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A review of research on the relationship between learning and health for older adults
International Journal of Lifelong Education
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A review of research on the relationship between
learning and health for older adults
Magnus Schoultz , Johan Öhman & Mikael Quennerstedt
To cite this article: Magnus Schoultz , Johan Öhman & Mikael Quennerstedt (2020): A review of research on the relationship between learning and health for older adults, International Journal of Lifelong Education, DOI: 10.1080/02601370.2020.1819905
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ARTICLE
A review of research on the relationship between learning and
health for older adults
Magnus Schoultza, Johan Öhman a and Mikael Quennerstedt b
aSchool of Humanities, Education and Social Sciences Örebro University, Örebro, Sweden; bSchool of Health Sciences, Örebro University, Örebro, Sweden
ABSTRACT
Previous studies have demonstrated that there is a positive relationship between learning activities and health in general and that learning has a positive impact on the psychological, mental and social aspects of health. Despite this, there are still unanswered questions about the rela-tionship between and the concepts of health and learning. The aim of this review has been to map and synthesise research on the relationship between learning and health for older adults in organised or institutiona-lised education using a conceptual analysis model. The results demon-strate that intrinsic values like learning for its own sake and the joy of learning are emphasised. Moreover, individual factors of health are emphasised and several different concepts are used to explain health. In the final synthesis, four logics are identified concerning the relationship between learning and health: Learning as Quality of Life, Learning as Social
Networks, Learning as a Means for Coping and Learning as a Means for Reducing Risk. In conclusion, there is a need for a more in-depth
under-standing of the ontological and epistemological grounds for learning and health in the field in order to strengthen the cumulative knowledge production about the relationship between older adults learning and health.
KEYWORDS Education; wellbeing; ageing; learning; health
Introduction
Interest in the relationship between learning and health for older adults has increased in recent decades. The field is constantly expanding and researchers from different disciplines and areas have investigated various aspects of this relationship both as a resource for health promotion and as a barrier to elder learning. For example, some researchers have reported a correlation between learning activities and health for older adults. Learning has also been found to have a positive impact on the psychological aspects of health in terms of life satisfaction and wellbeing (Tam & Chui, 2016). Research results have further demonstrated that important benefits of education include mental cognitive health and keeping the brain active (Hardy et al., 2017). Benefits have also been associated with social aspects of health, such as strengthening social networks and fellowship (Åberg, 2016).
The research hitherto undertaken implies that learning can strengthen different aspects of older people’s health. However, there is an ambiguity in these studies around what is meant by learning and health. Mestheneos and Withnall (2016) problematise the complexity of the connections between learning and older adults’ health and underline the difficulties of evaluating the effects of
CONTACT Magnus Schoultz magnus.schoultz@oru.se School of Humanities, Education and Social Science; Research School Successful Ageing, Örebro University, Örebro, Sweden
https://doi.org/10.1080/02601370.2020.1819905
© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
learning, especially as the concepts of health and wellbeing are used in different ways in the studies. Thus, without having any clear definitions of and theoretical foundations of these concepts it is difficult to draw general conclusions about the learning-health relationship. Considering the rapid growth of this research field it is important to scrutinise the conceptualisations of learning and health that have been used in previous research. Such a clarification could help to identify crucial knowledge gaps, facilitate the development of more appropriate designs in future research, strengthen the claims of the studies and make cumulative knowledge production possible. A more nuanced knowledge of the relationship between learning and health would also contribute to the organisation of education for older adults.
The aim of the present paper is to map and synthesise research that has focused on the relationship
between learning and health for older adults in organised or institutionalised education. In contrast to a lifelong learning approach which involves all learning activities that improve skills, knowledge and attitudes continuously throughout life, we in this review focus on organised education with the character of formal and non-formal learning settings where older adults participate (Findsen & Formosa, 2011). The authors of this study are situated in John Dewey’s pragmatic philosophy of learning and Aaron Antonovsky’s salutogenic perspective of health. Thus, the focus is on understanding the continuous relation between the individual and social dimensions of learning as well as health.
In this review, a conceptual analysis model is applied that focuses on the use of the health and learning concepts in adult education. Two central aspects of learning and two essential aspects of health are explored. The conceptual analysis of learning focuses on the aspects ‘values of learning’ and ‘processes of learning’, while the conceptual analysis of health focuses on the aspects ‘origins of health’ and ‘determinants of health’. Based on this analysis, a synthesis is conducted in order to demonstrate the different logics in how the relationship between learning and health has been described and used in previous research.
Methods
This section outlines the method used for the review. Here we describe the search strategy, the selection criteria and the principles for the conceptual analysis.
Search strategy
This review of research followed the methodologies outlined by Booth et al. (2016) and Nilholm (2017). The review has the character of a scoping or systematic scoping review where the purpose is to map a broader topic and not a specific question. In addition, we follow Nilholm’s (2017) suggestion to include synthesising features where some aspects are analysed more deeply, namely the conceptual boundaries and the clarity of central concepts (see also Munn et al., 2018; Peters et al., 2015). As suggested by Booth et al. (2016) the search for relevant studies was based on a ‘pearl growing model’. The strategy for the model started with a central article that was then used to identify suitable search terms on which to base the review. The search using the identified terms resulted in a number of other central articles, which in turn generated additional terms. This was repeated until saturation, i.e., until no new relevant terms were identified. This initial step resulted in the following six keywords: education, learning, health, wellbeing, older adults and ageing. Once the keywords had been identified, a thesaurus search was made in the database ERIC to broaden the scope of relevant search terms. A total of 24 search terms1 were identified and used in the final search for articles. The search terms were combined with the Boolean operators OR and AND in order to facilitate searches in the Scopus, Web of Science (WoS) and ERIC databases. The search terms were used for abstracts, titles and keywords in the topic fields of these databases. Scopus and WoS are multidisciplinary in character and free text searches were made in these databases. As ERIC focuses on education, we combined thesaurus searching and free-text searching. All the searches were made in August 2019 and all the years available in the databases were included.2
Selection of studies
With the aim of mapping and synthesising research focusing on the relationship between learning and health for older adults in organised or institutionalised education, the inclusion criteria for the selection of studies were:
● The study is empirical.
● The investigated learning is organised or institutionalised, i.e., the learning context is not specified exclusively for the particular study. Articles are excluded when the researcher has created the learning context, or when it is an intervention study aiming to improve the participants’ health and wellbeing.
● The aim of the article involves the relationship between learning and health for older adults. ● The participants are described as older adults by the researcher. If other age groups are
included, older adults are analysed as a separate group. We have excluded studies on older adults undertaking education in order to re-skill or up-skill in the age of multiple careers. The initial search in the databases resulted in 3470 articles. Of these articles, 2960 were excluded after reading the titles, as were those that were clearly outside the scope of the review. For the remaining 729 studies the abstracts were read in relation to the inclusion criteria. This assessment resulted in 541 articles being excluded and 188 being read as a whole. Of these, 100 were excluded due to criteria mismatches and duplications. The remaining 88 articles were read several times and of these 48 were excluded due to not relating to organised learning, not focusing on the relationship between learning and health enough and interventions created by the researchers. After this assessment process, 40 articles remained for further in-depth analysis. A conceptual analysis and a synthesis were then conducted to identify different conceptualisations of health and learning and the relationship between the concepts.
Conceptual analysis of learning and health
To enable expansion of knowledge in a research field, concepts must be clarified (Maggmetti et al.,
2013). Conceptual analysis was therefore applied in order to deepen the understanding of the meaning of the used concepts and how they are interpreted in the research field focusing on the relationship between learning and health for older adults.
Although the conceptual analysis focused on the articles as a whole, particular attention was given to the methods and results. The methods that were used in the studies and the questions directed to the participants and their answers provided useful information about the use of the concepts of learning and health. A wide understanding of learning and health is applied in the review to enable different interpretations in our analysis. Thus, no specific theoretical framework has guided the analysis as it would narrow the scope of the undertaken analysis. Instead, central aspects of learning and health, and the tensions that exist within them, highlighted in handbooks and the research literature were used as categorisation principles (see, e.g.,, Bengtsson & Settersten, 2016; Findsen & Formosa, 2011; Illeris, 2009b; Marmot, 2006; Mittelmark & Bauer,
2017; Reid et al., 2014). However, it is important to acknowledge that even if we use a wide understanding of learning and health, certain aspects of the relationship are missing in the review. Focus is not for example, given on the effectiveness of learning on health and wellbeing for older adults, or how certain learning methods contribute to health or how diseases are best treated through learning.
The conceptual analysis of learning accordingly focused on the aspects ‘values of learning’ and ‘processes of learning’ (see, e.g.,, Illeris, 2009b), while the conceptual analysis of health focused on the aspects ‘origins of health’ and ‘determinants of health’ (see, e.g.,, Marmot, 2006; Mittelmark & Bauer, 2017). For analytical purposes, each aspect was divided into two essential research foci:
● Values of learning: intrinsic values and instrumental values.
● Processes of learning: internal processes of learning and external processes of learning.
● Origins of health: resources of health and risks of health.
● Determinants of health: individual determinants of health and social determinants of health. In this review, the aspects have been divided into different research foci in order to clarify the internal logic of the analysed studies (e.g., internal and external processes of learning and individual and social determinants of health). However, it is important to acknowledge that these separations are done for analytical purposes and there can be continuous integration between, for example, the individual and the social environment. They are accordingly not exclusive categories. A more detailed description of these aspects and possible positions are described in the next section.
The conceptual analysis of learning
Researchers from different academic disciplines focus on older adult education (Kern, 2018). The concept of learning has therefore been interpreted in different ways and the complexity of learning is reflected in the numerous learning theories and concepts that are available (see, e.g.,, Illeris,
2009b). In order to identify the reviewed studies’ positions on learning, the conceptual analysis has focused on the aspects ‘values of learning’ and ‘processes of learning’ and the different research foci connected to these aspects.
Regarding ‘values of learning’, the articles were either classified as focusing on intrinsic values or instrumental values. Kapitzke and Hay (2014) argue that this is a fundamental division in learning theory and discuss the tension between intrinsic valuing and a more instrumental valuing of learning. Intrinsic values are values that reside within the learning processes themselves and not in the aim and goals of learning (Narushima et al., 2013a). The contribution of education can thus be, e.g.,, meaningfulness or personal enrichment (Sandell & Öhman, 2013). Learning for its own sake, for joy and other emotions as well as intellectual growth are seen as important arguments for older adults’ participation in education. Instrumental values are separated from the learning activity itself and the benefits of learning come after education (Sandell & Öhman, 2013). The focus often lies on skills and ability (Boulton-Lewis & Buys, 2015), e.g., learning is seen as a mental and/or physical activity that leads to new behaviour that could be positive for older adults. Attention can also be given to how skills like literacy, numeracy and physical literacy are working as mediators for the relationship between educational attainment and health (Whitehead, 2010; Yamashita et al., 2019, 2018). Here, education serves as a means for achieving better health, while effectivity (what works) and effect are central terms when arguing for certain learning activities.
The learning theorist Illeris (2009a) further holds that basic processes of learning can in principle be understood as internal in terms of reflective thinking and the acquisition and processing of information, and external in terms of the interaction between the individual and the environment. Regarding the aspects ‘processes of learning’, the articles were classified as either focusing on the
internal processes of learning or the external processes of learning. Research on the internal processes
typically highlights mental patterns and cognitive developments (Findsen & Formosa, 2011; Illeris,
2009a), where the focus is mainly on the individual and where learning is seen as a process in which individuals construct their own knowledge (Quennerstedt & Maivorsdotter, 2016). The research is often based on psychological learning theories (Jarvis, 2009). Research emphasising the external
processes of learning stresses that learning occurs by participating in different contexts. Here,
socialising and communicating with others are crucial. People use knowledge in activities that are undertaken together with other humans. Attention is mainly directed towards the context and the social factors of learning and research are often based on socio-cultural learning theories (Mercer & Littleton, 2007; Quennerstedt & Maivorsdotter, 2016).
The conceptual analysis of health
There are different perspectives on and ideas about how ageing should be viewed (Findsen & Formosa, 2011), and much in the same way as for learning, the concept of health is used and interpreted in various ways (see, e.g.,, Marmot, 2006; Mittelmark & Bauer, 2017). The conceptual analysis of health is grounded in an understanding of health development as an ongoing process. Health is considered to be more than absence of disease (Mittelmark & Bauer, 2017) and is dependent on various functions where the biological interacts with social and existential functions (Bauer et al., 2006). In order to identify the reviewed studies’ positions on health, the conceptual analysis concerns the ‘origins of health’ and the ‘determinants of health’ and the different research foci that are connected to these aspects.
Regarding ‘origins of health’, the articles are classified as emphasising the pathogenic risks of
health or salutogenic resources of health (Antonovsky, 1987; Mittelmark & Bauer, 2017). A pathogenic perspective on health has historically dominated the research on health and research focusing on the risks of health has tended to stress the dichotomy between health and disease. Health is seen as static and a goal in itself. Here the absence of disease or risk for disease are vital and education is often regarded as an important part of the solution to health-related problems. The problem is how to stay active in order to avoid illness and risk behaviour that could contribute to ill-health (Mittelmark & Bauer, 2017). In contrast to the pathogenic approach, the sociologist Aaron Antonovsky established the term salutogenesis in the 1970s, with a focus on the resources of health (Antonovsky, 1987). Research on this perspective concerns the constitutive elements of health, with an emphasis on individual, social and cultural resources, rather than on the lack of functionality (McCuaig & Quennerstedt, 2018; Mittelmark & Bauer, 2017). This perspective on health involves the interaction between physical, mental, social and cultural factors. Health is seen as a continuous process that is created and lived by human beings in the settings of their everyday lives (Mittelmark & Bauer, 2017). Education is here seen as a resource that strengthens people’s possibilities to live a good life and not primarily as something to be used to solve various health problems (Forbech Vinje et al., 2017; McCuaig & Quennerstedt, 2018). A similar discussion can be seen regarding the concept health literacy. One approach to health literacy has a functional approach and is influenced by medicine where the focus is on basic skills and the understanding of health information. The other approach gives attention to cultural and social contexts in relation to various skills where a more complex understanding to health literacy is embraced (Mårtensson & Hensing, 2012). In order to increase the possibilities for older people to gain power over their own lives, knowledge how to assess and use health-related information is vital together with critical and interactive skills to make appropriate health decisions. Health literacy is accordingly seen as an essential part of the work with health promotion for older adults (Mårtensson & Hensing, 2012; Nutbeam, 2019).
Regarding ‘determinants of health’, the articles were classified as either emphasising individual
determinants of health or social determinants of health (cf. Marmot, 2006). Central when focusing determinants is that social, biological and psychological processes throughout the life course, as well as the social environment, affect the health situation in later life. A life-course perspective can accordingly contribute to and broaden our understanding of age and ageing. Earlier life experiences and the changing sociohistorical context must therefore be taken in to account when discussing the situation of older people and their life circumstances (Bengtson, 2016; Koelen et al., 2017). Research on the individual determinants of health investigates which psychological and physical factors are vital for health and how they affect an individual’s health (Bauer et al., 2006). Here, health starts with the individual and their abilities, and attention is directed towards the functions of the human being and individual risk factors. Research on the social determinants of health stresses the importance of taking social and cultural factors into consideration in order to understand health, often in terms of public health (Marmot, 2006). The social conditions and the context are high-lighted and attention is drawn to aspects like communication, meeting new people and social
structures like employment, distribution of income, social gradient, educational attainment and occupation (McMunn et al., 2006).
Analytical procedure
The analysis was conducted in four steps. First, each article was analysed and categorised according to the different research foci of the article in relation to the four aspects of learning and health. Some articles were clear in their perspectives and definitions of learning and health, while others were more diffuse. Therefore, both the explicit and implicit research foci of each article were taken into consideration. When an article expressed several foci those that were emphasised most served as a basis for their categorisation. The initial analysis was conducted by one researcher. In order to strengthen the significance of the analysis, we used a so-called deliberative strategy (Goodyear et al.,
2017) where all researchers independently analysed the articles with help of the guiding analytical questions. Each researcher categorised the article according to their different research expertise. The researchers’ categorisations were then compered and deliberately discussed before the study’s final categorisations were decided. As Goodyear and colleagues argue: ‘[t]he goal of the deliberation is thus a form of collective agreement where all co-authors are given the possibility to make judge-ments in relation to different alternatives, views and argujudge-ments’ (p. 217).
Guiding analytical questions deriving from the previously described conceptual tools concerning learning foci were:
● What is the role of the teacher?
● What is the role of the learner?
● What are the goals of learning?
● How is knowledge explained?
● What is the motive for learning?
● Which factors determine learning?
Guiding analytical questions concerning health foci were:
● What is the main focus of health?
● What does health mean?
● What is the relationship between education and health?
● What is the role of the individual?
● Is there a problem to be solved regarding health?
Second, the number of articles emphasising each aspect was noted and the research foci relating to the aspects of learning and health were mapped and described in terms of the content of each concept.
Third, the relationships between the different foci in each article were analysed and the different kinds of relationships were compiled. In this way, a conceptual pattern was generated for each article to determine how the article related the different aspects to each other. How an article combines the different foci reveals the logical structure of the relationship between learning and health in the studies. For example, if an article focuses on instrumental values and internal processes of learning and the risk and individual determinants of health, it reveals how the study expects learning to contribute to the health and wellbeing of older adults in education.
Fourth, a synthesis was made in order to identify the most common patterns in the data set as a whole. These synthesised patterns demonstrate the different logics in the relationship between learning and health that dominate the research field. The logics were named and general descrip-tions of each logic were made. This final step resulted in four logics, all of which are presented and summarised in Table 5.
Findings
In this part, we present the results of the analysis of the relationship between learning and health for older adults in organised or institutionalised education. We first give an overview of the learning and the health perspectives separately and then present a synthesis of the four dominant logics in the relationship between learning and health in the field.
Learning
The conceptual analysis of learning focused on the aspects ‘values of learning’ and ‘processes of learning’. In the following sections, the result for each aspect is presented and demonstrated using examples from the articles.
Values of learning
Concerning the ‘values of learning’ expressed in the analysed articles, 23 articles emphasised the importance of intrinsic values and 16 articles focused on instrumental values (see Table 1).
Several of the analysed articles focused on intrinsic values in terms of the importance of learning for its own sake. In their research, McWilliams and Barrett (2018) emphasised that members of the Osher Lifelong Learning Institutes (OLLI) pursued learning as ‘learning for its own sake’ (p. 299). Another interesting observation in the study was that older adults defined themselves as more committed learners than younger students. The joy of learning was also raised as an important factor (Sloane-Seale & Kops, 2010). A few articles particularly underlined the joy of learning a certain content or activity, such as poetry or music (Perkins & Williamon, 2014; Richeson et al.,
2007). Learning as a quality of life was yet another theme that underlined the intrinsic values of organised educational settings. The findings from a study by Park et al. (2016) indicated that ‘the level of relationships that the participants had with classmates was positively related to social and psychological elements of their quality of life’ (p. 99).
In several of the articles (e.g., Mackowicz & Wnek-Gozdek, 2016; Sloane-Seale & Kops, 2010), finding and developing new interests were regarded as an essential part of the value of learning. Hachem and Vuopala (2016) summarised their findings in the following way; ‘They [older adults participating in the study] spoke of acquiring knowledge and information in topics that genuinely interest them; and what’s more, they got acquainted with totally new topics’ (p. 690). Similarly, Leung et al. (2006), identified ‘learn something new’, ‘make life more meaningful’ and ‘develop personal interests/hobbies’ as values of learning when asking participants about the perceived benefits of learning later in life. Moreover, the authors concluded that these educational activities:
[. . .] are broad terms and do not specify the types of skills to be learned. These terms, however, do refer to ‘general interest in subject matter’ and do not refer to skills leading to career advancement. (p. 11)
Articles emphasising instrumental values often focused on the effects and outcomes of learning in relation to health. Santos et al. (2014) discussed the relationship between learning and health in terms of the prevention of depressive and cognitive symptoms, drew attention to
Table 1. The distribution and some examples of the themes the articles highlighted in the different aspects of learning.
Aspects of learning Themes Number of articles
Intrinsic values New interest, for its own sake, joy, quality of life 23 Instrumental values Health outcomes, skill acquisition, physical effects 16 External processes Social interaction and support, sharing knowledge 12 Internal processes Experiences and perceived cognitive benefits 24
the numbers of years of university studies and instead stated that ‘the variables age and years of education were not associated with any quality of life domain’ (p. 174). Quantitative measures, such as ‘years of education’ or ‘duration of participation’ and its correlation to different health factors, were elucidated in several of the studies (Narushima et al., 2013b; Santos et al., 2014). Instrumental values were also provided by Jenkins (2012), who focused on the effects of learning on levels of depression. Thus, the focus in these studies was on values that were separated from the specific learning activity. In Leung and Liu (2011) and Santos et al. (2014) the learning outcomes of education were related to the level of cognitive symptoms, psychosomatic complaints and quality of life. Other studies analysed the effects of education in relation to acquiring certain abilities, such as increased cognitive functions and psychological wellbeing (Narushima et al., 2018; Simone & Cesena, 2010). Fernández- Ballesteros et al. (2012) found that three years of university studies improved the elderly participants’ memories and learning performances, while the control group without any university studies declined. In two articles, instrumental values were related to new technol-ogies (Díaz-López et al., 2016; Shapira et al., 2007). Díaz-López et al. (2016) explained the educational context and stated that ‘[t]he main objective was for the elderly participants to acquire new skills and abilities in order to optimise their digital competence, improving their emotional state and offering them more autonomy’ (p. 3). Some of the articles emphasising instrumental values also mentioned the physical gains of learning. For example, Fu et al. (2018) stated that ‘a group-singing program was well received and may promote memory, language, speech information processing, executive function, and respiratory muscle strength in older adults’ (p. 144).
Processes of learning
Twenty-four of the articles emphasised the internal processes of learning, while 12 articles focused on external processes, as outlined in Table 1.
Articles focusing on the external processes of learning highlighted a variety of themes, such as friendship, sharing knowledge, social networks and the cultural aspects of learning (Park et al., 2016; Richeson et al., 2007; Sabeti, 2015). Sabeti (2015), for example, demonstrated the external processes of learning in a writing class and concluded that: ‘This is a creative process that is collaborative and relational. The poem that is produced is the outcome of the inter-actions between members of the group’ (p. 221). The social interaction in the external processes was highlighted by Park et al. (2016) in a study focusing on older adults’ learning in a university environment. The study showed the importance of interaction, specifically with younger students at the university, and stated that ‘the intergenerational discussions gave the older adults an opportunity to share their knowledge and wisdom with younger students’ (p. 99). In addition, Mackowicz and Wnek-Gozdek (2016) emphasised that being part of a bigger group was an important way of strengthening new relationships and increas-ing social support durincreas-ing the educational activities. In much the same way, Åberg (2016) focused on participation in Swedish study circles and reported that:
[. . .] gaining or improving their knowledge and skills was not at all important as a reason for their study circle participation and that both being part of the fellowship in a study circle and meeting new people are rated even higher as motives. (p. 416)
A common focus in articles underlining the internal processes of learning was the participants’ learning experiences and how they were associated with the perceived benefits of learning. Older learners’ meanings of ageing in relationship to learning were also a recurring theme (Tam & Chui,
2016). For example, Hardy et al. (2017) investigated older adults’ experiences of participating in traditional university programmes and reported that: ‘education had informed and improved their way of thinking, and the satisfaction and challenge of developing their student identity’ (p. 735). Attention was also given to the intellectual parts of learning (Hebestreit, 2008), with the internal
processes being highlighted in terms of psychological and cognitive factors of learning (Fernández- Ballesteros et al., 2012; Narushima et al., 2013a; Shapira et al., 2007; Simone & Cesena, 2010). Narushima et al. (2013a) focused on the patterns of older adults’ motivations and the perceived benefits of learning in education and concluded:
The top two motivations for both men and women were to keep myself mentally active (cognitive) and to learn something for the joy of learning (psychological), while the I’ve got an opportunity to learn what I wanted to learn (cognitive) and I found learning keeps me mentally alert (cognitive) were the top two benefits of learning. (p. 577)
Health
The conceptual analysis of health focused on the aspects ‘origins of health’ and ‘determinants’ of health’. In the following sections, the result for each aspect is presented and demonstrated using examples from the articles.
The origins of health
Concerning the perspectives on the ‘origins of health’ expressed in the analysed articles, 35 articles focused on resources of health. Only four articles emphasised the risks of health (Table 2).
Many of the articles highlighted the importance of resources of health as understood in a salutogenic perspective in relationship to quality of life, coping strategies and life satisfaction. Quality of life was used both as a measurement and as a way of explaining the relationship of learning to health. Several methodological instruments were applied to assess ‘quality of life’. Those used were, for example, the WHO Quality of Life-Brief (WHOQOLBREF), CASP-19, the General Health Questionnaire (GHQ) and the Quality of Life Ladder (QoLL) (Jenkins, 2011; Leung & Liu,
2011; Park et al., 2016; Portero & Oliva, 2007). Park et al. (2016) showed that participants’ experiences in a university-based educational programme for older adults were associated with psychological and social elements of quality of life. Quality of life was also discussed in relationship to positive feelings and self-efficacy (Leung & Liu, 2011; Mackowicz & Wnek-Gozdek, 2016). In addition, some articles focused on measuring wellbeing and life satisfaction together with the quality of life (Jenkins, 2011). Narushima et al. (2018) explored older individuals in non-formal courses and stated that: ‘The findings generally support the benefits of meaningful social participa-tion for active ageing and enhanced quality of life in old age’ (p. 665). The authors further argued that the coping capacity of older adults could be a way of understanding the association with psychological wellbeing, even if in many respects older adults belong to vulnerable risk groups.
Sabeti (2015) explored a creative writing class and highlighted the ability to cope with different challenges and problems in life as a learning mechanism for older individuals’ health and wellbeing. Narushima (2008) argued that learning coping abilities: ‘in turn reinforces each individual’s interest, life satisfaction, self-efficacy, and self-management – all important intermediate factors for psychosocial wellbeing and effective coping in later life’ (p. 687). The ability to cope was also highlighted in relation to self-confidence (Boulton-Lewis & Buys, 2015) and self-efficacy (Richeson et al., 2007). Boulton-Lewis and Buys (2015), for example, stated that participating in learning activities: ‘keeps older people involved in enjoying and living life fully through, building self-
Table 2. The distribution and some examples of the themes the articles highlighted in the different aspects of health.
Aspects of health Themes Number of articles
Resources Quality of life, coping strategies, life satisfaction 35
Risks Illness, physical function, depression 4
Social determinants Social networks, community building, supportive environments 12 Individual determinants Psychological and physical aspects 25
confidence and coping strategies, maintaining cognitive functioning and knowledge, managing their health’ (p. 764).
In a number of articles, resources of health were salutogenically emphasised in terms of positive emotions and life satisfaction (Cody et al., 1999; Hachem & Vuopala, 2016; Perkins & Williamon,
2014; Simone & Cesena, 2010). For example, Hachem and Vuopala (2016) concluded that ‘seniors expressed feelings of happiness, high self-motivation, and a general level of satisfaction in life’ (p. 693). Similarly, Perkins and Williamon (2014) emphasised the importance of positive emotions and stated that ‘feelings of happiness, positive psychological functioning and behaviours optimizing social, physical and mental health, evidence from both studies point to the role that music can play in healthy ageing’ (p. 563). In addition to positive emotions, Tam and Chui (2016) highlighted the importance of the ability ‘to cope’ in older adults’ learning, while Sloane-Seale and Kops (2010) discussed the ability ‘to cope’ in terms of flexibility and adaptability.
A few articles focused on the risks of health, where an interest in risk factors and potential threats to older adults’ health was central. For example, Fernández-Ballesteros et al. (2012) mentioned how memory and learning performance increased in their experimental group, whereas the cognitive function of their control group declined significantly. The level of depression among older adults was also highlighted as a risk factor in an article by Jenkins (2012). The article examined the relationship between learning and depression using CES-D (The Centre for Epidemiologic Studies Depression Scale) to measure depressive symptoms. Attention was also given to the health status of older adults and factors like the number of chronic diseases and illnesses were emphasised. Fernández-Ballesteros et al. (2012) identified an association between participation in a university programme and illness. The authors declared that:
[. . .] no differences were found between the two groups in subjective health in any of the comparisons, our experimental (PUMA) participants maintained their objective health, as assessed through number of illness reported, while the control (ELEA) individuals showed a significant increase in the number of illnesses reported at the 3-year follow-up. (p. 8)
Some articles drew attention to the importance of physical factors in the relationship between learning and health. Fu et al. (2018) explored the effects of learning on breathing and lung-function, while Shapira et al. (2007) analysed the relationship between learning and levels of physical functioning and depression.
The determinants of health
When it comes to ‘determinants of health’, 12 articles focused on the social determinants of health, while 25 articles highlighted the individual determinants of health (Table 2).
Articles focusing on social determinants of health were mainly concerned with social networks, community building and positive learning environments. Park et al. (2016) for example, underlined the importance of building social networks in university-based learning programmes for older adults and stated that:
Although the participants’ relationships with classmates appeared to be weaker than that with instructors, the study findings indicated that the level of relationships that the participants had with classmates was positively related to social and psychological elements of their quality of life. (p. 99)
Park et al. (2016) used the WHOQOL-BREF survey to assess several elements of health and paid attention to the environmental and social parts of ‘quality of life’. Åberg (2016) also emphasised the environmental dimensions of health. In his study of Swedish study circles, the results showed that the wellbeing of older adults was positively affected by being part of a group. Fellowship and belonging to a community were important features for the participants. Åberg further argued that non-formal learning could create supportive environments for older adults’ wellbeing. Other aspects related to social networks as a social determinant were the possibility to connect with other people and establish new relationships (Mackowicz & Wnek-Gozdek, 2016; Sabeti, 2015).
Cody et al. (1999) maintained that social support ‘helps to maintain friendships longer, mainte-nance of positive self-esteem, reduced age-related stress and depression’ (p. 28).
Individual determinants of health recurred in different ways in the reviewed articles. The
participants’ characteristics and their own experiences and meaning of health were emphasised and the focus was on psychological, mental and physical parts of health. This was sometimes mentioned in conjunction with terms like function and activity (Sloane-Seale & Kops, 2010). Hardy et al. (2017) concluded that ‘mental health and keeping the brain active was identified as the main benefit gained by being enrolled in a university programme’ (p. 735).
Regarding personal characteristics, factors like age, gender, chronic conditions, difficulties in daily living and illness were highlighted (Fernández-Ballesteros et al., 2012; Leung & Liu, 2011; Narushima et al., 2013b).
In some articles, the psychological aspects of health were discussed in terms of positive emotions (Simone & Cesena, 2010; Tam & Chui, 2016). An article by Tam and Chui (2016) illustrated the participants’ own interpretations and meanings of health and concluded that the inner feelings of: ‘having a sense of peace’ and ‘feeling satisfied with life most of the time’ (p. 207) highlighted the importance of internal factors for successful ageing. Other articles took a more pathogenic stance. For instance, Jenkins (2012) focused on the depression levels of the participants in educational activities and on the various factors that could influence the risk of depression. Richeson et al. (2007) also measured the participants’ depression levels and argued that ‘providing older adults with early stage dementia educational opportunities in a normalised, dignified, and non-stigmatised environment has the possibility to influence their self-efficacy mood, and mental status’ (p. 735).
Several methodological tools were used to measure individual determinants like psychological well-being, e.g., the Psychological General Well Being Index (PGWBI) (Narushima et al., 2013b). Other tools for measuring the mental aspects of individual health were the Short Warwick Edinburgh Mental Well- being Scale (Short-WEMWBS) (Perkins & Williamon, 2014) and the General Health Questionnaire (GHQ-12), both of which have been used as mental wellbeing measures (Jenkins, 2011).
In addition to mental and psychological health, several articles also mentioned different physical determinants of health as a result of learning (Perkins & Williamon, 2014; Shapira et al., 2007; Tam & Chui, 2016). Boulton-Lewis and Buys (2015) explored older adults in organised learning and argued that learning activities had the potential to contribute directly or indirectly to physical or mental wellbeing. Li and Southcott (2015) demonstrated how older adults’ learning to play the piano increased and improved their coordination, finger and hand flexibility, body mobility and respiratory function. This activity also affected the participants’ emotions and gave them a sense of achievement.
The relationship between learning and health for older adults in education
In the final synthesis, four general patterns were identified concerning different logics in the relationship between learning and health in the analysed research literature. The logics consisted of the most recurrent combinations of the analysed aspects of learning and health (Table 3). The four logics, named after their main characteristics, are: (i) Learning as Quality of Life, (ii) Learning
as Social Network, (iii) Learning as a Means for Coping and (iv) Learning as a Means for Reducing
Table 3. Four main logics concerning the relation between learning and health in organised or institutionalised education for older adults.
Logics Values of learning
Processes of
learning Origins of health Determinants of health Number of articles
Learning as Quality of Life Intrinsic Internal Resources Individual 8
Learning as Social Networks Intrinsic External Resources Social 9
Learning as a Means for Coping Instrumental Internal Resources Individual 8
Learning as a Means for Reducing Risk
Risk. In the following, we describe how the four logics are developed to form different reasonable
relationships used in studies in the field.
The Learning as Quality of Life logic includes a combination of intrinsic values of learning, internal processes of learning, resources of health and individual determinants of health. This logic is about learning for its own sake as a resource for health and as personal development by considering mental and cognitive challenges in relation to earlier experiences. Learning contributes to inner personal qualities and the possibility to acquire knowledge in matters that interest the participants. This enjoyment of learning new things gives pleasure, creates engagement and leads to psychological and mental wellbeing. By participating in educational activities, the individual learner develops self-confidence and acquires coping strategies to handle different stressors. In this logic, feelings of joy and happiness are connected to the learning process itself and to the enhancement of older adults’ quality of life.
In the Learning as Social Networks logic, the relationship between health and learning is under-stood in terms of the intrinsic values of learning, external processes of learning, resources of health and social determinants of health. The focus in this logic is on how learning creates supportive environments for social interaction, social networks and community building. The possibility to communicate with other participants in educational contexts deepens the learning itself through new perspectives and leads to personal development and life satisfaction. The joy of learning together with others is important and the learning process itself is considered as enriching. Social interaction also creates happiness as well as a sense of community and a social network that helps people to adapt to changes in life.
The Learning as a Means for Coping logic is characterised by a combination of instrumental values of learning, internal processes of learning, resources of health and individual determi-nants of health. Here, learning is viewed as a means of acquiring different coping skills and abilities as resources in order to improve health and the quality of life. The focus is on the individual and how learning in an instrumental sense affects individual aspects of health. The positive effects of learning mainly concern the psychological and mental aspects of health, where coping skills enhance individual autonomy. Coping skills and autonomy can in turn strengthen individuals’ abilities to face different kinds of stress and various changes in life. By participating in educational activities coping strategies are claimed to be developed gradually in a lifelong process.
Finally, the Learning as a Means for Reducing Risk logic connects instrumental values of learning, internal processes of learning, risk of health and individual determinants of health. In this logic, participation in education is seen as way of stimulating mental and cognitive abilities. However, instead of focusing on how to enhance different resources of health, as in the previous logic, the focus here is on how learning can help to avoid and reduce certain individual risks and deficits like dementia, depression and illness that may occur in older age. The effects of participation in education or learning particular skills are instrumentally measured or claimed as a consequence after the educational event.
Discussion and conclusion
The results of the review of research reveal that a majority of the articles highlight intrinsic values of learning, i.e., interest-driven learning. Skills in relation to literacy, numeracy and physical literacy were emphasised to a very small extent or not at all in the articles. This is noteworthy, as instrumental values are often promoted in policy and in the regular school system (e.g., Biesta,
2009; Kapitzke & Hay, 2014; Lundgren, 2012). However, our review concerns research which focuses on the relationship between learning and health for older adults. This could partly explain the lack of instrumental values in the reviewed studies. A majority of the articles in the review also emphasise the internal processes of learning. However, how the articles draw attention to the aspect ‘processes of learning’ is more difficult to identify, because the tendency is to not ground the
research in existing theories of learning. Learning is rarely explicitly defined in the articles and, as a consequence, the processes and complexities of learning are often overlooked. This lack of attention to the processes of learning potentially creates misunderstandings, since learning and participation in education are sometimes perceived as the same thing. This clearly indicates a need to further explore the social and cultural aspects of learning and how they contribute to health by applying sociocultural theories of learning.
The review also reveals that resources of health are emphasised more than the risks of health. This is interesting, given that the research field on the relationship between learning and health often claims to focus on the deficits of health (Findsen & Formosa, 2011). However, the results of our review do not match those claims. One reason for this may be that our review focuses on studies researching organised or institutionalised settings and that targeted research interventions aiming specifically at the effects on participants’ health are excluded. However, there is a tendency in the articles to slip over and discuss health in terms of deficit and risks even if the main focus is on resources.
With our sample, the results indicate a shift towards a salutogenic approach to learning and health for older adults both in terms of the origins of health and the determinants of health, even though individual aspects are highlighted more than the social and cultural ones (see McCuaig & Quennerstedt, 2018). A majority of the articles emphasised individual determinants of health. This is in line with previous research which argues that some theories, like successful ageing, emphasise individuals’ control of their lives (McMunn et al., 2006). However, some articles touch upon social determinants of health, such as educational attainment, occupation or income as contextual information, but the studies generally base their claims on how learning contributes to the individual determinants of health. In the reviewed studies the participants’ characteristics were accordingly not explored in relationship to learning and health. Instead, it was more used as a way to illustrate the structure of the population or as a way to examine the effects of more individual determinants of health. Thus, there is a need to further elaborate how the social and cultural environment can be explored in relationship to learning and health for older adults in terms of health resources.
The results of our synthesis, which demonstrate four main logics concerning the relation-ship between learning and health, clearly reveal that when the concepts are used in different ways the claims that are made in research are difficult to evaluate in relation to other studies in the field. As each logic has its own internal and external logical sequence, when the definitions and theoretical foundations of learning and health are unclear it becomes difficult to draw any general conclusions about the learning-health relationship. We would argue that research should always make assumptions about essential concepts and the claims made in the studies clear. Our review shows that this lack of clarity is particularly noticeable when it comes to learning, especially where learning theories are seldom used for the research designs, theore-tical analyses or discussions about the consequences of the studies. This makes evaluating the effects of learning on the health of older adults in educational settings particularly challenging. It is also important to recognise that what we observe in the later life stage is not merely the product of current social conditions or individual characteristics – earlier experiences in life influence how people interpret and create meaning in a learning situation. It is accordingly essential to take sociohistorical trends and cumulative effects of earlier life events and decisions into consideration when investigating the relationship between older peoples learning and health.
In conclusion, the relationship between learning and health can be described and understood through different logics. However, these logics are seldom clear or made explicit in research since definitions and theories of learning and health often are implicit in the studies. We would consequently argue that research should always be explicit about which aspects of learning and which aspects of health have been considered, and also how the relationship between the concepts is understood, i.e., which logic is emphasised. If research does not pay attention to these issues it will
be more difficult to determine what the relationship between learning and health in the field is understood as, and we advocate for a more in-depth understanding of the ontological and epistemological grounds for learning as well as health. This kind of clarity would hopefully facilitate the development of research designs, strengthen the claims of the studies and make cumulative knowledge production possible regarding the relationship between older adults’ learning and health.
Notes
1. The 24 search terms used in the study were: Adult Learning, Adult Education, Ageing, Cognitive Processes, Education, Educational Benefits, Educational Experience, Gerontology, Health, Health Promotion, Health Status, Informal Education, Learning, Learning Activities, Learning Experience, Learning Processes, Lifelong Learning, Life Satisfaction, Mental Health, Older adult*, Outcomes of Education, Quality of Life, Sense of Community and Well Being.
2. Scopus (1960–2019); Web of Science (1975–2019); ERIC (1966–2019).
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Magnus Schoultz is a PhD student at Örebro University’s School of Humanities, Education and Social Sciences, Sweden. In his thesis he studies the relationship between learning and health for older adults. His research interests focus older adults' experiences of learning and his work is based on Dewey’s pragmatic philosophy of learning and Aaron Antonovsky’s salutogenic perspective of health.
Johan Öhman is a professor at Örebro University’s School of Humanities, Education and Social Sciences, Sweden. His area of research is ethical and democratic issues within the sphere of education for sustainable development, environmental education and outdoor education. His work is based on John Dewey’s pragmatic philosophy and view of the democratic potential of education.
Mikael Quennerstedt is a professor in Physical Education and Health at Örebro University, Sweden. Quennerstedt’s main area of research is within teaching and learning in physical education, and salutogenic perspectives of health education. In his research, questions of health, body, gender, artefacts, subject content, learning processes and governing processes within educational practices have been prominent.
ORCID
Johan Öhman http://orcid.org/0000-0002-1423-4233 Mikael Quennerstedt http://orcid.org/0000-0001-8748-8843
References
Åberg, P. (2016). Nonformal learning and well-being among older adults: Links between participation in Swedish study circles, feelings of well-being and social aspects of learning. Educational Gerontology, 42(6), 411–422. https:// doi.org/10.1080/03601277.2016.1139972
Antonovsky, A. (1987). Unraveling the mystery of health: How people manage stress and stay well. Jossey-Bass. Bauer, G., Davies, J. K., & Pelikan, J. (2006). The EUHPID health development model for the classification of public
health indicators. Health Promotion International, 21(2), 153–159. https://doi.org/10.1093/heapro/dak002 Bengtson, V. L. & Settersten, R. A. (Ed.). (2016). (Eds.), Handbook of theories of aging New York: Springer. Bengtson, V. L. (2016). How theories of aging became social: Emergence of the the sociology of aging. In
V. L. Bengtson & R. A. Settersten Jr (Eds.), Handbook of theories of aging, (pp. 67-86). Springer.
Biesta, G. (2009). What kind of citizenship for European higher education? Beyond the competent active citizen.
European Educational Research Journal, 8(2), 146–158. https://doi.org/10.2304/eerj.2009.8.2.146
Boulton-Lewis, G. M., & Buys, L. (2015). Learning choices, older australians and active ageing. Educational
Gerontology, 41(11), 757–766. https://doi.org/10.1080/03601277.2015.1039455
Cody, M. J., Dunn, D., Hoppin, S., & Wendt, P. (1999). Silver surfers: Training and evaluating internet use among older adult learners. Communication Education, 48(4), 269–286. https://doi.org/10.1080/ 03634529909379178
Díaz-López, M. D., López-Liria, R., Aguilar-Parra, J., & Padilla-Góngora, D. (2016). Keys to active ageing: New communication technologies and lifelong learning. SpringerPlus, 5(1), 1–8. https://doi.org/10.1186/s40064-016- 2434-8
Fernández-Ballesteros, R., Molina, M. Á., Schettini, R., & Del Rey, Á. L. (2012). Promoting active aging through university programs for older adults: An evaluation study. GeroPsych: The Journal of Gerontopsychology and
Geriatric Psychiatry, 25(3), 145–154. https://doi.org/10.1024/1662-9647/a000064
Findsen, B., & Formosa, M. (2011). Lifelong learning in later life: A handbook on older adult learning. Sense Publishers.
Forbech Vinje, H., Langeland, E., & Bull, T. (2017). Aaron Antonovsky’s development of salutogenesis, 1979 to 1994. In M. B. Mittelmark, S. Shagy, M. Eriksson, G. F. Bauer, J. M. Pelikan, B. Lindström, & G. A. Espnes (Eds.), The
handbook of salutogenesis (Vol. 2017, pp. 25-40). Springer.
Fu, M. C., Belza, B., Nguyen, H., Logsdon, R., & Demorest, S. (2018). Impact of group-singing on older adult health in senior living communities: A pilot study. Archives of Gerontology and Geriatrics, 76, 138–146. https://doi.org/10. 1016/j.archger.2018.02.012
Goodyear, V. A., Kerner, C., & Quennerstedt, M. (2017). Young people’s uses of wearable healthy lifestyle technol-ogies; surveillance, self-surveillance and resistance. Sport, Education and Society, 24(3), 212–225. https://doi.org/ 10.1080/13573322.2017.1375907
Hachem, H., & Vuopala, E. (2016). Older adults, in Lebanon, committed to learning: Contextualizing the challenges and the benefits of their learning experience. Educational Gerontology, 42(10), 686–697. https://doi.org/10.1080/ 03601277.2016.1218204
Hardy, M., Oprescu, F., Millear, P., & Summers, M. (2017). Baby boomers engagement as traditional university students: Benefits and costs. International Journal of Lifelong Education, 36(6), 730–744. https://doi.org/10.1080/ 02601370.2017.1382015
Hebestreit, L. (2008). The role of the university of the third age in meeting needs of adult learners in Victoria, Australia. Australian Journal of Adult Learning; Canberra, 48(3), 547–565. https://www.proquest.com/docview/ 89071639/4640F7F676914F7FPQ/1
Illeris, K. (2009a). A comprehensive understanding of human learning. In K. Illeris (Ed.), Contemporary theories of
learning: Learning theorists . . . in their own words, (pp.7-20). Routledge.
Illeris, K. (Ed.). (2009b). Contemporary theories of learning: Learning theorists . . . in their own words. Routledge. Jarvis, P. (2009). Learning to be a person in society: Learning to be me. In K. Illeris (Ed.), Contemporary theories of
learning: Learning theorists . . . in their own words, (pp. 21-34). Routledge.
Jenkins, A. (2011). Participation in learning and wellbeing among older adults. International Journal of Lifelong
Education, 30(3), 403–420. https://doi.org/10.1080/02601370.2011.570876
Jenkins, A. (2012). Participation in learning and depressive symptoms. Educational Gerontology, 38(9), 595–603. https://doi.org/10.1080/03601277.2011.595325
Kapitzke, C., & Hay, S. (2014). The creativity imperative: Implications for education research. In A. D. Reid, E. P. Hart, & M. A. Peters (Eds.), A companion to research in education, (pp. 281-287). Springer Netherlands. Kern, D. (2018). Research on epistemological models of older adult education: The need of a contradictory
discussion. Educational Gerontology, 44(5–6), 338–353. https://doi.org/10.1080/03601277.2018.1475123
Koelen, M., Eriksson, M., & Cattan, M. (2017). Older people, sense of coherence and community. In M. B. Mittelmark, S. Shagy, M. Eriksson, G. F. Bauer, J. M. Pelikan, B. Lindström, & G. A. Espnes (Eds.), The
handbook of salutogenesis (Vol. 2017, pp. 137-149). Springer.
Leung, A., Lui, Y.-H., & Chi, I. (2006). Later life learning experience among Chinese elderly in Hong Kong.
Gerontology & Geriatrics Education, 26(2), 1–15. https://doi.org/10.1300/J021v26n02_01
Leung, D. S. Y., & Liu, B. C. P. (2011). Lifelong education, quality of life and self-efficacy of Chinese older adults.
Educational Gerontology, 37(11), 967–981. https://doi.org/10.1080/03601277.2010.492732
Li, S., & Southcott, J. (2015). The meaning of learning Piano keyboard in the lives of older Chinese people.
International Journal of Lifelong Education, 34(3), 316–333. https://doi.org/10.1080/02601370.2014.999361 Lundgren, U. P. (2012). Education and the welfare society. In L. Wikander, C. Gustafsson, & U. Riis (Eds.),
Enlightenment, creativity and education: Polities, politics, performances, (pp. 61-77). SensePublishers.
Mackowicz, J., & Wnek-Gozdek, J. (2016). ‘It’s never too late to learn’—How does the polish U3A change the quality of life for seniors? Educational Gerontology, 42(3), 186–197. https://doi.org/10.1080/03601277.2015.1085789 Maggmetti, M., Gilardi, F., & Radaelli, C. M. (2013). Designing research in the social sciences. Sage.
Marmot, M. (2006). Introduction. In M. Marmot & R. G. Wilkinson (Eds.), Social determinants of health, (pp. 1-5). Oxford University Press.
Mårtensson, L., & Hensing, G. (2012). Health literacy - a heterogeneous phenomenon: A literature review.
Scandinavian Journal of Caring Sciences, 26(1), 151–160. https://doi.org/10.1111/j.1471-6712.2011.00900.x McCuaig, L., & Quennerstedt, M. (2018). Health by stealth – Exploring the sociocultural dimensions of salutogenesis
for sport, health and physical education research. Sport, Education and Society, 23(2), 111–122. https://doi.org/10. 1080/13573322.2016.1151779
McMunn, A., Breeze, E., Goodman, A., Nazroo, J., & Oldfield, Z. (2006). Social determinants of health. In M. Marmot & R. G. Wilkinson (Eds.), Social determinants of health in older age (pp. 267-296). Oxford University Press. McWilliams, S. C., & Barrett, A. E. (2018). “I hope I go out of this world still wanting to learn more”: Identity work in
a lifelong learning institute. The Journals of Gerontology: Series B, 73(2), 292–301. https://doi.org/10.1093/geronb/ gbv110
Mercer, N., & Littleton, K. (2007). Dialogue and the development of children’s thinking: A sociocultural approach. Routledge.
Mestheneos, E., & Withnall, A. (2016). Ageing, learning and health: Making connections. International Journal of
Lifelong Education, 35(5), 522–536. https://doi.org/10.1080/02601370.2016.1224039
Mittelmark, M. B., & Bauer, G. F. (2017). The meanings of salutogenesis. In M. B. Mittelmark, S. Shagy, M. Eriksson, G. F. Bauer, J. M. Pelikan, B. Lindström, & G. A. Espnes (Eds.), The handbook of salutogenesis (Vol. 2017, pp. 7-13). Springer.
Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC
Medical Research Methodology, 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x
Narushima, M., Liu, J., & Diestelkamp, N. (2018). Lifelong learning in active ageing discourse: Its conserving effect on wellbeing, health and vulnerability. Ageing and Society, 38(4), 651–675. https://doi.org/10.1017/ S0144686X16001136
Narushima, M. (2008). More than Nickels and Dimes: The health benefits of a community-based lifelong learning programme for older adults. International Journal of Lifelong Education, 27(6), 673–692. https://doi.org/10.1080/ 02601370802408332
Narushima, M., Liu, J., & Diestelkamp, N. (2013a). Motivations and perceived benefits of older learners in a public continuing education program: Influence of gender, income, and health. Educational Gerontology, 39(8), 569–584. https://doi.org/10.1080/03601277.2012.704223
Narushima, M., Liu, J., & Diestelkamp, N. (2013b). The association between lifelong learning and psychological well-being among older adults: Implications for interdisciplinary health promotion in an aging society. Activities,
Adaptation & Aging, 37(3), 239–250. https://doi.org/10.1080/01924788.2013.816834 Nilholm, C. (2017). SMART Ett sätt att genomföra forskningsöversikter. Studentlitteratur.
Nutbeam, D. (2019). Health education and health promotion revisited. Health Education Journal, 78(6), 705–709. https://doi.org/10.1177/0017896918770215
Park, J. H., Lee, K., & Dabelko-Schoeny, H. (2016). A comprehensive evaluation of a lifelong learning program: Program 60. The International Journal of Aging & Human Development, 84(1), 88–106. https://doi.org/10.1177/ 0091415016668352
Perkins, R., & Williamon, A. (2014). Learning to make music in older adulthood: A mixed-methods exploration of impacts on wellbeing. Psychology of Music, 42(4), 550–567. https://doi.org/10.1177/0305735613483668
Peters, M. D. J., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-based Healthcare, 13(3), 141–146. https://doi.org/10. 1097/XEB.0000000000000050
Portero, C. F., & Oliva, A. (2007). Social support, psychological well-being, and health among the elderly. Educational
Gerontology, 33(12), 1053–1068. https://doi.org/10.1080/03601270701700458
Quennerstedt, M., & Maivorsdotter, N. (2016). The role of learning theory in learning to teach. In C. D. Ennis (Ed.),
Routledge handbook of physical education pedagogies, (pp. 417-427). Routledge.
Reid, A. D., Hart, E. P., & Peters, M. A. (Ed.). (2014). A companion to research in education. Springer Netherlands. Richeson, N. E., Boyne, S., & Brady, E. M. (2007). Education for older adults with early-stage dementia: health
promotion for the mind, body, and spirit. Educational Gerontology, 33(9), 723–736. https://doi.org/10.1080/ 03601270701364438
Sabeti, S. (2015). Creative ageing? Selfhood, temporality and the older adult learner. International Journal of Lifelong
Education, 34(2), 211–229. https://doi.org/10.1080/02601370.2014.987710
Sandell, K., & Öhman, J. (2013). An educational tool for outdoor education and environmental concern. Journal of
Adventure Education and Outdoor Learning, 13(1), 36–55. https://doi.org/10.1080/14729679.2012.675146 Santos, B. R. D., Pavarini, S. C. I., Brigola, A. G., Orlandi, F. D. S., & Inouye, K. (2014). Factors associated with quality
of life in elderly undertaking literacy programs. Dementia & Neuropsychologia, 8(2), 169–174. doi:10.1590/S1980- 57642014DN82000013
Shapira, N., Barak, A., & Gal, I. (2007). Promoting older adults’ well-being through internet training and use. Aging &
