Social Support

Rowe and Kahn identify active engagement with life as one of the key components of successful aging, along with avoiding disease and maintaining high cognitive and physical function. They view these three components as intertwined, with high performance in any one area enabling higher performance in the others. Research on the benefits of social support and social integration suggests that social relationships can contribute to all three components.

John Cassel and Sidney Cobb have been credited with stimulating the flood of research on social support and health that began in the 1970s. In separate review articles, both men argued that social relationships appeared to be protective of health. The early evidence, however, primarily was cross-sectional, and thus unable to establish causation. It was unclear whether strong social ties protect health (social causation hypothesis), or whether individuals in poor health are unable to maintain strong social ties (social selection hypothesis).

In the late 1970s and early 1980s, prospective mortality studies from several community epidemiologic surveys were published and provided evidence for the social causation hypothesis. James House and colleagues reviewed this evidence in a 1988 Science magazine article. They concluded that low levels of social integration represented a ‘‘cause or risk factor of mortality, and probably morbidity, from a wide range of diseases.’’

Subsequent research has replicated and expanded on these findings by examining a variety of health outcomes in different populations. Further, researchers have attempted to elucidate the mechanisms linking social ties and health by developing more sophisticated measures of social relationships and testing more elaborate models.

The vast amount of research conducted on the relationship between social relationships and health in middle and old age has produced some mixed results, but it is possible to draw some generalizations.

Mortality. Low levels of social integration place individuals at higher mortality risk. Researchers have considered whether this relationship represents a threshold or gradient effect. In other words, is there a minimum number of social ties necessary to receive the health benefit (threshold effect)? Or, does the risk of mortality lessen with each increase in the number of ties (gradient effect)? Some evidence supports the threshold model, but the issue is not resolved. Fewer mortality studies have examined specific measures of social support, but there is limited evidence of an association between support and mortality.

Onset of physical disease. Few studies have produced evidence of an influence of social integration or social support on the development of physical disease.

Progression of and recovery from physical disease. Receipt of emotional support (and perhaps other forms of intangible support) contributes to physical health by slowing the progression of chronic disease and aiding in recovery from other physical ailments. Studies have examined conditions such as post–myocardial infarction, stroke, arthritis, different cancers, hip fractures, and extremity injuries from falls.

Emotional or mental health. Both social integration and social support are important for the maintenance of emotional health. Low levels of integration and support place seniors at heightened risk for depression, anxiety, and psychological distress. Social isolation and lack of emotional support are particularly strong predictors of emotional health problems. Perceived quality of life and positive affect are enhanced by social integration and reciprocal support networks.

Functional health Various aspects of social integration reduce the risks of developing physical disabilities (difficulty performing activities of daily living) and experiencing cognitive declines.

Why do social integration and social support promote health? Despite the vast number of studies, there is no clear answer to this question. The diversity of findings suggest, however, that there are several different mechanisms. The operative mechanism likely depends on the characteristics of the individual, his or her social situation, and the health condition of interest. Proposed mechanisms include the following:

• • Provision of health-enhancing material resources and services
• • Reduction of the perceived severity of stressors
• • Reduction in the occurrence of stressors
• • Improved coping skills and assistance with coping
• • Promotion of positive health behaviors (social control or social influence model)
• • Increased social bonding and attachment
• • Stronger sense of coherence and self-esteem