Social Support and Physical Activity Corroborating
Running head: HEALTHY AGING IN THE ELDERLY 1 Social Support and Physical Activity Corroborating Healthy Aging and Quality of Life in the Elderly Karen Cauthen Counseling 502-B21 Liberty University Abstract Can morbidity be deterred in the elderly or is disease and illness a fact of life for the aged? Does social support and physical activity play a part in preventing secondary aging processes? This paper will modestly explore and discuss the effects of social interactions and routine activity of the elderly upon healthy aging and quality of life. Successful healthy ageing is impacted by a healthy lifestyle and is positively related to a reduced mortality risk and a delay in health deterioration” (Merrill, Myklebust, Myklebust, Reynolds, & Duthie, 2008). It is not the absence of disease or disability that qualifies healthy aging, but response to the aging process that defines quality of life (Gilbert, Hagerty, & Taggert, 2012). According to Erik Erikson it is the eighth stage of development: integrity vs. espair (Erikson, Erikson, & Kivnick, 1986); the point in life where the reality of death becomes imminent and a review of life determines meaning (Elhman & Ligon, 2012). Social participation and an active lifestyle are good at any age but for the elderly it is the cover over the deep dark hole of despair and loneliness. Keywords: integrity, despair, activity, social, healthy aging, aging process, support Social Support and Physical Activity Corroborating Healthy Aging and Quality of Life in the Elderly
As we grow older our bodies change, our thoughts are more reflective, and our friendships more selective. Growing old is not a cookie cutter process. For each individual it is different. Some stay very busy, while others quit. They gradually halt participation in day-to-day events, or they take up yoga, run a marathon even go back to school. Successful aging is determined more by mental attitude than physical ability; how past life is perceived and future life accomplished.
It is how change is managed that determines healthy aging and quality of life in the aged. Growing old is a process gerontologist divide in two categories, “primary aging” and “secondary aging” (Berger, 2011). Primary aging is defined as the universal changes occurring with age that are not caused by diseases or environmental influences. Secondary aging is defined as changes involving interactions of primary aging processes with environmental influences and disease processes (Masoro & Austad, 2006).
According to Berger (Berger, 2011) there are three stages of old: “young-old,” “healthy, active, financially secure and independent;” “old-old,” although still independent suffer from “reductions in physical or mental ability or social support;” and last, “oldest-old,” “infirm, at risk for illness and injury. ” Not preferring to use the word old, some gerontologist describe four stages of aging as: “optimal aging,” “usual aging,” “impaired or pathological aging,” and the fourth, “successful aging,” (Rowe & Kahn, 1998) “signifying extensive social interaction and activity” (Berger, 2011).
The elderly tend to measure functional capacity by “their ability to carry out, independently, their routine activities, also called the activities of daily living” (Brito & Pavarini, 2012). After years of independent living, dependency on someone to carry out normal everyday functions can be emotionally and socially debilitating, even more so than the illnesses that made them dependent. “Loss, in instrumental activities of daily living contributes to greater estrangement from one’s social surroundings and consequently to a tendency to be isolated in one’s residence” (Brito & Pavarini, 2012).
Erik Erikson provided an in-depth philosophy in his final eighth stage of development: integrity vs. despair. This is a time in which the elderly desire to unite their vast experiences with their ideas of humanity (Erikson, et al, 1986). While despair stands for a complete loss of hope, integrity does not only mean honesty, but also “a feeling of being whole, not scattered, comfortable with oneself” (Berger, 2011). Yet it is in Erikson’s seventh stage, generativity vs. tagnation, we find that “in older adults, generativity may be the single most important factor in achieving ego integrity (James & Zarrett, 2006) and positively impacts well-being (Yuen, Huang, Burik, & Smith, 2008)” (Elhman & Ligon, 2012). Therefore, as Erikson (Erikson & Erikson, 1997) put it, “indeed, old people can and need to maintain a grand-generative function” (p. 63), and that “vital involvement…is necessary for staying really alive (p. 63)” (Elhman & Ligon, 2012). Theories
People are multi-dimensional, multi-faceted creatures. To lump us all under one roof would be a crime. Numerous theories, through research and study, try to describe human behavior but no one such study is sufficient. There are four main theories concerning the activities and social life of the elderly. Each theory holds truth but not the whole truth. The first, activity theory, views “older people as psychologically unchanged” holding “social and physical obstacles responsible for declining rates of social interaction” (Carstensen L.
L. , 1992). Activity theorists blame age-related health and social burdens for cause of change in social participation and activities (Carstensen L. L. , 1992). The second, disengagement theory, suggest “that old age instigates a mutual withdrawal between society and aging people” (Carstensen L. L. , 1992). Elaine Cumming and William Earl Henry (Cumming & Henry, 1961) suggest that in preparation for death withdrawal is manifested in a distancing in social relationships.
As death creeps ever closer what is important and what is not is more relevant. What we do, where we do it, and whom we do it with are choices that continue the idea of independence. A third theory proposed by Dr. Laura Carstensen (Carstensen L. L. , 1992), socioemotional selective theory, counters the assumption by the other two theories, that these changes in social activity are strictly late-life phenomena, with the proposition that these changes actually start earlier in life. Reduced rates of interaction in late life are viewed as the result of lifelong selection processes by which people strategically and adaptively cultivate their social networks to maximize social and emotional gains and minimize social and emotional risks” (Carstensen L. L. , 1992). Because so much is derived from social interaction; information, assistance, self-identity, selection of a mate, knowledge of culture and history, discriminate and careful examination of social partners is a must (Carstensen L. L. , 1992).
The fourth, gerotranscendence theory, was developed by Lars Tornstam to address a “perpetual mismatch between present theories in social gerontology and existing empirical data” (Tornstam, 2010). Gerotranscendence claims successful aging results from frequent contemplative thought, a decrease in materialism, and transcendence of primary aging processes (Adams & Sanders, 2010). In support of this theory a Change in Activities and Interest Index (CAII) was created to “examine empirically the perceived changes that occur in the lives of older adults” (Adams & Sanders, 2010).
The CAII is a 30-item questioner optimized to examine “self-perceived change in investment in and attitudes about social and leisure pastimes among older adults” (Adams & Sanders, 2010). As a result of the research by Drs. Kathryn Adams and Sara Sanders (Adams & Sanders, 2010) using the CAII, providers of health care to the elderly can better design ways to elevate direct engagement in valuable, desired activities and social relations as they advance within the aging process. As stated earlier, all four theories hold truth, but none the whole truth.
Each theory describes certain individuals but leaves out others. Because we are an ever changing species and constantly growing population more studies are needed in understanding the causes of healthy aging and defining quality of life. Gender Studies have shown that in later life numerous physical benefits, as well as, psychological benefits are a result of participation in social activity, “such as the promotion of happiness (Menec, 2003), reduction of the risk of depression (Hong, Hasche, & Bowland, 2009), reduction of the decline of motor function (Buchman, et al. 2009), and even reductions in mortality (Lennartsson & Silverstein, 2001)” (Li, Lin, & Chen, 2011). “Research to date indicates that participation in social activity exerts positive and psychological health effects among the elderly and that the pattern of activity participation differs by gender” (Li, et al, 2011). Numerous studies and literature report general differences in the social activities of men and women, but only one study “considered gender issues and social activity among the elderly (Arber, Perren, & Davidson, 2002).
When exploring the outcomes of healthy aging and quality of life in regards to social support and physical activity, gender cannot be overlooked. Changes take place throughout the lifespan and gender affects social and cultural relations to these changes. In the expansion of associations and community contacts the distinct social settings that men and women live in lead to dissimilar behaviors (Barer, 1994; Carstensen L. L. , 1991). Dr. Kate Bennett (Bennett K. M. 1998) did an 8-year longitudinal study on physical activity in the elderly. The results showed that women were more likely to occupy themselves with indoor activities (e. g. , housework) and men with outdoor activities (e. g. , walking or cycling) (Bennett K. M. , 1998). Involvement in activities, whether readily available or not, is also gender specific. Elderly women are more likely to attend or be involved with religious services and activities than elderly men (Arber, et al, 2002).
For men, staying in touch with what is going on through formal and informal associations or engaging in social activities such as volunteer work helps them maintain self-identity within their society (Arber, et al, 2002). Cultural context also plays a part in the construct of gender roles. In most societies, Western and non-Western, the male role is that of bread winner and the female role is that of homemaker (Li, et al, 2011). Western society mindset has changed over the years to the point where these roles are often reversed or completely annihilated.
In Asia, however, a study done between 1988 and 1997 of people aged 60 or older found that women were more likely to rely on their family for financial support and men were more likely to have their own source of income (Ofstedal, Reidy, & Knodel, 2004). However, a study of “5,294 noninstitutionalized elderly adults…concluded that working for a living was associated with high rates of depression among the elderly” (Hong, et al, 2009), most likely due to Asian traditional social value (xiao) which reflects bad on the family of children who cannot support their parents (Li, et al, 2011).
Facilitators and Barriers The earth’s populace of 60+ year olds has doubled since 1980 and will achieve the 2 billion mark by 2050 according to the World Health Organization (World Health Organization, n. d. ; Gilbert, et al, 2012). Catherine Gilbert, Debra Hagerty and Helen Taggert generated a study “to explore the factors associated with healthy ageing through personal interviews…giving voice to the elders regarding their impression of facilitators and barriers to healthy ageing” (Gilbert, et al, 2012).
The results found the elderly perceive three main facilitators to healthy ageing: “taking care of self; meaningful activity; and positive attitude,” and three main barriers to healthy ageing: “giving up or giving in; environmental limitations; and the ageing process” (Gilbert, et al, 2012). Empathy is a facilitator and plays an important role in healthy ageing and quality of life through social interaction and is a requirement for enduring social commitments (Bailey, Henry, & Von Hippel, 2008). Empathy has been described as the; ‘capacity to understand others and experience their feelings in relation to oneself’ (Decety & Jackson, 2004). Few studies have been done to reveal whether empathic capacity diminishes with age (Bailey, et al, 2008). Phoebe Bailey, Julie Henry and William Von Hippel researched the “possibility that age-related reductions in social functioning might be mediated by declining cognitive empathy” with results testifying “cognitive empathy was significantly reduced related to younger adults,” but “there were no age-related differences in affective empathy” (Bailey, et al, 2008).
Thus empathy as a facilitator to healthy aging and quality of life bares much weight in functional relationships. A social network also facilitates healthy aging and quality of life. Social support, created by relationships, both formal and informal, provides one with emotional, affective and material help, with information, and with positive social interaction (Ostergren, Hanson, Isacsson, & Tejler, 1991). It has been proven by studies that adequate social support is a efensive aspect in functional disability and cognitive compromise in the elderly (Golden, Conroy, & Lawlor, 2009; Bennett, Schneider, Tang, Arnold, & Wilson, 2006; Stuck, Walhert, Nikolaus, Bula, Hohmann, & Beck, 1999). Autonomy and independence within family and social circles is maintained through social supports and is essential to cognitive functions and psychological well-being (Golden, et al, 2009; Bennett, et al, 2006; Stuck, et al, 1999). On the other hand, barriers to healthy ageing and quality of life include physical ability and cognitive alterations.
Barriers “reported by older adults are physical health problems and frailty, resultant injury and falling, lack of motivation, feeling low, time constraints, social barriers, past seentary lifestyle, feeling too tired, and environmental restrictions such as transportation, weather, neighborhood safety, fatigue and having no one to exercise with” (Belza, et al. , 2004; Bird, et al. , 2009; Chen, 2010; Conn, 1998; Lees, Clark, Nigg, & Newman, 2005; Newson & Kemps, 2007; Prohaska, et al. , 2006).
Yet fear of disease and becoming dependent is a great motivator to be physically active (Welmer, Morck, & Dahlin-Ivanoff, 2012). Another barrier to healthy ageing and quality of life in the elderly is cognitive alterations. Primary aging results in a slow steady decline of mental functions. Loss of words, ability to understand and perceive, to move efficiently and smoothly, and ability to manage, control, and regulate cognitive processes all deteriorate as we get older, allbeit some faster than others (Brito & Pavarini, 2012). …with memory loss standing out most in the population in general.
Maintenance of cognition is an important determinant for quality of life and life expectancy in old age, as cognitive decline is associated with personal discomfort, loss of autonomy and increase of social costs (Brito & Pavarini, 2012). Research and Results The Center for Disease Control and Prevention (CDC), the CDC Healthy Ageing Research Network (CDC-HAN) and the European Union Active and Healthy Ageing partnership (ND) all agree healthy ageing is important and pursue educating the public through studies and research (Gilbert, et al, 2012).
The mission of the CDC Healthy Ageing Research Network is: “To better understand the determinants of healthy ageing in diverse populations and settings; to identify, develop, and evaluate programs and policies that promote healthy ageing; and to translate and disseminate research into effective and sustainable public health programs and policies throughout the nation (CDC, 2012). By using research from these agencies, communities throughout the world can develop programs that enhance and promote healthy aging and quality of life for the elderly (Gilbert, et al, 2012).
The World Health Organization is aware of the challenges in healthcare faced in the 21st century, as well as, the need for the contributions the elderly make (Gilbert, et al, 2012). In support of healthy ageing and quality of life we need “training for health professionals on old-age care; preventing and managing age-associated chronic diseases; designing sustainable policies on long-term and palliative care; and developing age-friendly services and settings” (WHO, n. d. ) Along with national research, colligate, institutional, private, and organizational studies continue the quest for positive healthy aging and quality of life.
Many studies extol the benefits of social support and physical activity upon the health and well-being, both mentally and physically, of the elderly. A study by Anna-Karin Welmer, Annika Morck, and Synneve Dahlin-Ivanoff; “Physical Activity in People Age 80 Years and Older as a Means to Counteracting Disability, Balanced in Relation to Frailty,” declares: …results suggest that physical activity was not seen as a separate activity but rather as a part of activities often rated as more important than the physical activity itself.
Thus, when designing physical activity interventions for elderly people, health care providers should consider including time for social interaction and possibilities to be outdoors (Welmer, et al, 2012). In another study exploring “Empathy and Social Functioning in Late Adulthood,” Bailey, Henry, and Von Hippel report: …aging may differentially impact cognitive and affective empathy, and that the former may be of particular importance for social functioning.
Given the negative consequences that loneliness and social isolation have for physical and mental well-being (House, Landis, & Umberson, 1988), particularly among older adults (for whom reduced social participation has been linked to increased mortality; (Bath & Deeg, 2005; Fry & Debats, 2006), these findings seem a worthwhile topic for further investigation (Bailey, et al, 2008). Yet another study by Gilbert, Hagerty and Taggert, “Exploring Factors Related to Healthy Ageing,” reveals the importance of environment in facilitating a healthy social and physically active lifestyle.
Tom, an interviewee and participant in the study “was very articulate about the need for environmental modifications that support the lifestyles of the elderly (Gilbert, et al, 2012). “To be active, means to be able to travel and do things. Unfortunately, when we travel, the people who claim to have handicap rooms have had the worst advice in the world. Numerous times I have been placed in situations where you can’t sit down in the shower or if you get in the tub, you can’t get out” (Gilbert, et al, 2012).
In a study, “Gender Differences in the Relationship of Social Activity and Quality of Life in Community- Dwelling Taiwanese Elders,” Li, Lin, and Chen find to some degree that gender does play a role in what activities are pursued and measured as resulting in quality of life by the elderly. For the men in this study, engaging in contact with friends, informal group activity, formal group activity, and voluntary work were significantly associated with the total quality of life. Among women, our data show that fewer types of social activity are associated with quality of life domains (Li, et al, 2011).
Men seemed to derive quality of life through formal groups where status and title were bestowed, whereas, women found quality of life sustained in religious activities (Li, et al, 2011). A study by Brito and Pavarini, “The Relationship Between Social Support and Functional Capacity in Elderly Persons with Cognitive Alterations,” corroborates the importance of social support in regards to healthy aging and quality of life, especially among the elderly with cognitive inpairment.
Social support may protect individuals from the pathogenic effects of stressing events, as much as it may positively affect people’s health by providing resources (economic and material help and information), better access to health care and regulation of living habits (Ramos, 2002). Research and study in gerontology promote understanding of the needs of the elderly in establishing adequate structuring and implantation of pathways that contribute to social support and physical activities, which in turn corroborates healthy aging and quality of life (Brito & Pavarini, 2012).
Conclusion Getting old is a fact of life and with advances in medicine and the world’s population living longer (WHO, n. d. ), coping successfully with getting older requires selective optimization with compensation; setting goals, assessing abilities, and making plans to achieve regardless of hindrances and limitations (Berger, 2011). A positive outlook, family and friends, and an active lifestyle are all deterrents of morbidity (Gilbert, Hagerty, & Taggert, 2012).
Influenced by a healthy lifestyle, successful healthy ageing is clearly related to a decreased mortality risk and a postponement in, and in some cases suspension of, health deterioration (Merrill, et al, 2008). Maintaining a social calendar and routine physical activity clearly supports healthy aging and quality of life in the elderly. Bibliography Adams, K. B. , & Sanders, S. (2010). Measurement of developmental change in late life: a validation study of the change in activities and interests index. Clinical Gerontologist, 92-108. Arber, S. , Perren, K. , & Davidson, K. (2002).
Involvement in social organizations in later life: Variations by gender and class. In L. Andersson (Ed. ), Cultural gerontology (pp. 77-93). Westport, CT: Auborn House. Bailey, P. E. , Henry, J. D. , & Von Hippel, W. (2008, July). Empathy and social functioning in late adulthood. Aging & Mental Health, Vol. 12, No. 4, 499-503. Barer, B. M. (1994). Men and women aging differently. International Journal of Aging and Hua Development, 38(1), 29-40. Bath, P. A. , & Deeg, D. (2005). Social engagement and health outcomes among older people: Introduction to a special section. European Journal of Aging, 2, 24-30.
Belza, B. , Walwick, J. , Shiu-Thornton, S. , Schwartz, S. , Taylor, M. , & LoGerfo, J. (2004). Older adult perspectives on physical activity and exercise: Voices from multiple cultures. Preventing Chronic Disease, 1, A09. Bennett, D. A. , Schneider, J. A. , Tang, Y. , Arnold, S. E. , & Wilson, R. S. (2006). The effect of social networks on the relation between Alzheimer’s disease pathology and level of cognitive function in old people: a longitudinal cohort study. Lancet Neurol, 5(1), 406-412. Bennett, K. M. (1998). Gender and longitudinal changes in physical activities in later life. Age and Ageing, 27(suppl. ), 24-28. Berger, K. (2011). The Developing Person Through the Life Span. New York: Worth Publishers. Bird, S. , Kurowski, W. , Feldman, S. , Browning, C. , Lau, R. , Radermacher, H. , ; Thomas, S. (2009). The insluence of the built environment and other factors on the physical activity of older women from different ethnic communities. Journal of Women and Aging, 21, 33-47. Brito, T. , ; Pavarini, S. (2012). The relationship between social support and functional capacity in elderly persons with cognitive alterations. Revista Latino-Americana de Enfermagem, 677-684. Buchman, A. S. , Boyle, P. A. Wilson, R. S. , Fleischman, D. A. , Leurgans, S. , ; Bennett, D. A. (2009). Association between late life social activity and motor decline in older adults. Archives of International Medicine, 169(12), 1139-1146. Carstensen, L. L. (1991). Selctivity theory: Social activity in life-span context. Annual Tview of Gerontology and Geriatrics, 11, 195-213. Carstensen, L. L. (1992). Social and Emotional Patterns in Adulthood: Support for Socioemotional Selectivity Theory. Psychology and Aging, 7(3), 331-338. CDC. (2012, April 12). CDC’s Prevention Research Centers Healthyy Aging Research Network (CDC-HAN).
Retrieved from Centers for Disease Control and Prevention: http://www. cdc. gov/aging/han/ Chen, Y. M. (2010). Perceived barriers to physical activity among older adults residing in long-term care institutions. Journal of Clinical Nursing, 19, 432-439. Conn, V. S. (1998). Older women’s beliefs avout physical activity. Public Health Nursing (Boston, Mass. ), 15, 370-378. Cumming, E. , ; Henry, W. E. (1961). Growing old: the process of disengagement. New York: Basic Books. Decety, J. , ; Jackson, P. L. (2004). The functional architecture of human empathy. Behavioural and Cognitive Neuroscience Reviews, 3, 71-100.
Elhman, K. , ; Ligon, M. (2012). The Application of a Generativity Model for Older Adults. International Journal of Aging and Human Development, 331-344. Erikson, E. H. , ; Erikson, J. M. (1997). The life cyclecompleted (Extended version ed. ). New York: W. W. Norton ; Company, Inc. Erikson, E. H. , Erikson, J. M. , ; Kivnick, H. Q. (1986). Vital involvement in old age. New York: Norton. Fry, P. S. , ; Debats, D. L. (2006). Sources of life strengths as predictors of late-life mortality and survivorship. International Journal of Aging and Human Development, 62, 303-334. Gilbert, C. , Hagerty, D. ; Taggert, H. (2012). Exploring Factors Related to Healthy Ageing. Self-Care, Dependent-Care ; Nursing, 20-25. Golden, J. , Conroy, R. M. , ; Lawlor, B. A. (2009). Social support network structure in older people: Underlying dimensions and association with psychological and phsical health. Psychological Health ; Medicine, 14(3), 280-290. Havighurst, R. , ; Albrecht, R. (1953). Older people. New York: Longmans, Green. Hong, S. I. , Hasche, L. , ; Bowland, S. (2009). Structural relationships between social activities and logitudinal trajectories of depression among older adults.
The Gerontologist, 49(1), 1-11. House, J. S. , Landis, K. R. , ; Umberson, D. (1988). Social relationships and health. Science, 241, 540-545. James, J. , ; Zarrett, N. (2006). Ego integrity in the lives of older women. Journal of Adult Development, 13(2), 61-75. Lees, F. D. , Clark, P. G. , Nigg, C. R. , ; Newman, P. (2005). Barriers to exercise behavior among older adults: A focus-group study. Journal of Aging and Physical Activity, 13, 23-33. Lennartsson, C. , ; Silverstein, M. (2001). Does engagement with life enhance survival of elderly people in Sweden? The role of social and leisure activities.
Journal of Gerontology, 56B(6), S335-342. Li, Y. , Lin, S. , ; Chen, C. (2011). Gender Differences in the Relationship of Social Activity and Quality of Life in Community-Dwelling Taiwanese Elders. Journal of Women ; Aging, 305-320. Masoro, E. J. , ; Austad, S. N. (2006). Handbook of the Biology of Aging (6th ed. ). Amsterdam: Elsevier Academic Press. Menec, V. H. (2003). The relation between everyday activities and successful aging: A 6-year longitudinal study. Journal of Gerontology: Social Sciences, 58B(2), S74-82. Merrill, S. J. , Myklebust, B. , Myklebust, J. , Reynolds, N. ; Duthie, E. (2008). A poisson-like model of sub-clinical signs from the examination of healthy aging subjects. Aging Clinical ; Experimental Research, 20(4), 368-375. Newson, R. S. , ; Kemps, E. B. (2007). Factors that promote and prevent exercise engagement in older adults. Journal of Aging and Health, 19, 470-481. Ofstedal, M. B. , Reidy, E. , ; Knodel, J. (2004). Gender differences in economic support and well-being of older Asians. Journal of Cross-Cultural Gerontology, 19, 165-201. Ostergren, P. O. , Hanson, B. S. , Isacsson, S. O. , ; Tejler, L. (1991).
Social network, social support and acute chest complaints among young and middle-aged patients in an emergency department: A case control study. Social Science ; Medicine, 33(3), 257-267. Prohaska, T. , Belansky, E. , Belza, B. , Buchner, D. , Marshall, V. , McTigue, K. , ; Wilcox, S. (2006). Physical activity, public health, and aging: Critical issues and research priorities. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61(5), S267-S273. Ramos, M. P. (2002). Apoio social e saude entre os idosos. Sociologias, 4(7), 156-175. Rowe, J. W. , ; Kahn, R.
L. (1998). Successful aging. New York: Pantheon. Stuck, A. E. , Walthert, J. M. , Nikolaus, T. , Bula, C. J. , Hohmann, C. , ; Beck, J. C. (1999). Risk factors for functional status decline in community-living elderly people: A systematic review. Social Science and Medicine, 48(1), 445-469. Tornstam, L. (2010). The theory of gerotranscendence. Retrieved 03 2013, from Department of Sociology Uppsala Universitet: http://www. soc. uu. se/en/research/research-fields/the-social-gerontology-group/research/the-theory-of-gerotranscendence/ Welmer, A. , Morck, A. , ; Dahlin-Ivanoff, S. (2012).
Physical Activity in People Age 80 Years and Older as a Means of Counteracting Disability, Balanced in Relation to Frailty. Journal of Aging and Physical Activity, 317-331. WHO. (n. d. ). Aging and Life-Course. Retrieved from World Health Organization: http://www. sho. int/ageing/en/ World Health Organization. (n. d. ). Aging and Life-Course. Retrieved February 24, 2012, from http://www. sho. int/ageing/en/ Yuen, H. K. , Huang, P. , Burik, J. K. , ; Smith, T. G. (2008). Impact of participating in volunteer activities for residents living in long-term-care facilities. The Journal of Occupational Therapy, 62(1), 71-77.