While having social support can contribute to better health, those in poor health may be limited in their capacity to receive social support. We studied the health factors associated with social support among community-dwelling older adults in Singapore. We used data from the third follow-up interviews [2014–2016] of 16,943 participants of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at a mean age of 73 years [range 61–96 years] using the Duke Social Support Scale [DUSOCS]. We first applied ordinary least squares regression to DUSOCS scores and found that those with instrumental limitations, poor self-rated health, cognitive impairment and depression had lower social support scores. We then applied latent class analysis to DUSOCS answer patterns and revealed four groups of older adults based on the source and amount of social support. Among them, compared to the ‘overall supported’ group [17%] with the highest social support scores and broad support from family members and non-family individuals, the ‘family restricted’ [50%] group had the lowest social support scores and only received support from children. Health factors associated with being ‘family restricted’ were instrumental limitations [odds ratio [OR] = 1.33, 95% confidence interval [CI] = 1.19–1.49], poor self-rated health [OR = 1.40, 95% CI = 1.28–1.53], cognitive impairment [OR = 1.19, 95% CI = 1.04–1.37] and depression [OR = 2.50, 95% CI = 2.22–2.82]. We found that while older adults in poor health have lower social support scores, they were more likely to receive a lot of support from children. Our results showed that lower social support scores among Singaporean older adults in poor health may not indicate lack of social support, but rather that social support is restricted in scope and intensified around children. These results may apply to other Asian societies where family plays a central role in elder-care.
中文翻译：
虽然获得社会支持有助于改善健康，但健康状况不佳的人获得社会支持的能力可能会受到限制。我们研究了与新加坡社区老年人的社会支持相关的健康因素。我们使用了新加坡华人健康研究的 16,943 名参与者的第三次后续访谈（2014 年至 2016 年）的数据，该研究是一个基于人群的老年新加坡华人队列。使用杜克社会支持量表（DUSOCS）对参与者的平均年龄为 73 岁（范围 61-96 岁）进行了采访。我们首先将普通最小二乘回归应用于 DUSOCS 评分，发现那些有工具限制、自评健康状况不佳、认知障碍和抑郁症的人的社会支持评分较低。然后，我们将潜在类别分析应用于 DUSOCS 答案模式，并根据社会支持的来源和数量揭示了四组老年人。其中，与社会支持得分最高、家庭成员和非家庭个人广泛支持的“全面支持”组（17%）相比，“家庭受限”组（50%）的社会支持得分最低，只得到了孩子们的支持。与“家庭受限”相关的健康因素是工具限制（优势比 [OR] = 1.33, 95% 置信区间 [CI] = 1.19–1.49），自评健康状况不佳（OR = 1.40, 95% CI = 1.28– 1.53]、认知障碍 [OR = 1.19, 95% CI = 1.04–1.37] 和抑郁症 [OR = 2.50, 95% CI = 2.22–2.82]。我们发现，虽然健康状况不佳的老年人的社会支持得分较低，他们更有可能从孩子那里得到很多支持。我们的研究结果表明，健康状况不佳的新加坡老年人的社会支持得分较低可能并不表明缺乏社会支持，而是社会支持在范围上受到限制，并且在儿童周围得到加强。这些结果可能适用于家庭在老年人护理中发挥核心作用的其他亚洲社会。
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Abstract
While having social support can contribute to the health of older adults, those in poor health may be limited in their capacity to receive social support. We studied health factors associated with social support among 16,948 participants from follow-up 3 of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese. Participants were interviewed at mean age of 73 years [range from 61 to 96 years] using the Duke Social Support Scale. Latent Class Analysis [LCA] was applied to derive groups based on the source and intensity of social support. We ran multivariate logistic regression models to study health factors associated with group membership. LCA revealed four groups in increasing social support scores: The “family restricted”, who had the lowest social support scores and only received support from family [50%]; the “loners”, who had some support from extended family and non-family [5%]; the “family oriented”, who had broad family support and some non-family support [28%]; and the “overall supported”, who had the highest social support scores and received broad support from family, extended family and non-family [17%]. Compared to the “overall supported” group, health factors associated with being “family restricted” were: having instrumental limitations [odds ratio [OR] 1.34, 95% confidence interval [CI] 1.19-1.50], having poor self-rated health [OR 1.40, 95% CI 1.28-1.54], being depressed [OR 2.49, 95% CI 2.21-2.81] and being cognitively impaired [OR 1.19, 95% CI 1.04-1.37]. Our results showed that older adults in poor health received social support mainly from family.
Introduction: Although living alone is associated with social disconnection, older adults could be socially disconnected despite living with others. Understanding the factors associated with social disconnection by living arrangement could help identify vulnerable older adults in the community. We examined the sociodemographic and health factors associated with social disconnection among two groups of older adults: those living alone and those living with others.
Methods: We used data from 16,943 community-dwelling older adults from the third follow-up of the Singapore Chinese Health Study [mean age: 73 years, range: 61-96 years]. We defined social disconnection as having no social participation and scoring in the lowest decile on the Duke Social Support Scale of perceived social support. We ran logistic regression models to study the sociodemographic [age, gender, and education] and health [self-rated health, instrumental limitations, cognitive function, and depression] factors associated with social disconnection, stratified by living arrangement.
Results: About 6% of our participants were socially disconnected. Although living alone was significantly associated with social disconnection [OR 1.93, 95% CI: 1.58-2.35], 85.6% of socially disconnected older adults lived with others, most of them [92%] with family. Lower education level, cognitive impairment, fair/poor self-rated health, instrumental limitations, and depression were independently associated with social disconnection. Among those living alone, men were more likely to experience social disconnection than women [OR 2.18, 95% CI: 1.43-3.32].
Discussion/conclusion: Though living alone is associated with social disconnection, most socially disconnected individuals lived with family. Community interventions could focus on those in poor health despite living with family and older men living alone.
Keywords: Community-dwelling older adult; Population-based design; Social isolation; Social networks; Social support.