Increased mortality risk in older adults with persistently low or declining feelings of usefulness to others.

Engagement in social and productive activities, especially those which contribute to the well-being of others and society, are often cited indicators of healthy or successful aging in later life (Fischer, 1995; Moody, 2001; Rowe & Kahn, 1998). The desire to contribute to others, be productive, and feel useful have also been cited as important motives for volunteerism and social activity in older adulthood (Hainsworth & Barlow, 2001; Okun, 1994). Such activity may, in turn, benefit older adults’ mental and physical well-being. A sizable body of research indicates that greater engagement in social and productive activity is linked to better functioning and health and greater longevity in later life (e.g., Glass, de Leon, Marottoli, & Berkman, 1999; Mendes de Leon, Glass, & Berkman, 2003; Menec, 2003; Musick, Herzog, & House, 1999). A handful of studies have also shown that what older adults think about their social value and usefulness may be as important as their actual activity in terms of an impact on health. Such work has focused on whether perceptions of social usefulness are linked with disability and mortality outcomes in later life. Studies of rural-dwelling French (age 60 years and older) and Japanese (aged 65 years and older) elders have shown that compared to older adults who frequently felt useful to others, those with low feelings of social usefulness were more likely to experience increases in physical disability and impairments in the ability to perform activities of daily living (ADLs) and more likely to die over follow-up periods of four to six years (Grand, Grosclaude, Bocquet, Pous, & Albarede, 1988; Okamoto & Tanaka, 2004). Similarly, not feeling needed by others predicted greater risk of institutionalization and mortality in a study of older Finnish adults (those age 75, 80, and 85 years; Pitkala, Laakkonen, Strandberg, & Tilvis, 2004)). These findings were recently replicated in a sample of older Americans; compared to elder Americans (those age 70–79 years) with high feelings of usefulness to others at study entry, those with low feelings of social usefulness were more likely to show increases in physical disability (ADL and mobility impairments) or to die over a seven-year follow-up period (Gruenewald, Karlamangla, Greendale, Singer, & Seeman, 2007). To date, studies on feelings of social usefulness in older adults demonstrate that characteristics of usefulness perceptions, such as having low versus high feelings of social usefulness, predict the likelihood of poor functioning and health outcomes years later. However, there has been relatively little work that has explored how these feelings change over time and the health correlates of different patterns of change in these perceptions. Older adults who maintain high feelings of usefulness may experience quite different health trajectories from those with persistently low or declining feelings of usefulness over time. A study of Japanese community-dwelling elders reported that feelings of usefulness to others were essentially stable over a six-year period (Okamoto & Tanaka, 2004). However, the stability of feelings of usefulness for other samples of elders, including older Americans, has not been examined. In addition, little is known regarding the social, behavioral or health correlates of change in perceptions of social usefulness. A number of characteristics of older adulthood, including declines in social, productive and physical activity, shrinking social networks, and deteriorations in health and functioning may have a negative impact on feelings of social usefulness. Although there is substantial variability in rates of participation in productive and social activity among older adults (Glass, Seeman, Herzog, Kahn, & Berkman, 1995), in general, older adulthood is characterized by a decline in such activities (Herzog, Kahn, Morgan, Jackson, & Antonucci, 1989; Rossi, 2004). Declines in social and productive activity may act to erode feelings of social usefulness, as older adults lose sources of activity in which a focus is on helping or doing for others. Another factor that may impact feelings of social usefulness are changes in the social networks of older adults, including a decrease in number of social ties and the frequency of interactions with ties due to poor health of network members, declines in social and productive activity, and deteriorations in functioning and health (Benjamins, Musick, Gold, & George, 2003; Cerhan & Wallace, 1993; Wenger & Burholt, 2004). The shrinking size of social networks in later adulthood limits the number of social targets to whom older adults can feel useful. Declines in functioning and health status may also constrain older adults’ ability to provide meaningful services to others, and may thereby have a negative impact on older adults’ perceptions of their level of usefulness to others. On the other hand, changes in feelings of social usefulness may themselves have an impact on social factors, health behaviors and health and functioning. As previously noted, the desire to be useful and productive is one motivator of social and productive activity (Hainsworth & Barlow, 2001; Okun, 1994); older adults with persistently low or declining feelings of usefulness may perceive that they have little to offer others and as a consequence may be less likely to initiate social interaction or engage in productive social activity. Negative changes in feelings of social usefulness may also impact self-care and engagement in health promotion behaviors. Less positive self-perceptions of aging, including the belief that one remains useful as one ages, predicted lower engagement in preventative health behaviors over a 20-year follow-up in a study of older adults (Levy & Myers, 2004). Previous investigations have also noted concurrent associations between low feelings of usefulness and poor health behaviors, including low levels of physical activity and smoking in older adults (Grand et al., 1990; Gruenewald et al., 2007). Although no study to date has examined associations between changes in perceptions of social usefulness and changes in health behavior over time, declining feelings of social usefulness may sap elders’ motivation to engage in health-promoting activities. As also previously reviewed, low feelings of social usefulness measured at a baseline point have been found to predict poor functioning and health outcomes years later, thus it is likely that the persistent experience of low feelings of usefulness or declines in these feelings over time may be detrimental for functioning and health in later life. The present study extends research in this area by examining how feelings of social usefulness change over time in older adulthood, the social, behavioral and health correlates of change in these feelings, and whether specific patterns of change in feelings of social usefulness differentially predict mortality risk in later life. Specifically, this study examines patterns of change in feelings of usefulness over a 3-year period in a cohort of older adults (age 70–79 at study entry) from the MacArthur Study of Successful Aging, and the association between change in usefulness perceptions over this period and hazard of mortality over a subsequent 9-year period. Associations between patterns of change in feelings of social usefulness and concurrent patterns of social, behavioral, health and functioning variables are also assessed. Given the concurrent measurement of these variables, it is difficult to disentangle whether changes in feelings of social usefulness might alter social, behavioral and health states, or whether changes in social relationships/activity, behavior and health status might impact feelings of social usefulness. As reviewed above, it is likely that relationships between perceptions of usefulness and these social, behavioral and health factors are bidirectional, affecting each other in a reciprocal fashion over time. However, alterations in the association between patterns of change in feelings of social usefulness and mortality hazard when including social, behavioral and health covariates into analytic models will at the very least provide knowledge as to mechanisms that may be involved in links between usefulness perceptions and mortality.