Effects of social relationships on mortality of the elderly: How do the influences change with the passage of time?
Introduction
Although in many previous studies dealing with social relationships the authors conducted long-term follow-ups (Avlund et al., 1998, Kushiro et al., 2002, Helmert, 2004), and tried to find characteristic aspects that could not be observed in short-term follow-ups, few studies focused on the alterations in their effects during a long term. Some aspects observed at the baseline conditions can be changed, and the intensity of the influence of each social relationship factor on mortality may change with age or the passage of time in a long term. To find out the changing or persisting aspects of various social relationship factors may help us to understand their roles in social relationships more clearly.
A number of studies have been carried out on social relationships with analysis of the aspects of social networks, i.e., the structural dimension, and social support, which represents the functional dimension (Berkman, 1983, Due et al., 1999). These social relationships directly or indirectly cause and result in active lifestyles of individuals to maintain social interactions. Active lifestyle is an important factor supporting the social relationships and the later also promotes it. In some studies, activity factors were examined in the analysis of social relationships (Walter-Ginzburg et al., 2002, Avlund et al., 2004, Fratiglioni et al., 2004). Therefore, in the present study, we examined three socially related aspects to analyze their influences on the mortality of the elderly, i.e., social network, social support and active lifestyle.
The aim of this study was to examine what changes occurred in the relationships of social factors with all-cause mortality and which aspect of social relationships persisted during the 12-year follow-up study.
Section snippets
Study population
In 1992, we selected all of 769 residents in the age range 68–82 years from the residential census data of a rural town in Hokkaido, Japan, where the population was about 7000 and the proportion of those aged 65 years and over was 18%, and distributed self-administering questionnaires to them. For 6 months after the selection of the subjects, we collected data: 652 (84.8%) persons answered, 44 refused to answer, 22 were hospitalized, 6 moved out, 3 died and 42 did not respond for unknown
Results
Table 2 shows the characteristics of the participants.
From the results of hazard proportionality test (Table 3), it was revealed that, for men, close friends, group membership, receiving emotional support, and finding life worth living significantly decreased their effects, where the hazard proportionalities were not satisfied (b > 0 and p < 0.05), and that, for women, group membership, finding life worth living, and leisure activity significantly decreased their effects, where the hazard
Discussion
We found that the effects of social relationships on the mortality of the elderly varied during the long-term observation and the increase or decrease of the effects differed from one factor to another factor. The consistency of HR that Cox's proportional hazard model postulated was not satisfied for the factors in which the effects decreased.
We postulated the following three patterns of the variables, considering the changes in the HR and their significance. The first pattern was characterized
Conclusions
In the present study we found alterations in the influences of social relationship factors through the 12 years of observation that might not be seen in short-term observation.
Acknowledgements
We appreciate the valuable assistance of Dr. Iwao Sugimura, and gratefully acknowledge municipal officials throughout the country who provided the residential data, and the elderly residents and their families in the town who generously made data available. This study was funded by Grants-in-Aid for Scientific Research from the Ministry of Health, Labour and Welfare, Grant-in-Aid from the Ministry of Education, Culture, Sports, Science and Technology, and Grant-in-Aid from the Toyota
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