Lindsay-Smith et al.

BMC Geriatrics (2018) 18:226

https://doi.org/10.1186/s12877-018-0913-1

RESEARCH ARTICLE Open Access

A mixed methods case study exploring the

impact of membership of a multi-activity,
multicentre community group on social
wellbeing of older adults
Gabrielle Lindsay-Smith1* , Grant O’Sullivan1, Rochelle Eime1,2, Jack Harvey1,2 and Jannique G. Z. van Uffelen1,3

Abstract
Background: Social wellbeing factors such as loneliness and social support have a major impact on the health of
older adults and can contribute to physical and mental wellbeing. However, with increasing age, social contacts
and social support typically decrease and levels of loneliness increase. Group social engagement appears to have
additional benefits for the health of older adults compared to socialising individually with friends and family, but
further research is required to confirm whether group activities can be beneficial for the social wellbeing of older
adults.
Methods: This one-year longitudinal mixed methods study investigated the effect of joining a community group,
offering a range of social and physical activities, on social wellbeing of adults with a mean age of 70. The study
combined a quantitative survey assessing loneliness and social support (n = 28; three time-points, analysed using
linear mixed models) and a qualitative focus group study (n = 11, analysed using thematic analysis) of members
from Life Activities Clubs Victoria, Australia.
Results: There was a significant reduction in loneliness (p = 0.023) and a trend toward an increase in social support
(p = 0.056) in the first year after joining. The focus group confirmed these observations and suggested that social
support may take longer than 1 year to develop. Focus groups also identified that group membership provided
important opportunities for developing new and diverse social connections through shared interest and
experience. These connections were key in improving the social wellbeing of members, especially in their
sense of feeling supported or connected and less lonely. Participants agreed that increasing connections was
especially beneficial following significant life events such as retirement, moving to a new house or partners
becoming unwell.
Conclusions: Becoming a member of a community group offering social and physical activities may improve
social wellbeing in older adults, especially following significant life events such as retirement or moving-house, where
social network changes. These results indicate that ageing policy and strategies would benefit from encouraging long-
term participation in social groups to assist in adapting to changes that occur in later life and optimise healthy ageing.
Keywords: Ageing, Social support, Social engagement, Friendship, Loneliness, Retirement, Group activity

* Correspondence: [email protected]
1
Institute for Health and Sport, Victoria University, Melbourne, Australia
Full list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 2 of 14

Background (health gap social determinants) and are sometimes re-

Ageing population and the need to age well ferred to as ‘social cure’ social determinants [11]. They
Between 2015 and 2050 it is predicted that globally the will be referred to as ‘social wellbeing’ outcome mea-
number of adults over the age of 60 will more than sures in this study.
double [1]. Increasing age is associated with a greater Unfortunately, with advancing age, there is often
risk of chronic illnesses such as cardio vascular disease diminishing social support, leading to social isolation
and cancer [2] and reduced functional capacity [3, 4]. and loneliness [18, 19]. Large nationally representative
Consequently, an ageing population will continue to studies of adults and older adults reported that social ac-
place considerable pressure on the health care systems. tivity predicted maintenance or improvement of life sat-
However, it is also important to consider the individuals isfaction as well as physical activity levels [20], however
themselves and self-perceived good health is very import- older adults spent less time in social activity than middle
ant for the individual wellbeing and life-satisfaction of age adults.
older adults [5]. The terms “successful ageing” [6] and
“healthy ageing” [5] have been used to define a broader Social wellbeing and health
concept of ageing well, which not only includes factors re- A number of longitudinal studies have found that social
lating to medically defined health but also wellbeing. Un- isolation for older adults is a significant predictor of mor-
fortunately, there is no agreed definition for what exactly tality and institutionalisation [21–23]. A meta-analysis by
constitutes healthy or successful ageing, with studies using Holt-Lunstadt [12] reported that social determinants of
a range of definitions. A review of 28 quantitative studies health, including social integration and social support (in-
found that successful ageing was defined differently in cluding loneliness and lack of perceived social support) to
each, with the majority only considering measures of dis- be equal to, or a greater risk to mortality as common be-
ability or physical functioning. Social and wellbeing factors havioural risk factors such as smoking, physical inactivity
were included in only a few of the studies [7]. and obesity. Loneliness is independently associated with
In contrast, qualitative studies of older adults’ opinions poor physical and mental health in the general population,
on successful ageing have found that while good physical and especially in older adults [13–15]. Adequate perceived
and mental health and maintaining physical activity social support has also been consistently associated with
levels are agreed to assist successful ageing, being inde- improved mental and physical health in both general and
pendent or doing something of value, acceptance of age- older adults [20, 24–29]. The mechanism suggested for
ing, life satisfaction, social connectedness or keeping this association is that social support buffers the negative
socially active were of greater importance [8–10]. impacts of stressful situations and life events [30]. The
In light of these findings, the definition that is most above research demonstrates the benefit of social engage-
inclusive is “healthy ageing” defined by the World ment for older adults; in turn this highlights the import-
Health Organisation as “the process of developing ance of strategies that reduce loneliness and improve
and maintaining the functional ability (defined as a social support and social connectedness for older adults.
combination of intrinsic capacity and physical and Socialising in groups seems to be especially important
social environmental characteristics), that enables for the health and wellbeing of older adults who may be
well-being in older age” (p28) [5].This definition, and adjusting to significant life events [26, 31–33]. This is
those provided in the research of older adults’ percep- sometimes referred to as social engagement or social
tions of successful ageing, highlight social engagement companionship [26, 30, 31]. It seems that the mechan-
and social support as important factors contributing ism enabling such health benefits with group participa-
to successful ageing, in addition to being important tion is through strengthening of social identification,
social determinants of health [11, 12]. which in turn increases social support [31, 34, 35]. Fur-
Social determinants of health, including loneliness and thermore, involvement in community groups can be a
social support, are important predictors of physical, cog- sustainable strategy to reduce loneliness and increase so-
nitive and mental health and wellbeing in adults [12] cial support in older adults, as they are generally low
and older adults [13–15]. Loneliness is defined as a per- cost and run by volunteers [36–39].
ception of an inadequacy in the quality or quantity of Despite the demonstrated importance of social factors
one’s social relationships [16]. Social support, has various for successful ageing and the established risk associated
definitions but generally it relates to social relationships with reduced social engagement as people age, few
that are reciprocal, accessible and reliable and provide in-depth studies have longitudinally investigated the im-
any or a combination of supportive resources (e.g. emo- pact of community groups on social wellbeing. For ex-
tional, information, practical) and can be measured as ample, a non-significant increase in social support and
perceived or received support [17]. These types of social reduction in depression was found in a year-long rando-
determinants differ from those related to inequality mised controlled trial conducted in senior centres in
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 3 of 14

Norway with lonely older adults in poor physical and and motivational support to older adults managing sig-
mental health [37]. Some qualitative studies have re- nificant change in their lives, especially retirement.
ported that community groups and senior centres can
contribute to fun and socialisation for older adults, how- Survey
ever social wellbeing was not the primary focus of the Eighteen out of 23 LAC clubs agreed to take part in the
studies [38, 40, 41]. Given that social wellbeing is a survey study. During the sampling period from May
broad and important area for the health and quality of 2014 to December 2016, new members from the partici-
life in older adults, an in-depth study is warranted to pating clubs were given information about the study and
understand how it can be maximised in older adults. invited to take part. Invitations took place in the form of
This mixed methods case study of an existing commu- flyers distributed with new membership material.
nity aims to: i) examine whether loneliness and social
support of new members of Life Activities Clubs (LACs) Inclusion/ exclusion criteria Community-dwelling
changes in the year after joining and ii) conduct an older adults who self-reported that they could walk at
in-depth exploration of how social wellbeing changes in least 100 m and who were new members to LACVI and
new and longer-term members of LACs. able to complete a survey in English were eligible to par-
ticipate. New members were defined as people who had
never been members of LACVI or who had not been
Methods
members in the last 2 years.
Design
To ensure that the cohort of participants were of a
A mixed methods study was chosen as the design for
similar functional level, people with significant health
this research to enable an in-depth exploration of how
problems limiting them from being able to walk 100 m
loneliness and social support may change as a result of
were excluded from participating in the study.
joining a community group. A case study was conducted
Once informed consent was received, the participants
using a concurrent mixed-methods design, with a quali-
were invited to complete a self-report survey in either
tative component giving context to the quantitative re-
paper or online format (depending on preference). This
sults. Where the survey focused on the impact of group
first survey comprised the baseline data and the same
membership on social support and loneliness, the focus
survey was completed 6 months and 12 months after
groups were an open discussion of the benefits in the
this initial time point. Participants were sent reminders
lived context of LAC membership. The synthesis of the
if they had not completed each survey more than 2 weeks
two sections of the study was undertaken at the time of
after each was delivered and then again 1 week later.
interpretation of the results [42].
The two parts of our study were as follows:
Focus groups
Two focus groups (FGs) were conducted with new and
a) a longitudinal survey (three time points over 1 year:
longer-term members of LACs. The first FG (n = 6) con-
baseline, 6 and 12 months). This part of the study
sisted of members who undertook physical activity in
formed the quantitative results;
their LAC (e.g. walking groups, tennis, cycling). The sec-
b) a focus group study of members of the same
ond FG (n = 5) consisted of members who took part in
organisation (qualitative).
activities with a non-physical activity (PA) focus (e.g.
book groups, social groups, craft or cultural groups).
Ethics approval to conduct this study was obtained
LACs offer both social and physical activities and it was
from the Victoria University Human Research Ethics
important to the study to capture both types of groups,
Committee (HRE14–071 [survey] and HRE15–291
but they were kept separate to assist participants in
[focus groups]) All participants provided informed con-
feeling a sense of commonality with other members
sent to partake in the study prior to undertaking the first
and improving group dynamic and participation in
survey or focus group.
the discussions [43]. Of the people who participated
in the longitudinal survey study, seven also partici-
Setting and participants pated in the FGs.
Life activities clubs Victoria The FG interviews were facilitated by one researcher
Life Activities Clubs Victoria (LACVI) is a large (GLS) and notes around non-verbal communication,
not-for-profit group with 23 independently run Life Ac- moments of divergence and convergence amongst group
tivities Clubs (LACs) based in both rural and metropol- members, and other notable items were taken by a sec-
itan Victoria. It has approximately 4000 members. The ond researcher (GOS). Both researchers wrote additional
organisation was established to assist in providing phys- notes after the focus groups and these were used in the
ical, social and recreational activities as well as education analysis of themes. Focus groups were recorded and later
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 4 of 14

transcribed verbatim by a professional transcriptionist, Sociodemographic variables

including identification of each participant speaking. The following sociodemographic characteristics were
One researcher (GLS) reviewed each transcription to collected in both the survey and the focus groups: age,
check for any errors and made any required modifica- sex, highest level of education, main life occupation [52],
tions before importing the transcriptions into NVivo for current employment, ability to manage on income avail-
analysis. The transcriber identified each focus group par- able, present marital status, country of birth, area of resi-
ticipant so themes for individuals or other age or gender dence [53]. They are categorised as indicated in Table 2.
specific trends could be identified.
Health variables
The following health variables were collected: Self-rated
Dependent variables
general health (from SF-12) [54] and Functional health
Social support
(ability to walk 100 m- formed part of the inclusion cri-
Social support was assessed using the Duke–UNC Func-
teria) [55]. See Table 2 for details about the categories of
tional Social support questionnaire [44]. This scale spe-
these variables.
cifically measures participant perceived functional social
support in two areas; i) confidant support (5 questions;
Analysis
e.g. chances to talk to others) and ii) affective support (3
Survey
questions; e.g. people who care about them). Participants
The effects of becoming a member on quantitative out-
rated each component of support on a 5-item likert scale
come variables (i.e. Social support, DJG loneliness and
between ‘much less than I would like’ (1 point) to ‘as
UCLA loneliness) were analysed using linear mixed
much as I would like’ (5 points). The total score used for
models (LMM). LMM enabled testing for the presence
analysis was the mean of the eight scores (low social
of intra-subject random effects, or equivalently, correl-
support = 1, maximum social support = 5). Construct
ation of subjects’ measures over time (baseline,
validity, concurrent validity and discriminant validity are
6-months and 12 months). Three correlation structures
acceptable for confidant and affective support items in
were examined: independence (no correlation), com-
the survey in the general population [44].
pound symmetry (constant correlation of each subjects’
measures over the three time points) and autoregressive
Loneliness (correlation diminishing with increase in spacing in
Loneliness was measured using the de Jong Gierveld and time). The best fitting correlation structure was com-
UCLA-3 item loneliness scales developed for use in pound symmetry; this is equivalent to a random
many populations including older adults [45]. The intercept component for each subject. The LMM incor-
11-item de Jong Gierveld loneliness scale (DJG loneli- porated longitudinal trends over time, with adjustment
ness) [46] is a multi-dimensional measure of loneliness for age as a potential confounder. Statistical analyses
and contains five positively worded and six negatively were conducted using SPSS for windows (v24).
worded items. The items fall into four subscales; feelings UCLA loneliness and social support residuals were not
of severe loneliness, feelings connected with specific normally distributed and these scales were Log10 trans-
problem situations, missing companionship, feelings of formed for statistical analysis.
belongingness. The total score is the sum of the items Analyses were all adjusted for age, group attendance
scores (i.e. 11–55): 11 is low loneliness and 55 is severe (calculated as average attendance at 6 and 12 months)
loneliness. Self-administered versions of this scale have and employment status at baseline (Full-time, Part-time,
good internal consistency (> = 0.8) and inter-item homo- not working).
geneity and person scalability that is as good or better
than when conducted as face-to face interviews. The val- Focus groups
idity and reliability for the scale is adequate [47]. The Focus group transcripts were analysed using thematic
UCLA 3-item loneliness scale consists of three questions analysis [56, 57], a flexible qualitative methodology that
about how often participants feel they lack companion- can be used with a variety of epistemologies, approaches
ship, feel left out and feel isolated. The responses are and analysis methods [56]. The transcribed data were
given on a three-point scale ranging from hardly ever (1) analysed using a combination of theoretical and induct-
to often (3). The final score is the sum of these three ive thematic analysis [56]. It was theorised that member-
items with the range being from lowest loneliness (3) to ship in a LAC would assist with social factors relating to
highest loneliness (9). Reliability of the scale is good, healthy ageing [5], possibly through a social identity
(alpha = 0.72) as are discriminant validity and internal pathway [58], although we wanted to explore this. Se-
consistency [48]. The scale is commonly used to meas- mantic themes were drawn from these codes in order to
ure loneliness with older adults ([49] – review), [50, 51]. conduct a pragmatic evaluation of the LACVI programs
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 5 of 14

[56]. Analytic rigour in the qualitative analysis was en- Outcome measures
sured through source and analyst triangulation. Tran- Overall, participants reported moderate social support
scriptions were compared to notes taken during the and loneliness levels at baseline (See Table 2). Loneli-
focus groups by the researchers (GOS and GLS). In ness, as measured by both scales, reduced significantly
addition, Initial coding and themes (by GLS) were over time. There was a significant effect of time on the
checked by a second researcher (GOS) and any disagree- DJG loneliness scores (F (2, 52) = 3.83, p = 0.028), with
ments regarding coding and themes were discussed prior Post-Hoc analysis indicating a reduction in DJG loneli-
to finalisation of codes and themes [57]. ness between baseline and 12 months (p = 0.008). UCLA
loneliness scores (transformed variable) also changed
Results significantly over time (F (2, 52) = 4.08, p = 0.023). Post
Survey hoc tests indicated a reduction in UCLA loneliness be-
Sociodemographic and health characteristics of the 28 tween baseline and 6 months (p = 0.007). There was a
participants who completed the survey study are re- small non-significant increase in social support (F (2, 53)
ported in Table 1. The mean age of the participants was =2.88, p = 0.065) during the first year of membership
66.9 and 75% were female. These demographics are rep- (see Table 2 and Figs. 1 and 2).
resentative of the entire LACVI membership. Education
levels varied, with 21% being university educated, and Focus groups
the remainder completing high school or technical cer- In total, 11 participants attended the two focus groups, six
tificates. Two thirds of participants were not married. people who participated in PA clubs (four women) and
Some sociodemographic characteristics changed slightly five who participated in social clubs (all women). All focus
at 6 and 12 months, mainly employment (18% in paid group participants were either retired (n = 9) or
employment at baseline and 11% at 12-months) and semi-retired (n = 2). The mean age of participants was
ability to manage on income (36% reporting trouble 67 years (see Table 2 for further details). Most of the par-
managing on their income at baseline and 46% at ticipants (82%) had been members of a LAC for less than
12 months). Almost 90% of the participants described 2 years and two females in the social group had been
themselves as being in good-excellent health. members of LAC clubs for 5 and 10 years respectively.
Analysis of the focus group transcripts identified two
themes relating to social benefits of group participation;
Types of activities i) Social resources and ii) Social wellbeing (see Fig. 3).
There were a variety of types of activities that partici- Group discussion suggested that membership of a LAC
pants took part in: physical activities such as walking provides access to more social resources through greater
groups (n = 7), table tennis (n = 5), dancing class (n = 2), and diverse social contact and opportunity. It is through
exercise class (n = 1), bowls (n = 2), golf (n = 3), cycling this improvement in social resources that social well-
groups (n = 1) and non-physical leisure activities such as being may improve.
art and literature groups (n = 5), craft groups (n = 5), en-
tertainment groups (n = 12), food/dine out groups (n = Social resources
18) and other sedentary leisure activities (e.g. mah jong, The social resources theme referred to an increase in the
cards),(n = 4). A number of people took part in more availability and variety of social connections that resulted
than one activity. from becoming a member of a LAC. The social nature
of the groups enabled an expansion and diversification
Frequency of attendance at LACVI and changes in social of members’ social network and improved their sense of
wellbeing social connectedness. There was widespread agreement
At six and 12 months, participants indicated how many in both the focus groups that significant life events, es-
times in the last month they attended different types of pecially retirement, illness or death of spouse and mov-
activities at their LAC. Most participants maintained the ing house changes one’s social resources. Membership of
same frequency of participation over both time points. the LAC had benefits especially at these times and these
Only four people participated more frequently at 12 than events were often motivators to join such a club. Most
at 6 months and nine reduced participation levels. The participants found that their social resources declined
latter group included predominantly those who reduced after retirement and even felt that they were grieving for
from more than two times per week at 6 months to 2×/ the loss of their work.
week at 6 months to one to two times per week (n = 5)
or less than one time per week (n = 2) at 12 months. “I just saw work as a collection of, um, colleagues as
Average weekly club attendance at six and 12 months opposed to friends. I had a few good friends there.
was included as a covariate in the statistical model. Most were simply colleagues or acquaintances ….
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 6 of 14

Table 1 Sociodemographic and health characteristics of survey and focus group respondents at baseline
Sociodemographic characteristics Survey respondents Focus groups (n = 11)
(n = 28)
Age in years, mean (SD) 66.9 (9.0) 67.1 (5.9)
Sex, n (%) Male 7 (25) 2 (18)
Female 21 (75) 9 (82)
Highest level of education, n (%) Completed primary school 0 (0) 1 (9)
Up to year 12 10 (36) 3 (27)
Technical studies/ trade certificate 10 (36) 4 (36)
Tertiary studies 6 (21) 3 (27)
Missing 2 (7) 0
Main life occupation, n (%) Manager 4 (14) 2 (18)
Professional 10 (36) 4 (3)
Clerical 9 (32) 5 (45)
Trade, production or labour 5 (18) 0
Current employment, n (%) Full-time 2 (7) 0
Part-time/casual 3 (11) 2 (18)
Not in paid employment 23 (82) 9 (81)
Ability to manage on Income, n (%) Very difficult 2 (7) 0
Somewhat difficult 8 (29) 3 (27)
Not difficult 18 (64) 8 (18)
Present marital status, n (%) Not married 17 (61) 8 (73)
Married/defacto 11 (40) 3 (27)
Country of birth, n (%) Australia 23 (82) 8 (73)
Other 5 (18) 3 (27)
Area of residence, n (%) Urban 23 (82) 9 (82)
Rural 5 (18) 2 (18)
Health
General health, n (%) Very good- excellent 16 (57) NA
Good 9 (32) NA
Fair 3 (11) NA
Functional health (Walking limitation), n (%) Some limitation 2 (7) NA
No limitation 26 (93) NA

Table 2 Means and standard errors for social wellbeing variables over time
Variable Baseline (n = 28) 6 months (n = 27) 12 months (n = 28) p-value
Duke social supporta 3.83 (0.2) 4.08 (0.2) 4.09 (0.2) 0.065d
b
DJG loneliness 27.95 (1.94) 26.18 (1.94) 25.17 (1.94) 0.028*
UCLA lonelinessc 5.31 (0.39) 4.64 (0.39) 4.93 (0.39) 0.023*d
*significant effect of time for the indicated variable at p < 0.05
All analyses are adjusted for age, employment at baseline, and mean weekly LAC attendance
a
Duke_UNC functional social support scale. Range 1–5. High social support = 5. p-value represents the p-value for the log-transformed variable
b
De Jong Gierveld loneliness scale. Scored as a 5 item likert scale from Yes!, yes, more or less, no, No! Range = 11–55. Highest loneliness = 55.
c
UCLA 3-item loneliness scale. Range = 3–9. Highest loneliness = 9
d
p-value presented here are log-transformed variable analyses
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 7 of 14

Fig. 1 DJG loneliness for all participants over first year of membership at LAC club (n = 28).
*Represents significant difference compared to baseline (p < 0.01)

[interviewer- Mmm.] ..Okay, you’d talk to them every a greater social life following retirement due to the busy
day. You’d chatter in the kitchen, oh, pass banter back nature of her job.
and forth when things are busy or quiet, but... Um, in Within the social resources theme, three subthemes
terms of a friendship with those people, like going to were identified, i) Opportunity for social connectedness,
their home, getting to know them, doing other things ii) Opportunity for friendships, and iii) Opportunity for
with them, very few. But what I did miss was the social responsibility/leadership. Interestingly, these sub-
interaction with other people. It had simply gone….. themes were additional to the information gathered in
But, yeah, look, that, the, yeah, that intervening period the survey. This emphasises the power of the inductive
was, oh, a couple of months. That was a bit tough…. nature of the qualitative exploration employed in the
But in that time the people in LAC and the people in focus groups to broaden the knowledge in this area.
U3A…. And the other dance group just drew me into The most discussed and expanded subtheme in both
more things. Got to know more people. So once again, focus groups was Opportunity for social connectedness,
yeah, reasonable group of acquaintances.” (Male, PAFG) which arose through developing new connections, diver-
sifying social connections, sharing interests and experi-
Group members indicated general agreement with ences with others and peer learning. Participants in both
these two responses, however one female found she had focus groups stated that being a member of LAC

Fig. 2 UCLA loneliness score for all participants over first year of membership at LAC club (n = 28).
*Indicates log values of the variable at 6-months were significantly different from baseline (p < 0.01)
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 8 of 14

Fig. 3 Themes arising from focus group discussion around the benefits of LAC membership

facilitated their socialising and connecting with others to “Well, my experience is very similar to everybody
share ideas, skills and to do activities with, which was es- else’s…….: I, I went from having no social life to a
pecially important through times of significant life social life once I joined a group.” (Female, PAFG)
events. Furthermore, participants in each of the focus
groups valued developing diverse connections: There was agreement in both focus groups that these
initial new connections made at a LAC are strengthened
“Yeah, I think, as I said, I finished up work and I, and through development of deeper personal connections
I had more time for wa-, walking. So I think a, in with others who have similar demographics and who are
meeting, in going to this group which, I saw this group interested in the same activities. This concurs with the
of women but then someone introduced me to them. Social Identity Theory [58] discussed previously.
They were just meeting, just meeting a new different
set of people, you know? As I said, my work people “and I was walking around the lake in Ballarat, like
and these were just a whole different group of wandering on my own. I thought, This is ridiculous. I
women, mainly women. There’s not many men. mean, you’ve met all those groups of women coming
[Interviewer: Yes.]….. Although our leader is a man, the opposite way, so I found out what it was all about,
which is ironic and is about, this man out in front so I joined, yeah. So that’s how I got into that.[
and there’s about 20 women behind him, but, um, Interviewer: Yeah.] Basically sick of walking round the
so yeah, and people from different walks of life and lake on my own. [Interviewer: Yeah, yeah.] So that’s
different nationalities there which I never knew in great. It’s very social and they have coffee afterwards
my work life, so yeah. That’s been great. So from which is good.” (female, PAFG)
that goes on other things, you know, you might, uh,
other activities and, yeah, people for coffee and go The subtheme Opportunity for development of
to the pictures or something, yeah. That’s great.” friendships describes how, for some people, a number
(Female, PAFG) of LAC members have progressed from being just ini-
tial social connections to an established friendship.
Simply making new connections was the most widely This signifies the strength of the connections that
discussed aspect related to the opportunity for social may potentially develop through LAC membership.
connectedness subtheme, with all participants agreeing Some participants from each group mentioned friend-
that this was an important benefit of participation in ships developing, with slightly more discussion of this
LAC groups. seen in the social group.
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 9 of 14

“we all have a good old chat, you know, and, and it’s agreement indicated by most of the others in the social
all about friendship as well.” (female, SocialFG) focus group.
Discussion in the focus groups also touched on the
The subtheme Opportunity for social responsibility or subthemes Reduced loneliness and Improved home rela-
leadership was mentioned by two people in the active tionships, which were each mentioned by one person.
group, however it was not brought up in the social And focus groups also felt that group membership Im-
group. This opportunity for leadership is linked with the proved social skills through opening up and becoming
development of a group identity and desiring to contrib- more approachable (male, PAFG) or enabling them to
ute meaningfully to a valued group. become more accepting of others’ who are different
(general agreement in Social FG).
“with our riding group, um, you, a leader for probably
two rides a year so you’ve gotta prepare for it, so some Discussion
of them do reccie rides themselves, so, um, and also This case study integrated results from a one-year longi-
every, uh, so that’s something that’s, uh, a responsibility.” tudinal survey study and focus group discussions to
(male, PAFG) gather rich information regarding the potential changes
in social wellbeing that older adults may experience
when joining community organisations offering group
Social wellbeing activities. The findings from this study indicate that be-
The social resources described above seem to contribute coming a member of such a community organisation
to a number of social, wellbeing outcomes for partici- can be associated with a range of social benefits for older
pants. The sub themes identified for Social wellbeing adults, particularly related to reducing loneliness and
were, i) Increased social support, ii) Reduced loneliness, maintaining social connections.
iii) Improved home relationships and iv) Improved social
skills. Loneliness
Joining a LAC was associated with a reduction in loneli-
Increased social support ness over 1 year. This finding is in line with past
Social support was measured quantitatively in the survey group-intervention studies where social activity groups
(no significant change over time for new members) and were found to assist in reducing loneliness and social
identified as a benefit of LAC membership during the isolation [49]. This systematic review highlighted that
focus group discussions. However, only one of the mem- the majority of the literature explored the effectiveness
bers of the active group mentioned social support of group activity interventions for reducing severe loneli-
directly. ness or loneliness in clinical populations [49]. The
present study extends this research to the general older
‘it’s nice to be able to pick up the phone and share adult population who are not specifically lonely and re-
your problem with somebody else, and that’s come ported to be of good general health, rather than a clin-
about through LAC. ……‘Cos before that it was ical focus. Our findings are in contrast to results from
through, with my family (female, PAFG) an evaluation of a community capacity-building program
aimed at reducing social isolation in older adults in rural
There was some agreement amongst participants of Australia [59]. That program did not successfully reduce
the PA group that they felt this kind of support may de- loneliness or improve social support. The lack of change
velop in time but most of them had been members for from pre- to post-program in that study was reasoned to
less than 2 years. be due to sampling error, unstandardised data collection,
and changes in sample characteristics across the pro-
“[Interviewer: Yeah. Does anyone else have that grams [59]. Qualitative assessment of the same program
experience? (relating to above quote)]” There is one [59] did however suggest that participants felt it was
lady but she’s actually the one that I joined with successful in reducing social isolation, which does sup-
anyway. [Interviewer: Okay.] But I, I feel there are port our findings.
others that are definitely getting towards that stage. Changes in loneliness were not a main discussion
It’s still going quite early days. (female1, PAFG) point of the qualitative component of the current study,
[Interviewer: I guess it’s quite early for some of you, however some participants did express that they felt less
yeah.] “yeah” (female 2, PAFG) lonely since joining LACVI and all felt they had become
more connected with others. This is not so much of a
Social support through sharing of skills was mentioned contrast in results as a potential situational issue. The
by one participant in the social group also, with lack of discussion of loneliness may have been linked to
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 10 of 14

the common social stigma around experiencing loneli- does not seem to change in the time frames often
ness outside certain accepted circumstances (e.g. widow- studied [61–63].
hood), which may lead to underreporting in front of There were many social wellbeing benefits such as in-
others [45]. creased social connectivity identified in focus group dis-
Overall, both components of the study suggest that be- cussion, but the specific theme of social support was
coming a member of an activity group may be associated rarely mentioned. It may be that general social support
with reductions in loneliness, or at least a greater sense through such community groups may take longer than 1
of social connectedness. In addition to the social nature year to develop. There is evidence that strong group ties
of the groups and increased opportunity for social con- are sequentially positively associated between social
nections, another possible link between group activity identification and social support [34], suggesting that the
and reduced loneliness is an increased opportunity for connections formed through the groups may lead in-
time out of home. Previous research has found that creased to social support from group members in the fu-
more time away from home in an average day is associ- ture. This is supported by results from the focus group
ated with lower loneliness in older adults [60]. Given the discussions, where one new member felt she could call
significant health and social problems that are related to on colleagues she met in her new group. Other new
loneliness and social isolation [13–15], the importance members thought it was too soon for this support to be
of group involvement for newly retired adults to prevent available, but they could see the bonds developing.
loneliness should be advocated.
Other social wellbeing changes
In addition to social support and loneliness that were
Social support the focus of the quantitative study, the focus group dis-
In line with a significant reduction in loneliness, there cussions uncovered a number of other benefits of group
was also a trend (p = 0.056) toward an increase in social membership that were related to social wellbeing (see
support from baseline to 12 months in the survey study. Fig. 3). The social resources theme was of particular
Whilst suggestive of a change, it is far less conclusive interest because it reflected some of the mechanisms
than the findings for loneliness. There are a number of that appeared enable social wellbeing changes as a result
possible explanations for the lack of statistically signifi- of being a member of a LAC but were not measured in
cant change in this variable over the course of the study. the survey. The main social resources relating to group
The first is the small sample size, which would reduce membership that were mentioned in the focus groups
the statistical power of the study. It may be that larger were social connectedness, development of friendships
studies are required to observe changes in social sup- and opportunity for social responsibility or leadership.
port, which are possibly only subtle over the course of 1 As mentioned above, there was wide-spread discussion
year. This idea is supported by a year-long randomised within the focus groups of the development of social
controlled trial with 90 mildly-depressed older adults connections through the clubs. Social connectedness is
who attended senior citizen’s club in Norway [37]. The defined as “the sense of belonging and subjective psy-
study failed to see any change in general social support chological bond that people feel in relation to individuals
in the intervention group compared to the control over and groups of others.” ([25], pp1). As well as being an
1 year. Additional analysis in that study suggested that important predecessor of social support, greater social
people who attended the intervention groups more connectedness has been found to be highly important
often, tended to have greater increases in SS (p = 0.08). for the health of older adults, especially cognitive and
The researchers stated that the study suffered from sig- mental health [26, 32, 34, 35, 64]. One suggested theory
nificant drop-out rates and low power as a result. In this for this health benefit is that connections developed
way, it was similar to our findings and suggests that so- through groups that we strongly identify with are likely
cial support studies require larger numbers than we to be important for the development of social identity
were able to gain in this early exploratory study. Another [34], defined by Taifel as: “knowledge that [we] belong to
possible reason for small changes in SS in the current certain social groups together with some emotional and
study may be the type of SS measured. The scale used value significance to [us] of this group membership” (Taj-
gathered information around functional support or sup- fel, 1972, p. 31 in [58] p 2). These types of groups to
port given to individuals in times of need. Maybe it is which we identify may be a source of “personal security,
not this type of support that changes in such groups but social companionship, emotional bonding, intellectual
more specific support such as task-specific support. It stimulation, and collaborative learning and……allow us to
has been observed in other studies and reviews that achieve goals.” ([58] p2) and an overall sense of self-worth
task-specific support changes as a result of behavioural and wellbeing. There was a great deal of discussion relat-
interventions (e.g. PA interventions) but general support ing to the opportunity for social connectedness derived
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 11 of 14

through group membership being particularly pertinent qualitative exploration through focus group discussions
following a significant life event such as moving to a new and thematic analysis, was a strength of the current study.
house or partners becoming unwell or dying and espe- It allowed the researchers to not only examine the associ-
cially retirement. This change in their social circumstance ation between becoming a member of a community group
is likely to have triggered the need to renew their social on social support and loneliness over an extended period,
identity by joining a community group. Research with uni- but also obtain a deeper understanding of the underlying
versity students has shown that new group identification reasons behind any associations. Given the variability of
can assist in transition for university students who have social support definitions in research [17] and the broad
lost their old groups of friends because of starting univer- area of social wellbeing, it allowed for open exploration of
sity [65]. In an example relevant to older adults, mainten- the topic, to understand associations that may exist but
ance or increase in number of group memberships at the would have otherwise been missed. Embedding the
time of retirement reduced mortality risk 8 years later research in an existing community organisation was a
compared to people who reduce their number of group strength, although with this also came some difficulties
activities in a longitudinal cohort study [66]. This would with recruitment. Voluntary coordination of the commu-
fit with the original Activity Theory of ageing; whereby nity groups meant that informing new members about the
better ageing experience is achieved when levels of social study was not always feasible or a priority for the volun-
participation are maintained, and role replacement occurs teers. In addition, calling for new members was innately
when old roles (such as working roles) must be relin- challenging because they were not yet committed to the
quished [67]. These connections therefore appear to assist club fully. This meant that so some people did not want
in maintaining resilience in older adults defined as “the to commit to a year-long study if they were not sure how
ability to maintain or improve a level of functional ability long they would be a member of the club. This resulted in
(a combination of intrinsic physical and mental capacity slow recruitment and a resulting relatively low sample size
and environment) in the face of adversity” (p29, [5]). Fac- and decreased power to show significant statistical differ-
tors that were mentioned in the focus groups as assisting ences, which is a limitation of the present study. However,
participants in forming connections with others were the use of Linear Mixed Models for analysis of the survey
shared interest, learning from others, and a fun and data was a strength because it was able to include all data
accepting environment. It was not possible to assess all life in the analyses and not remove participants if one time
events in the survey study. However, since the discussion point of data was missing, as repeated measures ANOVAs
from the focus groups suggested this to be an important would do. The length of the study (1 year) is another
motivator for joining clubs and potentially a beneficial strength, especially compared to previous randomised
time for joining them, it would be worth exploring in fu- controlled studies that are typically only 6–16 weeks in
ture studies. length. Drop-out rate in the current study is very low and
Focus group discussion suggested that an especially probably attributable to the benefits of working with
valuable time for joining such clubs was around retire- long-standing organisations.
ment, to assist with maintaining social connectivity. The The purpose of this study was to explore in detail
social groups seem to provide social activity and new whether there are any relationships between joining
roles for these older adults at times of change. It is not existing community groups for older adults and social
necessarily important for all older adults but maybe wellbeing. The lack of existing evidence in the field
these ones identify themselves as social beings and meant that a small feasibility-type case study was a good
therefore this maintenance of social connection helps to sounding-board for future larger scale research on the
continue their social role. Given the suggested import- topic, despite not being able to answer questions of
ance of social connectivity gained through this organisa- causality. Owing to the particularistic nature of case
tion, especially at times of significant life events, it studies, it can also be difficult to generalise to other
would valuable to investigate this further in future and types of organisations or groups unless there is a great
consider encouragement of such through government deal of similarity between them [68]. There are however,
policy and funding. The majority of these types of clubs other types of community organisations in existence that
exist for older adults in general, but this study empha- have a similar structure to LACVI (Seniors centres [36,
sises the need for groups such as these to target newly 40], Men’s Sheds [38], University of the Third Age [34,
retired individuals specifically and to ensure that they 69], Japanese salons [70, 71]) and it may be that the re-
are not seen as ‘only for old people’. sults from this study are transferable to these also. This
study adds to the literature around the benefits of join-
Strengths and limitations ing community organisations that offer social and phys-
The use of mixed –methodologies, combining longitu- ical activities for older adults and suggests that this
dinal survey study analysed quantitatively, with a engagement may assist with reducing loneliness and
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 12 of 14

maintaining social connection, especially around the Funding

time of retirement. The primary author contributing to this study (GLS) receives PhD scholarship
funding from Victoria University. The other authors were funded through
salaries at Victoria University.
Directions for future research Availability of data and materials
Given that social support trended toward a significant The datasets generated and/or analysed during the current study are not
increase, it would be useful to repeat the study on a lar- publicly available due the ethics approval for this study not allowing open
access to the individual participant data but are available from the
ger scale in future to confirm this. Either a case study on corresponding author on reasonable request.
a similar but larger community group or combining a
number of community organisations would enable re- Authors’ contributions
GLS, RE and JVU made substantial contributions to the conception and
cruitment of more participants. Such an approach would design of the study. GLS and GOS supervised data collection for the surveys
also assist in assessing the generalisability of our findings (GLS) and focus groups (GOS and GLS). GLS, GOS, RE, JH and JVU were
to other community groups. Given that discussions involved in data analysis and interpretation. All authors were involved in
drafting, the manuscript and approved the final version.
around social benefits of group membership in the focus
groups was often raised in conjunction with the occur- Ethics approval and consent to participate
rence of significant life events, it would be beneficial to Ethics approval to conduct this study was obtained from the Victoria University
Human Research Ethics Committee (HRE14–071 [survey] and HRE15–291 [focus
include a significant life event scale in any future studies groups]). All survey participants provided informed consent to partake in the
in this area. The qualitative results also suggest that it study prior to undertaking the first survey by clicking ‘agree’ in the
would be useful to investigate whether people who join survey software (online participants) or signing a written consent form
(paper participants) after they had read all participant information relating to
community groups in early years post retirement gain the study. Focus group participants also completed a written consent form
the same social benefits as those in later stages of retire- after reading and understanding all participant information regarding the study.
ment. Studies investigating additional health benefits of
Consent for publication
these community groups such as physical activity, de- Focus group participants have given permission for their quotes to be used
pression and general wellbeing would also be warranted. in de-identified form prior to undertaking the research.

Competing interests
Conclusion The authors declare that they have no competing interests.
With an ageing population, it is important to investigate
ways to enable older adults to age successfully to ensure Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published
optimal quality of life and minimisation of health care
maps and institutional affiliations.
costs. Social determinants of health such as social sup-
port, loneliness and social contact are important contrib- Author details
1
Institute for Health and Sport, Victoria University, Melbourne, Australia.
utors to successful ageing through improvements in 2
School of Health and Life Sciences, Federation University, Ballarat, Australia.
cognitive health, quality of life, reduction in depression 3
Department of Movement Sciences, Physical Activity, Sports and Health
and reduction in mortality. Unfortunately, older adults Research Group, KU Leuven - University of Leuven, Leuven, Belgium.
are at risk of these social factors declining in older age
Received: 19 April 2018 Accepted: 10 September 2018
and there is little research investigating how best to
tackle this. Community groups offering a range of activ-
References
ities may assist by improving social connectedness and
1. United Nations. In: P.D. Department of Economic and Social Affairs, editor.
social support and reducing loneliness for older adults. World Population Ageing 2015. New York: United Nations; 2015.
Some factors that may assist with this are activities that 2. World Health Organisation. Global Health and Ageing. 2011 [cited 2014
March 25]; Available from: http://www.who.int/ageing/publications/global_
encourage sharing interests, learning from others, and
health/en/.
are conducted in a fun and accepting environment. Such 3. Balogun JA, et al. Age-related changes in balance performance. Disabil
groups may be particularly important in developing so- Rehabil. 1994;16(2):58–62.
4. Singh MAF. Exercise comes of age: rationale and recommendations for a
cial contacts for newly retired individuals or around
geriatric exercise prescription. J Gerontol Ser A Biol Med Sci. 2002;57(5):
other significant life events such as moving or illness of M262–82.
loved ones. In conclusion, ageing policy and strategies 5. World Health Organisation. World report on ageing and health. Geneva:
World Health Organisation; 2015.
should emphasise participation in community groups es-
6. Rowe JW, Kahn RL. Successful Aging1. The Gerontologist. 1997;37(4):433–40.
pecially for those recently retired, as they may assist in 7. Depp CA, Jeste DV. Definitions and predictors of successful aging: a
reducing loneliness and increasing social connections for comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry.
2006;14(1):6–20.
older adults.
8. Song M, Kong E-H. Older adults’ definitions of health: a metasynthesis. Int J
Nurs Stud. 2015;52(6):1097–106.
Abbreviations 9. Tate RB, Lah L, Cuddy TE. Definition of successful aging by elderly Canadian
FG: Focus group; LAC: Life Activities Club; LACVI: Life Activities Clubs Victoria; males: the Manitoba follow-up study. The Gerontologist. 2003;43(5):735–44.
LMM: Linear mixed model; PA: Physical activity; WHO: World Health 10. Phelan EA, et al. Older Adults’ views of “successful aging”—how do they
Organisation compare with Researchers’ definitions? J Am Geriatr Soc. 2004;52(2):211–6.
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 13 of 14

11. Haslam SA, et al. Social cure, what social cure? The propensity to 39. Life Activities Clubs. Life Activities Clubs. About Us. . 2014 [cited 2014
underestimate the importance of social factors for health. Soc Sci Med. January 13, 2014]; Available from: http://www.life.org.au/aboutus.
2018;198:14–21. 40. Hutchinson SL, Gallant KA. Can senior Centres be contexts for aging in third
12. Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a places? J Leis Res. 2016;48(1):50–68.
meta-analytic review. PLoS Med. 2010;7(7):e1000316. 41. Millard J. The health of older adults in community activities. Work Older
13. Richard A, et al. Loneliness is adversely associated with physical and mental People. 2017;21(2):90–9.
health and lifestyle factors: results from a Swiss national survey. PLoS One. 42. Creswell JW, Plano-Clark VL. Designing and conducting mixed methods
2017;12(7):1–18. research. Thousand Oaks, Calif: SAGE Publications; 2007. p. c2007.
14. Luo Y, et al. Loneliness, health, and mortality in old age: a national 43. Loeb S, Penrod J, Hupcey J. Focus groups and older adults: tactics for
longitudinal study. Soc Sci Med. 2012;74(6):907–14. success. J Gerontol Nurs. 2006;32(3):32–8.
15. Luo Y, Waite LJ. Loneliness and mortality among older adults in China. J 44. Broadhead W, et al. The Duke-UNC functional social support questionnaire:
Gerontol B Psychol Sci Soc Sci. 2014;69(4):633–45. measurement of social support in family medicine patients. Med Care. 1988;
16. de Jong Gierveld J, Van Tilburg T, Dykstra PA. Loneliness and social isolation. In: 26(7):709–23.
Vangelisti A, Perlman D, editors. Cambridge handbook of personal 45. De Jong Gierveld J, Van Tilburg T. Living arrangements of older adults in
relationships. Cambridge: Cambridge University Press; 2006. p. 485-500. the Netherlands and Italy: Coresidence values and behaviour and their
17. Williams P, Barclay L, Schmied V. Defining social support in context: a consequences for loneliness. J Cross Cult Gerontol. 1999;14(1):1–24.
necessary step in improving research, intervention, and practice. Qual 46. de Jong-Gierveld J, Kamphuls F. The development of a Rasch-type
Health Res. 2004;14(7):942–60. loneliness scale. Appl Psychol Meas. 1985;9(3):289–99.
18. Valtorta N, Hanratty B. Loneliness, isolation and the health of older adults: 47. Tilburg Tv, Leeuw Ed. Stability of scale quality under various data collection
do we need a new research agenda? J R Soc Med. 2012;105(12):518–22. procedures: a mode comparison on the ‘De Jong-Gierveld loneliness scale.
19. Jylhä M. Old age and loneliness: cross-sectional and longitudinal analyses in Int J Public Opin Res. 1991;3(1):69–85.
the Tampere longitudinal study on aging. Can J Aging La Revue can du 48. Hughes ME, et al. A short scale for measuring loneliness in large surveys -
vieil. 2010;23(2):157–68. results from two population-based studies. Res Aging. 2004;26(6):655–72.
20. Huxhold O, Miche M, Schüz B. Benefits of having friends in older ages: 49. Dickens AP, et al. Interventions targeting social isolation in older people: a
differential effects of informal social activities on well-being in middle-aged systematic review. BMC Public Health. 2011;11:647.
and older adults. J Gerontol B Psychol Sci Soc Sci. 2014;69(3):366–75. 50. Hawkley LC, et al. Loneliness predicts increased blood pressure: 5-year
21. Berkman L, Syme S. Social networks, host resistance and mortality: a nine cross-lagged analyses in middle-aged and older adults. Psychol Aging.
year follow-up study of alameda county residents. Am J Epidemiol. 1979; 2010;25(1):132.
185(11):1070–88. 51. Netz Y, et al. Loneliness is associated with an increased risk of sedentary life
22. House JS, Landis KR, Umberson D. Social relationships and health. Science. in older Israelis. Aging Ment Health. 2013;17(1):40–7.
1988;241(4865):540–5. 52. Australian Bureau of Statistics. Australian and New Zealand Standard
23. Pynnonen K, et al. Does social activity decrease risk for institutionalization and Classification of Occupations, 2013, Version 1.2. Canberra: Australian Bureau
mortality in older people? J Gerontol B Psychol Sci Soc Sci. 2012;67(6):765–74. of Statistics; 2013.
24. Broadhead WE, et al. The epidemiologic evidence for a relationship 53. Australian Bureau of Statistics, Australian Standard Geographical
between social support and health. Am J Epidemiol. 1983;117(5):521–37. Classification (ASGC). Canberra: Australian Bureau of Statistics; 2011.
25. Haslam C, et al. Social connectedness and health. Encyclopedia of geropsychology. 54. Ware JE, Kosinski M, Keller SD. A 12-item short-form health survey -
2017:2174–82. https://doi.org/10.1007/978-981-287-080-3_46-1. construction of scales and preliminary tests of reliability and validity. Med
26. Haslam C, Cruwys T, Haslam SA. “The we’s have it”: evidence for the Care. 1996;34(3):220–33.
distinctive benefits of group engagement in enhancing cognitive health in 55. Sanson-Fisher RW, Perkins JJ. Adaptation and validation of the SF-36 health
aging. Soc Sci Med. 2014;120:57–66. survey for use in Australia. J Clin Epidemiol. 51(11):961–7.
27. Uebelacker LA, et al. Social support and physical activity as moderators of 56. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol.
life stress in predicting baseline depression and change in depression over 2006;3(2):77–101.
time in the Women’s Health Initiative. Soc Psychiatry Psychiatr Epidemiol. 57. Patton MQ. Qualitative research & evaluation methods. 4 ed. Thousand
2013;48(12):1971–82. Oaks, California: Sage Publications; 2015.
28. Tajvar M, et al. Social support and health of older people in middle eastern 58. Haslam SA, et al. Social identity, health and well-being: an emerging
countries: a systematic review. Australas J Ageing. 2013;32(2):71–8. agenda for applied psychology. Appl Psychol. 2009;58(1):1–23.
29. Dalgard OS, Bjork S, Tambs K. Social support, negative life events and 59. Bartlett H, et al. Preventing social isolation in later life: findings and insights
mental health. Br J Psychiatry. 1995;166(1):29–34. from a pilot Queensland intervention study. Ageing Soc. 2013;33(07):1167–89.
30. Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. 60. Petersen J, et al. Time out-of-home and cognitive, physical, and emotional
Psychol Bull. 1985;98(2):310–57. wellbeing of older adults: a longitudinal mixed effects model. PLoS One.
31. Gilmour H. Social participation and the health and well-being of Canadian 2015;10(10):e0139643.
seniors. Health Rep. 2012;23(4):1B. 61. Lindsay Smith G, et al. The association between social support and
32. Glei DA, et al. Participating in social activities helps preserve cognitive physical activity in older adults: a systematic review. Int J Behav Nutr
function: an analysis of a longitudinal, population-based study of the Phys Act. 2017;14(1):56.
elderly. Int J Epidemiol. 2005;34(4):864–71. 62. Sallis JF, et al. The development of scales to measure social support for diet
33. Lee SH, Kim YB. Which type of social activities may reduce cognitive decline in and exercise behaviors. Prev Med. 1987;16(6):825–36.
the elderly?: a longitudinal population-based study. BMC Geriatr. 2016;16(1):165. 63. Oka R, King A, Young DR. Sources of social support as predictors of exercise
34. Haslam C, et al. Group ties protect cognitive health by promoting social adherence in women and men ages 50 to 65 years. Womens Health Res
identification and social support. J Aging Health. 2016;28(2):244–66. Gender Behav Policy. 1995;1:161–75.
35. Haslam C, et al. Groups 4 health: evidence that a social-identity intervention 64. Greenaway KH, et al. From “we” to “me”: group identification enhances
that builds and strengthens social group membership improves mental perceived personal control with consequences for health and well-being. J
health. J Affect Disord. 2016;194:188–95. Pers Soc Psychol. 2015;109(1):53–74.
36. Bøen H. Characteristics of senior Centre users -- and the impact of a group 65. Iyer A, et al. The more (and the more compatible) the merrier: multiple
programme on social support and late-life depression. Norsk Epidemiologi. group memberships and identity compatibility as predictors of adjustment
2012;22(2):261–9. after life transitions. Br J Soc Psychol. 2009;48(4):707–33.
37. Bøen H, et al. A randomized controlled trial of a senior Centre group 66. Steffens NK, et al. Social group memberships in retirement are associated
programme for increasing social support and preventing depression in with reduced risk of premature death: evidence from a longitudinal cohort
elderly people living at home in Norway. BMC Geriatr. 2012;12:20. study. BMJ Open. 2016;6(2):e010164.
38. Golding BG. Social, local, and situated: recent findings about the 67. Havighurst RJ. Successful aging. Gerontol. 1961;1:8–13.
effectiveness of older Men’s informal learning in community contexts. Adult 68. Yin R. Case study research: design and methods. Beverly Hills, CA: Sage
Educ Q. 2011;61(2):103. publishing; 1994.
Lindsay-Smith et al. BMC Geriatrics (2018) 18:226 Page 14 of 14

69. Merriam SB, Kee Y. Promoting community wellbeing: the case for lifelong
learning for older adults. Adult Educ Q. 2014;64(2):128–44.
70. Hikichi H, et al. Social interaction and cognitive decline: results of a 7-year
community intervention. Alzheimers Dement: Translat Res Clin Interv. 2017;
3(1):23–32.
71. Hikichi H, et al. Effect of a community intervention programme promoting
social interactions on functional disability prevention for older adults:
propensity score matching and instrumental variable analyses, JAGES
Taketoyo study. J Epidemiol Community Health. 2015;69(9):905–10.