Social Participation in Older Adults: The Effects of Social and Leisure Participation on Cognitive Processing

We’ve all been there- scrolling through social media and seeing a sad video of an older adult, sitting in the park, in a restaurant, running errands, alone. We feel so bad for this person, but what we truly don’t see is the benefits of what they are doing. They are out in the community, participating in social or leisure activities. For my doctoral capstone during my graduate studies, I researched the effects of social participation on older adults, and how this affects leisure and occupational engagement. Being in a time like a global pandemic was not only hard on the physical health of older adults but also took a toll on mental health due to increased feelings of loneliness and isolation.

Since entering the field of Occupational Therapy (OT), I have witnessed first-hand the important role social participation plays in supporting cognitive processing. I have worked with patients who, after three to five days on isolation procedures, demonstrated noticeable decline in cognition and orientation. Let’s dive into the benefits social participation can offer in promoting cognitive processes in this population.

Social Participation in a Group Setting

When socially isolated, an older adult's health may be affected as they are not engaging in meaningful occupations (V olkmer, 2022). In this way, social isolation has been identified as a threat to the population. In the Occupational Therapy Practice Framework (OTPF), social participation and leisure engagement are listed as occupations. As OT’s, we play a large role in discovering these pathways for our patients. Social participation in a group setting offers numerous benefits for older adults, enhancing their overall well-being. Engaging in group activities can promote a sense of belonging and reduce feelings of loneliness and isolation. It provides opportunities for meaningful social interaction, which can help maintain cognitive function and emotional health (Smallfield & Molitor, 2018). Group settings also encourage physical activity, creativity, and continued learning through shared hobbies, discussions, or volunteer efforts. Furthermore, being part of a supportive community can provide a sense of purpose, contributing to a more fulfilling and active lifestyle in older age.

Social Participation through Leisure Engagement

According to the CDC, social isolation was associated with a 50% increased risk of dementia and other serious health conditions (2021). While other health conditions are listed– such as heart disease, stroke, depression, and anxiety– dementia risks come out on top as the highest condition at risk when socially isolated as an older adult. Leisure engagement, as listed in the OTPF, is described as maintaining a balance of leisure activities with other occupations (2020). As an OT working with older adults, I am not only looking at ADL and IADL areas where the person may need modification or adaptation but also taking a look into their daily occupations and interests. What is it about this person that makes them, them? And how is it that we can get back to participating in this hobby or activity more.

Depending on the person's environment, we may be able to incorporate an increase in leisure engagement. “...although the dosage and content of the programs varied, strong evidence supports use of leisure programs in occupational therapy interventions targeting engagement in leisure activities for community-dwelling older adults” (Smallfield & Molitor, 2018). For example, I worked with an individual residing in an assisted living facility who was initially living on the independent floor. At that time, she was highly engaged—regularly attending building-hosted activities, sharing meals with friends, and participating in off-site outings. However, during my time with her, she was transitioned to the memory care unit due to cognitive decline. Unfortunately, this move significantly impacted her overall engagement and well-being. She became increasingly isolated, spending most of her time in her room and only leaving for meals. As her OT, I provided education to both her family and facility staff on the importance of maintaining social and activity participation. I emphasized the benefits of continued involvement in daily events, group outings, and community activities within the building. As a result, she began to reconnect with familiar residents and demonstrated improved attention throughout the day. This shift had a positive impact on both her emotional and cognitive well-being.

Social Participation and Cognitive Processing

Social participation plays a critical role in supporting cognitive functioning and promoting successful aging, making it a key focus in OT interventions (Bourassa et al., 2015).

For older adults and individuals experiencing cognitive decline, engagement in meaningful social activities provides opportunities to stimulate attention, memory, and executive function in real-world contexts. OTs use these group-based and interpersonal interactions to foster communication, problem-solving, and adaptive thinking—skills essential to maintaining and enhancing cognitive performance. Research shows that social participation not only predicts changes in cognitive function over time but also serves as a protective factor against cognitive decline (Bourassa et al., 2015). By including social engagement into therapeutic plans, OTs support both cognitive health and emotional well-being, reinforcing a sense of purpose, identity, and community. Additionally, cognitive and social engagement has been linked to multiple domains of cognition and is a valuable indicator of functional decline associated with aging and dementia progression (Liebzeit et al., 2022). This highlights the importance of social participation as a powerful tool in OT practice.

How to Incorporate Social Participation into Practice

As OTs, we take a holistic approach to care, considering the physical, cognitive, emotional, and mental health needs of individuals across their lifespan. Social participation can include numerous different interventions tailored to each individual's interests and preferences. At evaluation, we can ask questions regarding activities and hobbies they enjoy, how often they spend time outside of their house, how they typically spend their weeks, and any activities they would like to participate in if given the chance (Papageorgiou et al., 2016). We may identify potential barriers to these hobbies, recommend modifications to support current leisure pursuits, or even introduce new activities that align with their interests. Through intervention, we can engage an older adult in memory, sequencing, matching, attention, problem solving, and executive functioning tasks to challenge cognitive processing. It is essential to continue advocating for older adults to engage in the activities they enjoy, recognizing that each person we encounter once led a life filled with unique skills, interests, and passions.

About the Author

Ashley Denny, OTD, OTR/L is a geriatric Occupational Therapist for FOX Rehabilitation. She is a graduate of Chatham University, receiving her Doctorate in Occupational Therapy in 2023. She has received her First Response Low Vision Certification from the Pennsylvania Occupational Therapy Association (POTA) and her Low Vision Micro-Credential from the American Occupational Therapy Association (AOTA). She also works as a content developer for FOX Rehabilitation digital platforms, creating content for clinicians across the United States on topics such as low vision and dementia modifications, arthritis, stroke rehabilitation, and home safety for older adults.

References

Bourassa, K. J., Memel, M., Woolverton, C., & Sbarra, D. A. (2015). Social participation predicts cognitive functioning in aging adults over time: comparisons with physical health, depression, and physical activity. Aging & Mental Health, 21(2), 133–146. https://doi.org/10.1080/13607863.2015.1081152

Centers for Disease Control. (2021, April 29). Loneliness and social isolation linked to serious health conditions. https://www.cdc.gov/aging/publications/features/lonely-older-adults.html

Liebzeit, D., Kuo, W. C., Carlson, B., Mueller, K., Koscik, R. L., Smith, M., Johnson, S., & Bratzke, L. (2022). Relationship of Cognitive and Social Engagement to Health and

Psychological Outcomes in Community-Dwelling Older Adults. Nursing research, 71(4), 295–302. https://doi.org/10.1097/NNR.0000000000000589

Pagageorgiou, N., Marquis, R., & Dare, J. (2016). Identifying the enablers and barriers to community participation amongst older adults. British Journal of Occupational Therapy, 79(12), 724-751. DOI: 10.1177/0308022616656195

Smallfield, S., & Molitor, W. L. (2018). Occupational therapy interventions supporting social participation and leisure engagement for community-dwelling older adults: A systematic review. American Journal of Occupational Therapy, 72(4), 1-8. https://doi.org/10.5014/ajot.2018.030627

V olkmer, K. (2022). Using the Model of Human Occupation as a framework for promoting occupational engagement among socially isolated older adults. SIS Quarterly Practice Connections, 7(2), 21–23. https://www.aota.org/publications/sis-quarterly/productive-aging-sis/pasis-5-22

‍