Abstract
Purpose
To evaluate the relative importance of structural and functional social relationships for quality of life (QoL) and the extent to which diagnosed chronic disease modifies these associations.
Methods
Multivariate linear regression was used to investigate time-lagged associations between structural and functional measures of social relationships and QoL assessed 5 years apart by CASP-19, in 5925 Whitehall II participants (mean age 61, SD 6.0). Chronic disease was clinically verified coronary heart disease, stroke, diabetes or cancer.
Results
Social relationships–QoL associations were consistent across disease status (P-values for interaction: 0.15–0.99). Larger friend network (β = 1.9, 95 % CI 1.5–2.3), having a partner (β = 1.2, 95 % CI 0.5–1.7), higher confiding support (β = 2.2, 95 % CI 1.8–2.7) and lower negative aspects of close relationships (β = 3.3, 95 % CI 2.8–3.8) were independently related to improved QoL in old age. The estimated difference in QoL due to social relationships was equivalent to up to 0.5 SD of the CASP-19 score and was stronger than the effect of chronic disease (coronary heart disease β = 2.0, 95 % CI 1.4–2.6).
Conclusions
We found that beneficial aspects of social relationships in relation to QoL were, in order of importance: avoiding negative aspects of close relationships, having confiding support, having a wide network of friends and having a partner. These associations were not modified by chronic disease. Thus, despite inevitable physical deterioration, we may be able to enhance a satisfying late life by optimizing our social relationships.
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References
Fries, J. F. (2005). The compression of morbidity. Milbank Quarterly, 83(4), 801–823.
Wiggins, R. D., Higgs, P. F., Hyde, M., & Blane, D. B. (2004). Quality of life in the third age: Key predictors of the CASP-19 measure. Ageing and Society, 24(05), 693–708. doi:10.1017/S0144686X04002284.
Hyde, M., Wiggins, R. D., Higgs, P., & Blane, D. B. (2003). A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19). Aging and Mental Health, 7(3), 186–194.
Higgs, P., Hyde, M., Wiggins, R., & Blane, D. (2003). Researching quality of life in early old age: the importance of the sociological dimension. Social Policy and Administration, 37(3), 239–252.
Maslow, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370.
Doyal, L., & Gough, I. (1991). A theory of human need. UK: Palgrave Macmillan.
Von dem Knesebeck, O., Hyde, M., Higgs, P., Kupfer, A., & Siegrist, J. (2005). Quality of life and wellbeing. In A. Börsch-Supan, A. Brugiavini, H. Jürges, J. Mackenbach, J. Siegrist, & G. Weber (Eds.), Health, ageing and retirement in Europe: First results from the survey of health, ageing and retirement in Europe (pp. 199–203). Strauss, Mannheim: Mannheim Research Institute for the Economics of Aging (MEA) Mannheim Germany.
Wiggins, R. D., Netuveli, G., Hyde, M., Higgs, P., & Blane, D. (2008). The evaluation of a self-enumerated scale of quality of life (CASP-19) in the context of research on ageing: A combination of exploratory and confirmatory approaches. Social Indicators Research, 89(1), 61–77.
Marmot, M., Banks, J., Blundell, R., Lessof, C., & Nazroo, J. (2003). Health, wealth and lifestyles of the older population in England: The 2002 English longitudinal study of ageing. London: Institute for Fiscal Studies.
Taylor, M. J. B., Buck, N., & E., P.-L. (2003). British household panel survey-user manual-volume a: Introduction, technical report and appendices (Annals of Neurology). Colchester, Essex: UK: Institute for Social and Economic Research, Data Archive, University of Essex.
Kearney, P. M., Cronin, H., O’Regan, C., Kamiya, Y., Savva, G. M., Whelan, B., et al. (2011). Cohort profile: The irish longitudinal study on ageing. International Journal of Epidemiology, 40(4), 877–884.
Orth-Gomér, K., & Undén, A. L. (1987). The measurement of social support in population surveys. Social Science and Medicine, 24(1), 83–94.
House, J. S. (1987) Social support and social structure. In Sociological Forum, (Vol. 2, pp. 135–146). Springer: New York.
Zaninotto, P., Falaschetti, E., & Sacker, A. (2009). Age trajectories of quality of life among older adults: Results from the English longitudinal study of ageing. Quality of Life Research, 18(10), 1301–1309.
Layte, R., Sexton, E., & Savva, G. (2013). Quality of life in older age: Evidence from an Irish cohort study. Journal of the American Geriatrics Society, 61(s2), S299–S305.
Demakakos, P., McMunn, A., & Steptoe, A. (2010). Well-being in older age: A multidimensional perspective. In J. Banks, C. Lessof, J. Nazroo, N. Rogers, M. Stafford, & A. Steptoe (Eds.), Financial circumstances, health and well-being of the older population in England: The 2008 English longitudinal study of ageing (wave 4) (pp. 115–177). London: The Institute for Fiscal Studies.
Netuveli, G., Wiggins, R. D., Hildon, Z., Montgomery, S. M., & Blane, D. (2006). Quality of life at older ages: Evidence from the English longitudinal study of aging (wave 1). Journal of Epidemiology and Community Health, 60(4), 357–363.
Webb, E., Blane, D., McMunn, A., & Netuveli, G. (2011). Proximal predictors of change in quality of life at older ages. Journal of Epidemiology and Community Health, 65, 542–547.
House, J. S., Umberson, D., & Landis, K. R. (1988). Structures and processes of social support. Annual Review of Sociology, 14, 293–318.
Cohen, S., Gottlieb, B. H., & Underwood, L. G. (2000). Social relationships and health: Challenges for measurement and intervention. New York: Oxford University Press Inc.
Litwin, H., & Stoeckel, K. J. (2013). Confidant network types and well-being among older Europeans. The Gerontologist,. doi:10.1093/geront/gnt056.
Warner, L. M., Schüz, B., Wurm, S., Ziegelmann, J. P., & Tesch-Römer, C. (2010). Giving and taking—Differential effects of providing, receiving and anticipating emotional support on quality of life in adults with multiple illnesses. Journal of Health Psychology, 15(5), 660–670.
Silverstein, M., Chen, X., & Heller, K. (1996). Too much of a good thing? Intergenerational social support and the psychological well-being of older parents. Journal of Marriage and the Family, 58, 970–982.
Warner, L. M., Ziegelmann, J. P., Schüz, B., Wurm, S., Tesch-Römer, C., & Schwarzer, R. (2011). Maintaining autonomy despite multimorbidity: Self-efficacy and the two faces of social support. European Journal of Ageing, 8(1), 3–12.
Rook, K. S. (1984). The negative side of social interaction: Impact on psychological well-being. Journal of Personality and Social Psychology, 46(5), 1097.
Antonucci, T. C., Lansford, J. E., & Akiyama, H. (2001). Impact of positive and negative aspects of marital relationships and friendships on well-being of older adults. Applied Developmental Science, 5(2), 68–75.
Pinquart, M., & Sörensen, S. (2000). Influences of socioeconomic status, social network, and competence on subjective well-being in later life: A meta-analysis. Psychology and Aging, 15(2), 187.
Aartsen, M. J., van Tilburg, T., Smits, C. H. M., & Knipscheer, K. C. P. M. (2004). A longitudinal study of the impact of physical and cognitive decline on the personal network in old age. Journal of Social and Personal Relationships, 21(2), 249–266. doi:10.1177/0265407504041386.
Gurung, R. A. R., Taylor, S. E., & Seeman, T. E. (2003). Accounting for changes in social support among married older adults: Insights from the MacArthur Studies of Successful Aging. Psychology and Aging, 18(3), 487. doi:10.1037/0882-7974.18.3.487.
Aguado Loi, C. X., Baldwin, J. A., McDermott, R. J., McMillan, S., Martinez Tyson, D., Yampolskaya, S., et al. (2013). Risk factors associated with increased depressive symptoms among Latinas diagnosed with breast cancer within 5 years of survivorship. Psycho-Oncology, 22(12), 2779–2788.
Ringdal, G. I., Rindal, K., JorhØy, M., & Kaasa, S. (2007). Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliative & supportive care, 5(01), 61–69.
Wikman, A., Wardle, J., & Steptoe, A. (2011). Quality of life and affective well-being in middle-aged and older people with chronic medical illnesses: A cross-sectional population based study. PLoS One, 6(4), e18952.
Grimmett, C., Wardle, J., & Steptoe, A. (2009). Health behaviours in older cancer survivors in the English longitudinal study of ageing. European Journal of Cancer, 45(12), 2180–2186.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310–357.
Thoits, P. A. (1982). Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of Health and Social Behavior, 23, 145–159.
Young, Y., Frick, K. D., & Phelan, E. A. (2009). Can successful aging and chronic illness coexist in the same individual? A multidimensional concept of successful aging. Journal of the American Medical Directors Association, 10(2), 87–92.
Blane, D., Netuveli, G., & Montgomery, S. M. (2008). Quality of life, health and physiological status and change at older ages. Social Science and Medicine, 66(7), 1579–1587.
Zaninotto, P., Pierce, M., Breeze, E., Oliveira, C., & Kumari, M. (2010). BMI and waist circumference as predictors of well-being in older adults: Findings from the English longitudinal study of ageing. Obesity, 18(10), 1981–1987.
Gwozdz, W., & Sousa-Poza, A. (2010). Ageing, health and life satisfaction of the oldest old: An analysis for Germany. Social Indicators Research, 97(3), 397–417.
Carstensen, L. L., Fung, H. H., & Charles, S. T. (2003). Socioemotional selectivity theory and the regulation of emotion in the second half of life. Motivation and emotion, 27(2), 103–123. doi:10.1023/A:1024569803230.
Marmot, M., & Brunner, E. (2005). Cohort profile: the Whitehall II study. International Journal of Epidemiology, 34(2), 251–256.
Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109(2), 186–204.
Stansfeld, S., & Marmot, M. (1992). Deriving a survey measure of social support: The reliability and validity of the close persons questionnaire. Social Science and Medicine, 35(8), 1027–1035. doi:10.1016/0277-9536(92)90242-I.
Watson, R., Deary, I., & Shipley, B. (2008). A hierarchy of distress: Mokken scaling of the GHQ-30. Psychological Medicine, 38(04), 575–579.
Ferrie, J. E., Langenberg, C., Shipley, M. J., & Marmot, M. G. (2006). Birth weight, components of height and coronary heart disease: Evidence from the Whitehall II study. International Journal of Epidemiology, 35(6), 1532–1542.
Britton, A., Milne, B., Butler, T., Sanchez-Galvez, A., Shipley, M., Rudd, A., et al. (2012). Validating self-reported strokes in a longitudinal UK cohort study (Whitehall II): Extracting information from hospital medical records versus the hospital episode statistics database. BMC Medical Research Methodology, 12(1), 83.
WHO. (2006). Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia: Report of a WHO/IDF consultation (p. P3). Geneva: World Health Organization.
Sexton, E., King-Kallimanis, B. L., Conroy, R. M., & Hickey, A. (2013). Psychometric evaluation of the CASP-19 quality of life scale in an older Irish cohort. Quality of Life Research, 22(9), 2549–2559.
Fingerman, K. L., Hay, E. L., & Birditt, K. S. (2004). The best of ties, the worst of ties: Close, problematic, and ambivalent social relationships. Journal of Marriage and Family, 66(3), 792–808.
Gleason, M. E. J., Iida, M., Shrout, P. E., & Bolger, N. (2008). Receiving support as a mixed blessing: Evidence for dual effects of support on psychological outcomes. Journal of Personality and Social Psychology, 94(5), 824.
Adams, R. G., & Blieszner, R. (1995). Aging well with friends and family. American Behavioural Scientist, 39, 209–224.
Walen, H. R., & Lachman, M. E. (2000). Social support and strain from partner, family, and friends: Costs and benefits for men and women in adulthood. Journal of Social and Personal Relationships, 17(1), 5–30.
Deng, J., Hu, J., Wu, W., Dong, B., & Wu, H. (2010). Subjective well-being, social support, and age-related functioning among the very old in China. International Journal of Geriatric Psychiatry, 25(7), 697–703.
Norman, G. R., Sloan, J. A., & Wyrwich, K. W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41(5), 582–592.
Kouvonen, A., Stafford, M., De Vogli, R., Shipley, M. J., Marmot, M. G., Cox, T., et al. (2011). Negative aspects of close relationships as predictor of increase in body mass index and waist circumference: The Whitehall II study. American Journal of Public Health, 101(8), 1474–1480.
De Vogli, R., Chandola, T., & Marmot, M. G. (2007). Negative aspects of close relationships and heart disease. Archives of Internal Medicine, 167(18), 1951–1957.
Liao, J., Head, J., Kumari, M., Stansfeld, S., Kivimaki, M., Singh-Manoux, A., et al. (2014). Negative aspects of close relationships as risk factors for cognitive aging. American Journal of Epidemiology, 180(11), 1118–1125.
Newsom, J. T., Nishishiba, M., Morgan, D. L., & Rook, K. S. (2003). The relative importance of three domains of positive and negative social exchanges: A longitudinal model with comparable measures. Psychology and Aging, 18(4), 746–754.
Fingerman, K. L., & Charles, S. T. (2010). It takes two to tango why older people have the best relationships. Current Directions in Psychological Science, 19(3), 172–176.
Jopling, K. (2015). Promising apporaches to reducing loneliness and isolation in later life UK:London: Campaing to end loneliness, Age, UK.
Cornwell, B., Laumann, E. O., & Schumm, L. P. (2008). The social connectedness of older adults: A national profile*. American Sociological Review, 73(2), 185.
Beach, B., & Bamford, S.-M. (2014). Isolation: The emerging crisis for older men a reoport exploring experiences of social isolation and loneliness among older men in England. UK: Independent Age, and The International Longevity Center-UK (ILC-UK).
Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science and Medicine, 51(6), 843–857.
Gupta, V., & Korte, C. (1994). The effects of a confidant and a peer group on the well-being of single elders. The International Journal of Aging and Human Development, 39(4), 293–302.
Harper, S. (2006). Chapter 11: Mature societies: Planning for our future selves. In S. Harper (Ed.), Ageing Societies: Myths, Challenges and Opportunities (pp. 271–299). London: Hodder Arnold.
Shouse, J. N., Rowe, S. V., & Mast, B. T. (2013). Depression and cognitive functioning as predictors of social network size. Clinical Gerontologist, 36(2), 147–161.
Netuveli, G., Wiggins, R. D., Hildon, Z., Montgomery, S. M., & Blane, D. (2005). Functional limitation in long standing illness and quality of life: Evidence from a national survey. BMJ, 331(7529), 1382–1383.
Aartsen, M. J., Smits, C. H., van Tilburg, T., Knipscheer, K. C., & Deeg, D. J. (2002). activity in older adults cause or consequence of cognitive functioning? A longitudinal study on everyday activities and cognitive performance in older adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 57(2), P153–P162.
Broese van Groenou, M., Hoogendijk, E. O., & van Tilburg, T. G. (2013). Continued and new personal relationships in later life differential effects of health. Journal of aging and health, 25(2), 274–295.
Lang, F. R. (2001). Regulation of social relationships in later adulthood. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56(6), P321–P326.
Saczynski, J. S., Pfeifer, L. A., Masaki, K., Korf, E. S., Laurin, D., White, L., et al. (2006). The effect of social engagement on incident dementia the Honolulu-Asia aging study. American Journal of Epidemiology, 163(5), 433–440.
Bowling, A., Seetai, S., Morris, R., & Ebrahim, S. (2007). Quality of life among older people with poor functioning. The influence of perceived control over life. Age and Ageing, 36(3), 310–315.
Lafortune, G., Balestat, G., & the Disability Study Expert Group Members. (2007). Trends in severe disability among elderly people: Assessing the evidence in the 12 OECD countries and the future implications. OECD health working papers (26). Paris: OECD.
Ouwehand, C., de Ridder, D. T., & Bensing, J. M. (2007). A review of successful aging models: Proposing proactive coping as an important additional strategy. Clinical Psychology Review, 27(8), 873–884.
Settersten, J., & Richard, A. (2002). Social sources of meaning in later life. In R. A. Weiss & S. A. Bass (Eds.), Challenges of the third age: Meaning and purpose in later life (pp. 55–79). New York: Oxford University Press.
Netuveli, G., Pikhart, H., Bobak, M., & Blane, D. (2012). Generic quality of life predicts all-cause mortality in the short term: Evidence from British household panel survey. Journal of Epidemiology and Community Health, 66(10), 962–966.
Silver, C. B. (2003). Gendered identities in old age: Toward (de) gendering? Journal of aging studies, 17(4), 379–397.
Baltes, P. B., & Baltes, M. M. (1990). Psychological perspectives on successful aging: The model of selective optimization with compensation. In P. B. Baltes & M. M. Baltes (Eds.), Successful aging: Perspectives from the behavioral sciences (Vol. 1, pp. 1–34). Cambridge, England: Cambridge University Press.
Acknowledgments
We thank all participating civil service departments and their welfare, personnel and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; and all members of the Whitehall II study team. Whitehall II data, protocols and other metadata are available to bona fide researchers for research purposes. Please refer to the Whitehall II data sharing policy at http://www.ucl.ac.uk/whitehallII/data-sharing.
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The Whitehall II study is also supported by a grant from the British Medical Research Council (K013351), the British Heart Foundation (RG/13/2/30098) and National Institute on Aging, US National Institutes of Health (AG13196). The funding bodies did not play a role in the study design, the collection, analysis and interpretation of data, the writing and the decision to submit the paper.
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The authors have no conflicts of interests to declare. Ethical approval for the Whitehall II study was obtained from the University College London Medical School Committees on the Ethics of Human Research. The study procedures are in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. All participants were asked to give written informed consent at each phase.
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Liao, J., Brunner, E.J. Structural and functional measures of social relationships and quality of life among older adults: does chronic disease status matter?. Qual Life Res 25, 153–164 (2016). https://doi.org/10.1007/s11136-015-1052-1
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DOI: https://doi.org/10.1007/s11136-015-1052-1