Social Engagement and Well-Being in the Final Five Years of Life - PROJECT SUMMARY/ABSTRACT The objectives of this proposal are to: (A) identify how patterns of social engagement change in the final five years of life, and (B) explore the roles of these changes in shaping well-being and quality-of-life in the years prior to death, as well as end-of-life health care quality, among the older adult population in the United States. Social engagement is a well-established determinant of health, well-being, and mortality, and includes both interaction with close, intimate social ties as well as broader participation in social activities. Prior research demonstrates that patterns of social engagement change throughout later life in response to changes in health and other life course transitions. However, these patterns are relatively understudied during the final years of life, when cognitive and physical health declines may limit social engagement, and yet, when well-being may especially benefit from social engagement. To accomplish these objectives, we will draw on secondary survey data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of Medicare recipients. First, we will use growth curve models to accomplish our aim of estimating how personal social networks and participation in various social activities (e.g., volunteering, organized group activities) each change during the final five years of life. Second, we will use multiple regression and cross-lagged panel models to accomplish our aim of identifying how various forms of social engagement are associated with quality of life in the five years prior to death. Our focus on quality of life will include healthcare in the last month of life, and physical function, cognitive function, and psychological well-being in the five years prior to death. We will pay particular attention to how changes in social engagement vary across older adults with and without dementia and physical functional impairment, for whom social engagement may be particularly difficult to maintain, but for whom maintaining high levels of social engagement might greatly benefit end-of-life experiences. We expect that the findings from this study will inform the potential for social interventions to enhance quality of life at the end of the life course, as a particularly vulnerable period for both health and social well-being. The number of older adults in the United States who will die with dementia is projected to more than double in the next three decades, highlighting the urgent need to understand the social contexts of end-of-life experiences that are unique to this population. As the United States ranks below many peer countries in quality of end-of-life care, this proposal will draw much needed attention to social factors outside of the healthcare system that may be considered in efforts to improve end-of-life experiences for older adults, their family members, and their care providers.
