Harnessing the wisdom of the ages

At age 63, Joyce Lawrence found that for the first time in her life, she had time on her hands. Her children had left her Baltimore home to raise their own families and she had retired from her job as a correction officer in prisons. Her duties were over, but she felt a growing urge to contribute to society in some other way.

"At our age, you're left alone a lot of the time and it's easy to just watch TV or watch cars go by because you feel no one needs you anymore," she says. "But that's not true. After you have that pity party, you need to find out how you're needed and go make yourself useful."

For Lawrence, the opportunity to be useful came through the Experience Corps, a nonprofit organization that brings retired volunteers as mentors to struggling students in needy schools. The program was the brainchild of psychologist and social reformer John Gardner, PhD, remembered for his push to improve education, eliminate poverty and promote equality. As Secretary of Health, Education and Welfare under President Lyndon Johnson in the 1960s, he launched Medicare and oversaw the passage of the Elementary and Secondary Education Act, which aimed to ensure quality education for poor and rich students alike. At 76 years old, he wrote a concept paper that served as the blueprint for the Experience Corps. In it, he argues that sending seniors out to pasture does a disservice to them as well as to society, and that a program like Experience Corps could capitalize on the wisdom of the elderly.

"We believe," he wrote, "that the large numbers of us over age 65 constitute a rich reservoir of talent, experience and commitment potentially available to society."

The Experience Corps now include about 2,000 seniors nationwide, who mentor elementary school students for at least 15 hours each week, especially in low-income neighborhoods where class sizes swell. Student attendance and reading comprehension appear to improve in classes supported by volunteers. And based on testimonials, the volunteers enjoy the program.

However, anecdotes may not be enough to keep the program afloat when education and public health budgets are strained. At the moment, the program relies on federal funding through AmeriCorps (the Corporation for National and Community Service), as well as state and local public and private funds, and foundations including the Atlantic Philanthropies. To examine whether the cost of the program is justified, Linda Fried, MD, MPH, the dean of Columbia's Mailman School of Public Health, has solicited help from an interdisciplinary group of colleagues to assess its impact on the students and elderly volunteers. Together with the Johns Hopkins Center on Aging and Health, she's developed a research-community partnership with the Greater Homewood Community Corporation to conduct trials assessing the program.

Quantifying cognition

Michelle Carlson, PhD, an associate professor of psychology at Johns Hopkins, says her preliminary findings suggest that the cognitive capabilities of elderly volunteers in the Experience Corps improve. Small teams of Experience Corps volunteers cooperate with teachers to help children who struggle with reading and learning. Beyond aiding kids with their studies, the volunteers provide the individual encouragement often lacking in crowded classrooms.

"Every child has different needs, so that means the volunteers must solve problems, multitask and exercise their executive abilities on a broad level," says Carlson. After 32 hours of training, participants volunteer for at least 15 hours per week within schools, where they assist classroom teachers and librarians by helping students read, recommending books, and providing one-on-one encouragement to children who've struggled with their lessons.

Those executive abilities—planning, abstract thinking and filtering relevant sensory information—are also crucial for driving, shopping, cooking and other activities necessary for independent living, and so strengthening those abilities can help seniors stay independent longer. Carlson says the intellectual and social engagement, and the physical activity, which volunteering in schools requires, might have that effect, but it's difficult to prove causation. After all, seniors who retain their cognitive faculties longer might volunteer more often—and might fare equally well if they didn't.

To demonstrate causality, Carlson and her colleagues analyzed functional magnetic resonance imaging (fMRI) data for signs of improvement or at least maintenance in the prefrontal brain region that supports executive function, in Experience Corps volunteers and in elderly people not involved in the program. In two pilot studies published in 2008 and 2009 in The Gerontologist and the Journal of Gerontology, the team reported gains in executive function, according to cognitive tests and increased activity in the prefrontal regions of volunteers compared with controls. She and her colleagues have increased the number of participants to 702 in a trial that began in 2005. If participants who have been active in the program for two years show cognitive benefits or cognitive stability that accrues beyond one year of exposure or less, Carlson and colleagues can check off a critical element in proving causality—a dose-dependent effect.

"Even if the program simply maintains brain function over two years, that implies we can delay an individual's progression to dementia, and that has huge personal and public health implications," says Carlson.

Importantly, the Experience Corps reaches a population of senior citizens who are at high risk for cognitive impairment—often those from lower economic classes with no college education. The majority of participants are African American. Carlson says that in her trials, she intentionally tries to reach this at-risk population, who traditionally do not volunteer for health promotion programs, but are willing to serve the community.

"These volunteers are not the ‘worried well,'" says Carlson. They don't usually leap at treatments and tasks marketed as cognitive-enhancing, such as ginkgo biloba and Sudoku, she says, but many respond to "calls to service" to help youth in need.

Nonetheless, the program in Baltimore, with 292 volunteers, costs about $1.5 million a year. That cost includes stipends for the volunteers' food and travel expenses, yearly salaries for the directors, program administrator, entry personnel, a volunteer coordinator and the cost of the training sessions. So, the Experience Corps is far more expensive than Sudoku and ginkgo. But Carlson argues that quick fixes like these haven't been shown to translate into broad improvements in cognition, particularly in real-world measures of executive functioning, while her preliminary analyses suggest the Experience Corps does. The way in which the program's activities improve executive functioning, however, may be tough to untangle.

"The Experience Corps can't tell us the nitty-gritty details on mechanism," says Arthur Kramer, PhD, a professor of psychology at the University of Illinois at Urbana-Champaign, "but from a practical point of view, it doesn't matter a whole heck of a lot."

A boost for students

To complement the neuroscience research, Johns Hopkins health economist Kevin Frick, PhD, is leading an effort to compute the program's financial and health effects by looking at its impact on teachers, tutored students and elderly participants. In a 2004 pilot study in the Journal of Urban Health, Frick's team found that the immediate improvements in health gained by participants over two years don't balance out the program's cost. However, this equation might change if long-term studies find that the program staves off dementia, Frick says.

Moreover, it's too soon to tell if the program increases children's chances of graduating high school. If it does, the program would be well worth its price tag. The team determined that the annual cost of the Baltimore program would be offset by the higher salaries earned by people with high school diplomas, if graduation rates increase by just 0.5 percent, or 1 in 200, because of Experience Corps interventions early on. However, filling in variables like the rate of high school graduation and the time to dementia, which would decrease medical costs, may take up to a decade. "The biggest threat to an economic argument is people's impatience in waiting for a benefit," Frick says.

Finances aside, preliminary results support the notion that the program provides a meaningful ray of light for people in their golden years and in their dawn. And testimony from volunteers doesn't hurt the case. "I go for the mental stimulation, and I go because physically it's good to move around," says Barbara, a 77-year-old participant. "It's emotional, and I must say it's awfully spiritual to know I'm making a difference."

Amy Maxmen is a writer in New York City.