Variation in the impact of social network characteristics on physical functioning in elderly persons: MacArthur Studies of Successful Aging.

OBJECTIVES: Social support and social networks have been shown to exert significant effects on health and functioning among elderly persons. Although theorists have speculated that the strength of these effects may differ as a function of sociodemographic characteristics and prior health status, few studies have directly tested the moderating effects of these variables. METHODS: Longitudinal data from the MacArthur Study of Successful Aging were used to examine the effects of structural and functional social support on changes in physical functioning over a 7-year period, measured by the Nagi scale, in a sample of initially high-functioning men and women aged 70 to 79 years. Multiple regression analyses were used to test the main effects of social support and social network variables, as well as their interactions with gender, income, and baseline physical performance. RESULTS: After controlling for potential confounding effects, respondents with more social ties showed less functional decline. The beneficial effects of social ties were stronger for respondents who were male or had lower levels of baseline physical performance. DISCUSSION: The effects of social support and social networks may vary according to the individual's gender and baseline physical capabilities. Studies of functional decline among elderly persons should not ignore this population variation in the effects of social networks.     

Family ties, physical health, and psychological well-being

OBJECTIVE: This study assesses the impact of number and quality of family ties on the health and well-being of elderly people. METHOD: Measures of the quantity and quality of family ties, adjusting for gender, education, and income, were correlated with the self-rating of health and well-being of a sample of 534 married parents between 68 and 73 years of age. RESULTS: The quality of an individual's relationships with spouse, children, and other family members was associated with personal feelings of well-being, but the quantity of such associations had little impact on either physical or psychological health. DISCUSSION: Researchers and those working with elderly people should not assume that the presence of family members necessarily implies that social support affecting physical health and well-being will be forthcoming.     

The impact of perceived stress, social support, and home-based physical activity on mental health among older adults

This study investigated how perceived stress, social support, and home-based physical activity affected older adults' fatigue, loneliness, and depression. We also explored whether social support and physical activity mediated the relationships between stress and mental health problems. The data of 163 older participants were analyzed in this study. Structural equation modeling using LISREL 8.71 was performed to assess the effects of stress, support, and physical activity on mental health. The findings indicate that perceived stress predicted higher levels of depression, social support predicted lower levels of loneliness and fatigue, and physical activity predicted lower levels of fatigue among older adults. Social support and physical activity mediated the relationships between stress and mental health, except depression. In conclusion, the relative impacts of perceived stress, social support, and physical activity on types of mental health (e.g., fatigue, loneliness, and depression) were different. Furthermore, stress had direct and indirect effects on each construct of mental health (e.g., fatigue, loneliness, and depression).     

Longitudinal effects of social support on the health and functioning of older women with heart disease

This study examined the effects of: 1) four dimensions of social support, 2) the number of close social ties, and 3) marital status on the physical and psychological health and functioning of 471 women aged 60 years and over with heart disease. Linear mixed models were used to assess the impact of each baseline social relations predictor on health outcomes at four-, 12-, and 18-month follow-up intervals. A second set of models examined the association between change in support variables over time with concomitant change in health outcomes. Results indicated that baseline emotional/ informational support, positive social interaction, affectionate support, tangible support, number of close friends and relatives, and marital status all significantly predicted (p < .05) one or more health outcomes over time. Increases in positive social interaction and emotional support over time were significantly associated with concurrent improvement in all self-reported physical and psychological health outcomes. Interventions that enhance the availability of emotional/informational support and promote social interaction are needed for this population.     

Strain, social support, and mental health in rural elderly individuals

This study examined the relationships among social support, life strain, and mental health in a sample of 210 rural elderly individuals. Life strain was operationalized as economic deprivation, illness disability, and ADL impairment. Demographic characteristics had little effect on mental health. Physical health status was highly predictive of life satisfaction and psychological distress among rural elderly individuals. Disability associated with chronic illness and ADL impairment was related to increased reports of symptoms of emotional and psychosomatic distress. Measures of social contacts and instrumental support exerted small to moderate effects on life satisfaction, psychosomatic distress, and emotional distress. Affective support moderated the effects of health-related strain on mental health.     

Coping strategies and adaptation for the disabled elderly in Taiwan

Aim: This study explored the relationship between coping strategies and adaptation difficulties for the disabled elderly. Methods: Data were collected during face‐to‐face interviews with the physically disabled elderly in long‐term care institutions and in rehabilitation departments in middle Taiwan. Totally, 505 persons were analyzed. The adaptation to disability was evaluated by health care, domestic environment, family relationships, social life and psychological distress as the dependent variables. Factor analysis and multiple regression models were applied for the analysis. Results: Three types of coping strategies were identified: (i) acceptance and action reduced the difficulty in adapting to disability in the health‐care and social life dimensions; (ii) venting and avoidance increased the difficulty in adapting in the health‐care, domestic environment and psychological distress dimensions; and (iii) seeking support was related to greater adapting to difficulty in terms of family relationships. Conclusion: More effective coping strategies should be offered to the disabled elderly to help them adapt to their disability. Geriatr Gerontol Int 2011; 11: 488–495.     

Supportive exchange: an exploration of the relationship between social contacts and perceived health status in the elderly

While social ties are known to bear an important relationship to health status among the elderly, the components of that association remain unclear. This study explored the hypothesis that 'supportive exchange', or the giving and seeking of advice and other forms of assistance, bears an important relationship to perceived health status. Six-hundred and seventy-eight elderly residents of Alameda County, CA, participated in this survey research study, which examined social ties, supportive exchange, and health status. A strong relationship was found between a key dimension of supportive exchange - the giving and seeking of advice - and self-reported health status. The association between advice seeking and health status was particularly high, demonstrating that advice seeking may be as strongly associated with health status as social ties. While it is important to develop refined indices for the measurement of other dimensions of supportive exchange, this exploratory study suggests that the concept may be a useful one in furthering research on the relationship between health status and social contacts among the elderly.     

Religious involvement,social support,and health among African-American women on the east side of detroit

BACKGROUND: A significant body of research suggests that religious involvement is related to better mental and physical health. Religion or spirituality was identified as an important health protective factor by women participating in the East Side Village Health Worker Partnership (ESVHWP), a community-based participatory research initiative on Detroit's east side. However, relatively little research to date has examined the mechanisms through which religion may exert a positive effect on health. OBJECTIVE: The research presented here examines the direct effects of different forms of religious involvement on health, and the mediating effects of social support received in the church as a potential mechanism that may account for observed relationships between church attendance and health. DESIGN: This study involved a random sample household survey of 679 African-American women living on the east side of Detroit, conducted as part of the ESVHWP. MAIN RESULTS: Results of multivariate analyses show that respondents who pray less often report a greater number of depressive symptoms, and that faith, as an important source of strength in one's daily life, is positively associated with chronic conditions such as asthma or arthritis. Tests of the mediating effect of social support in the church indicated that social support received from church members mediates the positive relationship between church attendance and specific indicators of health. CONCLUSIONS: These findings are consistent with the hypothesis that one of the major ways religious involvement benefits health is through expanding an individual's social connections. The implications of these findings for research and practice are discussed.     

Influence of companion animals on the physical and psychological health of older people: an analysis of a one-year longitudinal study

OBJECTIVE: To examine whether companion animals or attachment to a companion animal was associated with changes in physical and psychological health in older people and whether the relationships between physical and psychological health and human social networks were modified by the presence or absence of a companion animal. DESIGN: A 1-year longitudinal study with standardized telephone interview data collected at baseline and repeated at 1-year SETTING: Wellington County, Ontario, Canada PARTICIPANTS: An age- and sex stratified random sample (baseline n = 1054; follow-up n = 995) of noninstitutionalized adults aged 65 and older (mean age = 73, SD +/- 6.3) MEASUREMENTS: Social Network Activity was measured using a family and non-family social support scale, participation in an organized social group, involvement in the affairs of the social group, the practice of confiding in others, feelings of loneliness, and the perceived presence of support in a crisis situation. Chronic conditions were measured as the current number of selected health problems. Pet ownership was assessed by the report of owning a dog or a cat and the Lexington Attachment to Pets Scale score. Physical health was assessed as the ability to perform Activities of Daily Living (ADLs). Psychological health was measured as a summed score comprising the level of satisfaction regarding one's health, family and friend relationships, job, finances, life in general, overall happiness, and perceived mental health. Sociodemographic variables assessed include subject age, sex, marital status, living arrangements, education, household income, and major life events. RESULTS: Pet owners were younger, currently married or living with someone, and more physically active than non-pet owners. The ADL level of respondents who did not currently own pets deteriorated more on average (beta = -.270, P = .040) than that of respondents who currently owned pets after adjusting for other variables during the 1-year period. No statistically significant direct association was observed between pet ownership and change in psychological well-being (P > .100). However, pet ownership significantly modified the relationship between social support and the change in psychological well-being (P = .001) over a 1-year period. CONCLUSIONS: The results demonstrate the benefits of pet ownership in maintaining or slightly enhancing ADL levels of older people. However, a more complex relationship was observed between pet ownership and an older person's well-being.     

Church-based social support and health in old age: exploring variations by race

OBJECTIVES: A conceptual model is evaluated that explores the relationship between church-based support and health. In the process, an effort is made to see if the relationships in this model differ for older White and African American people. METHODS: Interviews were conducted with a national sample of 748 older White and 752 older Black people. The responses of 1,126 of these study participants are used in the analyses presented herein. Survey measures were administered to assess church-based social ties and health. RESULTS: Empirical support was provided for the following theoretical linkages: Older people who attend church often feel their congregations are more cohesive; older people in highly cohesive congregations receive more spiritual and emotional support from their fellow parishioners; older respondents who receive more church-based support have a more personal relationship with God; older people who feel more closely connected with God are more optimistic; and older people who are more optimistic enjoy better health. Data further reveal that older Black people are more likely than older White people to reap the health-related benefits of religion. DISCUSSION: The findings contribute to research on religion and health by specifying how the salubrious effects of religion may arise.     

Mastery and coping moderate the negative effect of acute and chronic stressors on mental health-related quality of life in HIV

Acute and chronic life stressors have a detrimental effect on the health of people living with HIV. Psychosocial resources such as mastery, coping, and social support may play a critical role in moderating the negative effects of stressors on health-related quality of life. A total of 758 participants provided baseline enrolment data on demographics (age, gender, ethnicity, sexual orientation, education, employment, income), clinical variables (CD4 counts, viral load, AIDS-defining condition, time since HIV diagnosis), psychosocial resources (mastery, coping, social support), life stressors (National Population Health Survey [NPHS] Stress Questionnaire), and health-related quality of life (SF-36). We performed hierarchical multivariate regression analyses to evaluate the potential moderating effects of psychosocial resources on the relationship between stressors and health-related quality of life. The top three stressors reported by participants were trying to take on too many things at once (51%), not having enough money to buy the things they needed (51%), and having something happen during childhood that scared them so much that they thought about it years later (42%). Life stressors were significantly and inversely associated with both physical and mental health-related quality of life. Mastery and maladaptive coping had significant moderating effects on mental health but not on physical health. These results suggest that developing interventions that improve mastery and reduce maladaptive coping may minimize the negative impact of life stressors on the mental health of people with HIV. They also highlight that it is important for clinicians to be mindful of the impact of life stressors on the health of patients living with HIV.     

The Effects of Religious Participation and Familial Assistance on Mental Health among Older Chinese and Korean Immigrants: Multiple Mediator Analyses

Older Asian immigrants are one of the fastest growing segments of the U.S. population and a growing number of them reside in non-traditional destination cities. However, there is a paucity of research on older Asian immigrants living in these non-traditional destination cities, and how this residential choice impacts their stress and mental health. In the current study, we examined how stressors and social support contribute to the overall mental health of older Asian immigrants who lack access to culturally responsive formal social support services. Using a convenience sample of older Chinese (n?=?120) and Korean (n?=?118) immigrants living in Arizona, we conducted multiple mediator analyses, focusing specifically on how ethnicity would differentially influence mediating effects of religious participation and familial assistance in the relationships between physical/acculturative stressors and mental health outcomes. The results showed that among older Chinese immigrants, religious participation significantly mediated the relationships between both physical/acculturative stressors and mental health, while there was no significant mediation effect detected among older Korean immigrants. Although Asian Americans are often perceived as a monolithic homogeneous group, the multiple mediator models suggest significant differences in the use of cultural/information resources in coping with life stressors and their impact on mental health outcomes between the older Chinese and Korean immigrants in our study. The study findings suggest a need for developing and strengthening formal social services in non-traditional destination cities that are culturally and linguistically responsive to those older Asian immigrants.     

Racial differences in social support and mental health in men with HIV infection: a pilot study.

The mediating role of social support in the mental health and behaviours of persons coping with life-threatening chronic illness is of potentially great importance in determining the quality of life of persons with HIV infection (PWHs). As part of a biracial pilot study of the ways black and white men manage the stresses of sexually acquired HIV infection, we have examined the relationship between social support and mental health and behaviours. Forty homosexual/bisexual men (20 white and 20 black) attending a Detroit hospital-based HIV outpatient clinic were recruited for the study and underwent physical and mental health (HSCL-59 and NIMH DIS interview), behavioural and psychosocial evaluations, and a neuropsychologic screening test battery. The black and white men did not differ in terms of age, education, sexual behaviours, physical or mental health status. However, the black men were less likely to be open about their sexuality to their primary social support network, and to report that their social support was less affirmative than did the white men. When correlations between the six-dimensional social support measures (Wortman & O'Brien, 1987) and HSC-L distress scores were examined, both availability of material social support and affirmation were correlated negatively with distress among the white men but positively among the black men. Similarly, the previously observed positive relationship between perceived adequacy of social support and adoption of safer sexual practices was observed among white but not black participants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Employment status is associated with both physical and mental health quality of life in people living with HIV

To evaluate the relationship between employment status and health-related quality of life (HRQOL) in HIV/AIDS. A total of 361 participants provided baseline data in the context of an ongoing cohort study examining the natural history of neurobehavioral functioning and its effects on HRQOL. We administered tests and collected laboratory data to determine demographic status, HIV disease markers, psychosocial symptom burden, neurocognitive function and HRQOL (MOS-HIV). We performed regression analyses to evaluate the contribution of employment status to the physical and mental health components of quality of life (QOL). Multivariate analyses showed that employment status was strongly related to better physical and mental health QOL after controlling for potential confounders. We found, however, that employment status had a greater impact on physical health than mental health QOL [physical health (β = 6.8, 95% CI 4.6 to 9.1) and mental health QOL (β = 3.3, 95% CI 0.93 to 5.7)]. The effect of employment for physical health QOL was stronger than that observed for ethnicity, social support, or having an AIDS diagnosis and was comparable to that observed with having many HIV-related symptoms. This cross-sectional study suggests that there may be physical and mental health benefits associated with obtaining or keeping employment, or more likely that both selection and causation mechanisms comprise an interactional and reinforcing process.     

Stability and change in the perceived social support of older Taiwanese adults

OBJECTIVE: The purpose of this study is to examine stability and change in Taiwanese elders' perceptions about the availability of social support and the sociodemographic and cultural factors associated with change. METHODS: This study uses data from four waves of the Survey of Living Status of the Elderly in Taiwan that spans a 10-year period and employs latent growth curve models to examine trajectories of perceived support and the sociocultural factors that may explain variability in baseline levels of support and variability in changes in support as respondents age. RESULT: Perceptions about social support appear to follow a linear trajectory across age, with significant variation in baseline perceptions and in patterns of change in perceived support across the sample. Sociocultural factors primarily explain differences in initial levels of support but also have some effect on changes in support. DISCUSSION: Despite the increasing pressures and demands on adult children's time that are associated with social and economic development, the elderly in Taiwan on average feel supported by their social networks, with the perceived availability of support increasing with age.     

Emotional and physical health of informal caregivers of residents at the end of life: the role of social support

OBJECTIVES: The objectives of this study were to examine the relationship between selected decedent and caregiver characteristics, facility-related perceptions, and emotional and physical health of 434 informal caregivers (94% family) of recently deceased residents of residential care/assisted living facilities and nursing homes. We also examined potential mediating effects of social support (informal, staff, and spiritual). METHODS: We analyzed data using linear mixed models. RESULTS: Among caregivers, younger age, female gender, more education, financial burden, other dependents, poorer perceptions of care, and more care involvement were associated with more emotional strain. More staff support also was associated with more emotional strain and partially mediated the relationship between having a trusted staff member and emotional strain. Characteristics associated with poorer physical health included unemployment, financial burden, poorer physician communication, and trusted staff member. Informal social support was directly related to better physical health and mediated the relationships between physical health and both physician communication and financial burden. DISCUSSION: Many characteristics related to end-of-life caregiving outcomes in long-term care are consistent with community-based studies, suggesting that end-of-life caregiving outcomes in long-term care are not markedly different than in other settings. However, the role of staff support may either facilitate or complicate emotional strain and merits additional study.     

In the company of wolves: the physical, social, and psychological benefits of dog ownership

OBJECTIVE: The increase in aging populations has implications for the provision of health and social services. A preventative approach is taken to address this problem by examining a mechanism that can enhance physical health and reduce minor ailments. METHODS: Participants in 10 focus groups discussed physical, psychological, and social benefits associated with human-dog interactions. METHOD: RESULTS: Interaction between humans and dogs is a mechanism that can enhance the physical and psychological health of elderly citizens and promote a social support network between dog owners. In turn, dependence and impact on health and social services are alleviated. DISCUSSION: The social and community consequences of promoting dog ownership in the elderly are addressed, and it is concluded that the benefits of dog ownership should be promoted among the elderly and acknowledged by relevant agencies.     

Trajectories and covariates of life satisfaction among older adults in Taiwan

The goals of this study were to identify different life satisfaction trajectory groups among the Taiwanese elderly and to explore the relationships between life satisfaction and time-varying physical, mental, social, health, and economic variables. The data used herein were from five waves of a longitudinal study conducted from 1993 to 2007. Those who completed at least three waves were included in the analysis, for a total of 2584 participants. A group-based trajectory model was used to analyze the data. Time-constant variables and time-varying covariates were used as the moderators of changes in life satisfaction trajectories. Four life satisfaction trajectories were identified: low (21.8%), middle (39.7%), increasing (25.9%), and high-declining (12.5%). Having more education and better physical and psychological health, social support, and economic satisfaction were predictors of a higher life satisfaction trajectory, and maintaining good physical and emotional health, having a spouse, and having better economic satisfaction were associated with an increase in life satisfaction over time.