, but also about potential preventive health interventions for these older Americans.
This is not the first study looking at the health benefits of volunteering, but it is unique in its design, scope, and focus on a specific age group. Past observational studies have suggested there are health benefits associated with volunteering, including a reduced risk of hypertension, cardiovascular disease, and cognitive impairment, but causality has been hard to confirm. Furthermore, with small numbers of participants and homogenous populations, generalization of results has been difficult.6,7
Interestingly, results from Kim et al show a significant association with volunteering for more than 100 hours yearly and reduced mortality, but they do not show any association between this frequency of volunteering and at least 10 other physical health outcomes and numerous health behaviors. Similarly, there appears to be an association with perception of good health and positive affect for those volunteering for more than 100 hours yearly, but there is no clear association with reduced symptoms of depression.
These results are somewhat puzzling, appear counterintuitive, and may point to a direction for future research in this field. It may be that people who feel healthy are more likely to volunteer, but it also may be that the full scope of health benefits of volunteering is unable to be captured by these traditional measures. Perhaps the most glaring limitation of the study is the reliance on self-reported data, including not only hours volunteering, but also many of the health outcomes. A more objective manner of measurement may strengthen, and perhaps clarify, the conclusions. Additionally, a narrow definition of “volunteering,” rather than the broad term used in most studies, may help reduce discrepancies among study results.
However, even with the stated limitations and areas of uncertainty, there are clear clinical implications from this research. A diverse, nationally representative sampling of Americans aged older than 55 years showed that volunteering for at least two hours a week is associated with less mortality, better self-rated health, positive affect, a perception of more purpose in life, and greater contact with friends than matched peers who reported no volunteer hours. This health message is straightforward and can become a building block in an overall plan for addressing health and wellness during aging.
REFERENCES
- Corporation for National and Community Service. Volunteer Growth in America: A Review of Trends Since 1974. Washington, D.C.; 2006.
- Yeung JWK, Zhang Z, Kim TY. Volunteering and health benefits in general adults: Cumulative effects and forms. (Published correction appears in BMC Public Health 2017;17:736.) BMC Public Health 2017;18:8.
- The Health and Retirement Study Survey Research Center. The health and retirement study. The University of Michigan. https://hrs.isr.umich.edu/about
- Weisstein EW. Bonferroni correction. MathWorld — A Wolfram Web Resource. https://mathworld.wolfram.com/BonferroniCorrection.html
- Mather M, Scommegna P, Kilduff L. Fact sheet: Aging in the United States. PRB. July 15, 2019. https://www.prb.org/aging-unitedstates-fact-sheet/
- Burr JA, Han SH, Tavares JL. Volunteering and cardiovascular disease risk: Does helping others get “under the skin?” Gerontologist 2016;56: 937-947.
- Infurna FJ, Okun MA, Grimm KJ. Volunteering is associated with lower risk of cognitive impairment. J Am Geriatr Soc 2016;64:2263-2269.
