Low supply of social support as risk factor for mortality in the older adults

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Highlights

  • The support offered seems to be as important as that received.

  • Social networks have been found to have protective effects on mortality.

  • Reciprocity in relationships has been associated with higher levels of health.

Abstract

Objectives

To determine the relationship between social support and mortality in older adults, independent of other health conditions.

Method

This was a longitudinal study using the database of the 2006 SABE Study (Heath, Well-being and Aging), composed of 1413 individuals aged 60 years and over, living in São Paulo/Brazil. The present study used a questionnaire constructed for the SABE Study, which was reviewed by experts of Latin America and the Caribbean. The social network was evaluated using the variables: social support received; social support offered; number of members in the social network. The covariates included were age, gender, living arrangements, marital status, income, education, comorbidity, depressive symptoms, cognition and functional difficulties. Death as an outcome was evaluated after four years of follow-up.

Results

From a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE = 0,03). In the model adjusted offering social support and having networks composed of 9 or more members reduced the risk of death in the older adults.

Conclusions

This study suggest that older adult who are offered support can benefit from mutual exchanges since reciprocity in relationships improves psychological well-being and is indicative of the quality of relationships. Thus, the older adults are part of a group of people whose role is not only to receive, but also to provide help to others, and the support offered seems to be as important as that received.

Introduction

The term “social network” can be understood as a form of social bonding where different types of mutual aid link individuals to defined groups of relatives, friends or acquaintances (Bowling, 1997; McDowell & Newell, 1996; O’Reilly, 1988). The social network is the web of social relationships which an individual maintains, including their closest relationships (such as family and close friends) and more formal relationships (such as other individuals and groups) (Seeman, 1996). In addition to the structural aspects (size and composition), social networks are composed of functional aspects. The “social support” is the primary function of the networks and also promoting construction of themselves (Meneses, 2007).

Since the early 1950s several studies have attempted to explain the relationship between social support networks and the health status of individuals (Muramatsu, Yin, & Hedeker, 2010; Stephens, Alpass, Towers, & Stevenson, 2011). A pioneering study on this subject by Émile Durkheim in 1897, demonstrated the link between the occurrence of suicides and the lack of a network of consistent relationships in society (Durkheim, 1951). Since then, many studies have linked the presence of social networks with different levels of health and disease. The effects of social support networks on older adults can be seen principally through their functional performance (D’Orsi, Xavier, & Ramos, 2011; James, Boyle, Buchman, & Bennett, 2011), quality of life (Atkins, Naismith, Luscombe, & Hickie, 2013; Gallegos-Carrillo, 2009), depression (Ciao, Weng, & Botticello, 2011), subjective well-being (Adams, Leibbrandt, & Moon, 2011), and cognitive decline (James, Wilson, Barnes, & Bennett, 2011). According to these authors, having only a few social contacts may promote the development of disability and decreased physical function, worsen the perception of quality of life, and consequently exacerbate depressive symptoms, while participating in social activities and maintaining multiple relationships can improve functional performance. Social networks have been found to have protective effects on mortality, and involvement in numerous social networks with strongly established ties is associated with decreased mortality (Blazer, 1982; Holt-Lunstad, Smith, & Layton, 2010; Julianne, Timothy, & Layton, 2010; Kaplan et al., 1988; McLaughlin, Leung, Dobson, & Almeida, 2011; Seeman et al., 1993).

The first large study on social relationships and mortality reported data from a probabilistic sample of 2229 men and 2496 women, who were between 30 and 69 years of age, living in Alameda County, California. In this study, the low social support index was considered a significant predictor of mortality (Berkman & Syme, 1979). House, Robbins, & Metzner (1982) and Schoenbach, Kaplan, Fredman, & Kleinbaum (1986) replicated and expanded the results of the Alameda County study and showed that the level of social support received was inversely related to mortality. In 1987, Seeman, Kaplan, Knudsen, Cohen, & Guralnik, 1987 published the mortality data from seventeen years of the Alameda County study, demonstrating the relative importance of social ties as predictors of survival among the older adults. Still in this vein, important review studies have consistently shown the increased risk of death among individuals with a low number of and low-quality social relationships (House, Landis, & Umberson, 1988). Although some studies (Holt-Lunstad, Smith, & Layton, 2010; Julianne, Timothy, & Layton, 2010; McLaughlin, Leung, Dobson, & Almeida, 2011) have shown a relationship between social support and mortality, little is known about this relationship in older adults Brazilians (people aged 60 years or more). Understanding this relationship may assist in the implementation of public policies to promote the reorganization of family roles and help the State to confront the new living arrangements that are being established. The aim of this study is to determine the relationship between social support and mortality in older adults, independent of other health conditions.

Section snippets

Method

Data came from the Health, Well-being and Aging study (SABE). SABE is a panel study that began in 2000 with a representative cohort of 2143 participants living in Sao Paulo, Brazil, aged 60 years and over. Detailed description of the study and sampling has been published previously (Lebrão, 2003). The baseline sample was obtained with a two-stage stratified sampling method, following the framework of the 1996 National Household Survey based on geographic areas of the city, either an oversample

Results

From a total of 1413 older adults at baseline, 268 died in a mean follow-up period of 3,9 years (SE = 0,03). The majority of the sample was women (59.4%), with aged between 60 and 69 years (58.7%), married (57.4%), with 4–7 years of schooling (38.6%), independent to perform ADL and IADL (77.3% and 69.0%, respectively) and having two or more diseases (55.0%) (Table 1).

No statistically significant difference was observed between the baseline characteristics of the older adults re-interviewed in

Discussion

As in other studies, an association was observed between the social support network and mortality in older adults (Holt-Lunstad, Smith & Layton, 2010; Hill, Uchino, Eckhardt, & Angel, 2016; Julianne, Timothy, & Layton, 2010; McLaughlin, Leung, Dobson, & Almeida, 2011). The risk of death among the older adults was lower among those who offered support and who had networks composed of nine or more members, regardless of gender, age, living arrangements difficulty in performing ADLs, number of

Funding

This work was supported by Foundation for research Support of São Paulo (FAPESP) for financing the SABE Study (grant numbers 1999/05125, 2005/54947-2, 2009/53778-3).

Acknowledgments

No potential conflicts of interest relevant to this article were reported by the authors. We thank Maria Lucia Lebrão (in memory) for her valuable work in coordinating the SABE Study.

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