The Helping Older People Engage Project: Improving Social Well-Being in Later Life

The many negative outcomes associated with loneliness in older people have rendered
loneliness itself a new public health target. Older adults who feel lonely carry increased
risk for reduced quality of life, morbidity, and mortality. The risk of premature mortality
related to loneliness is at least as large as the risks arising from such factors as obesity,
physical inactivity, alcohol misuse, and smoking. Volunteering is a promising intervention
for reducing loneliness in later life. The primary objective of this proposal is to test the
hypothesis that a social volunteering program for lonely older adults will lead to reduced
loneliness and improved quality of life. National infrastructure for volunteering (The Senior
Corps) ensures that volunteering is a highly scalable intervention.

The investigators propose to compare the effect of a Senior Corps volunteering intervention
versus a self-guided life review active control condition on feelings of loneliness in older
adults. The investigators' preliminary data, as well as published studies of volunteering in
later life, strongly suggest that volunteering should reduce loneliness. Rigorous
experimental study is needed, however, to examine volunteering in both men and women who are
lonely, to determine conditions that maximize benefit, and to understand mechanisms. The
investigators hypothesize, per tenets of Self-Determination Theory, that increased social
engagement and feelings of both usefulness and social support function as psychological
mechanisms whereby volunteering reduces loneliness. Understanding these mechanisms will
promote effective implementation, allowing communities to adapt volunteering programs while
retaining the active ingredients.

The study involves randomly assigning older adults (150 women, 150 men) who report loneliness
to 12 months of either: 1) a structured social volunteering program providing peer
companionship to frail, homebound older adults for at least 4 hours per week, or 2) an active
control intervention with self-guided life review.

Specific aims are as follows: 1) To examine the effect of volunteering on loneliness and
quality of life; 2) To examine social engagement, perceived usefulness, and social support as
mechanisms for reducing loneliness; 3) To examine conditions under which volunteering is most
effective at reducing loneliness.

The volunteering intervention is already implemented nation-wide, indicating high feasibility
of going to scale (http://www.nationalservice.gov/programs/senior-corps). If effective,
volunteering should be "prescribed" by physicians and promoted by policy. Dissemination and
scaling up efforts will involve connecting primary care patients and aging services clients
who are lonely with The Senior Corps, shown to be feasible in the investigators' companion
study, The Senior Connection. Existing infrastructure will make it possible to reach a large
proportion of lonely older adults. Reducing loneliness has the potential to improve
well-being and save lives.