SOCIAL/INTERPERSONAL FACTORS AND THE ROLE OF SOCIAL SUPPORT
The older adult understands health and illness through frameworks based on generational factors, social and cultural contexts, and personal beliefs and values. There are an inhnite number of ways in which different individuals view illness and treatment based on these factors. It is important to consider these individual and social factors in the treatment of illness. The role of social support has been widely researched from perspectives including social support as a protective factor, social isolation as a risk factor, and social support as it relates to adjustment/coping.
Considering the social network as a system, the advent of an acute medical event or diagnosis can have a signihcant impact on existing social relationships. There is a complex interplay within this social system, including the impact of how each of the individuals within the social system cope with a medical event, how this impacts each of the relationships within the system, and how the social system responds as a whole to the medical event. Ideally, the introduction of a stressor such as a medical event contributes to cohesion within the social structure. Unfortunately, the result can also be that of increased conflict within the system, particularly when all members do not agree on the best course of action or if they have differing views and expectations surrounding the medical event. The individual diagnosed with the medical condition rarely adjusts to this stressor in isolation; rather, there is a ripple effect within the social context.
The role of social support has been studied in various diagnostic populations, with a common theme emerging: the presence of social support is positively related to physical and mental health.32-38 Social isolation has consistently been found to be a prevalent health problem among community-dwelling older adults, leading to numerous health conditions and affective disorders. Particularly given the increasing older adult population, social isolation will continue to be a prominent focus in regards to its impact on the health, well-being, and quality of life of older adults. In a systematic literature review, Nicholson39 found that there is extensive evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation.
Investigators have also examined the mechanisms through which social isolation and loneliness affect health, including health-related behavioral and biological factors. As investigated by Shankar et al.,40 loneliness and social isolation may affect health through their effects on health behaviors (e.g., greater risk of multiple health-risk behaviors) as well as through biological processes associated with the development of cardiovascular disease (e.g., social isolation being positively associated with blood pressure, C-reactive protein, and fibrinogen levels). Both social isolation and loneliness have been found to be associated with increased mortality in the older adult population.41 Holwerda et al.42 also investigated the increased risk of mortality associated with social isolation in older adults, finding that at 10 years follow up, feelings of loneliness were found to be a major risk factor for increasing mortality in older men.
Regarding the nature and quality of relationships, Seeman43 found through literature review that social relationships have the potential for both health-promoting and health-damaging effects in older adults. Protective effects have been documented with respect to mental and physical health outcomes and better recovery after disease onset. On the contrary, there is also a growing awareness of the potential for negative health effects from social relationships characterized by more negative patterns, with increased risks for depression. There is also literature that supports biological pathways related to the impact of social interactions, with more negative social interactions being associated with certain physiological prohles (e.g., elevated stress hormones, increased cardiovascular activity, and depressed immune function).43
In regards to the role of marital quality in physical health in the geriatric population, it has been found that higher levels of negative spousal behaviors uniquely contributed to more physical symptoms, chronic health problems, and physical disability.44 Caregivers providing care to chronically ill family members have been found to be at risk for caregiver burden as well as at increased risk, compared to their noncaregiving peers, for health problems, depression, and poor quality of life.45,46 Heavy caregiving burden has been associated with various health effects, hospitalization, and mortality among community-dwelling dependent older adults.47-50 These hndings lead to the conclusion that the reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.