Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
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10 The Role of Social and Personal Resources in Ethnic Disparities in Late-Life Health
10 The Role of Social and Personal Resources in Ethnic Disparities in Late-Life Health
Pages 353-405
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From page 353... ...
In this chapter, we consider the role of personal and social resources in explaining the origins and consequences of racial/ethnic disparities in late-life health. From a lifespan developmental perspective, individuals actively regulate personal and social resources as they "age" for the purpose of personal growth and adaptation (Baltes and Lang, 1997; Lang, 2001; Lang, Featherman, and Nesselroade, 1997; Ryff, 1991)
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From page 354... ...
Investigation of these resources may help us to achieve a deeper understanding of the origins of health disparities across race/ethnic lines in late life. Figure 10-1 presents Upstream Factors Downstream Factors Macrosocial Social and Personal Mechanisms Outcomes Influences Resources Stress/ General health Social networks Social allostatic load and well-being -Availability engagement of ties -Social activity -Social -Composition -Productive Happiness or stratification Physical of ties activity quality of life -Racism activity/mobility -Structure of ties -Religious and racial -Efficacy of ties participation discrimination Mortality/ -Labor market Psychosocial survival characteristics mechanisms -Political Community Social support strategies networks -Emotional Access to Physical -Public policy -Physical support material function/ -Demographic characteristics -Instrumental resources disability forces -Mediating support and sources institutions -Informational of care -Services support Cognitive -Social -Appraisal health organizations support Collective and function efficacy FIGURE 10-1 Conceptual model of the impact of personal resources on health outcomes.
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From page 355... ...
Personal resources, on the other hand, encompass assets that place primary emphasis on the individual, even if the asset has an inherent social dependency. This chapter will focus on two types of personal resources, social engagement and social support.
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From page 356... ...
Next, we will turn our attention to the differential distribution by race/ethnicity of personal resources. These resources are further classified into social engagement, defined as participation in meaningful social activity, and social support.
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From page 357... ...
Earlier gerontologic work suggested that older African Americans tend to have larger social networks compared with whites (Ball, Warheit, Vandiver, and Holzer, 1980; Taylor and Chatters, 1986a; Vaux, 1985)
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From page 358... ...
. Based on the available evidence, the overall pattern is that older blacks have similarly sized or slightly smaller social networks, but that these networks are more likely to include extended family and fictive kin (Ajrouch et al., 2001)
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From page 359... ...
work size between older Hispanics and non-Hispanic whites who live in a mostly rural area. However, older Hispanics living in New York City reported more children and close relatives in their social networks compared to either blacks or whites, but significantly fewer distant relatives, friends, and other social contacts (Cantor, 1975; Cantor, Brennan, and Sainz, 1994)
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From page 360... ...
. An important aspect of social engagement among older adults is participation in productive activity.
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From page 361... ...
. However, data from the National Survey of Self-Care and Aging did not show any racial differences in caregiving, although blacks were more likely to provide emotional support (Kincade et al., 1996)
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From page 362... ...
. Social Support The social support needs of adults are likely to change as they enter the postretirement years.
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From page 363... ...
. Several other studies, however, are less consistent with important ethnic/racial differences in social support among the elderly.
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From page 364... ...
Social Networks and Late-Life Health The health benefits of social and personal resources have been a major theme in social epidemiology since the 1970s. One of the first seminal papers in this area was a study by Berkman and Syme (1979)
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From page 365... ...
. Similar "composite" measures of social networks and social engagement have also been used in studies of dementia and cognitive decline.
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From page 366... ...
Although findings in this literature are often interpreted as though greater availability of social ties is causally involved in the prevention of functional decline and disability, the actual interrelationships may be more complex. While older adults with larger social networks on average report significantly less disability, it may also be true that the absence of disability is directly related to the magnitude of one's social network that one is able to maintain (Mendes de Leon et al., 2001)
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From page 367... ...
One example of this research is an analysis of the Alameda County Study data in which individual-level data were combined with data at the neighborhood level to predict 11-year mortality risk. A neighborhood social environment score was constructed on the basis of information at the level of Census tracts on population socioeconomic status (e.g., per capita income, residential crowding)
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From page 368... ...
MENDES DE LEON AND THOMAS A GLASS tionships between social networks and late-life health are mostly independent of other important influences such as socioeconomic status, lifestyle habits, and poor physical health status.
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From page 369... ...
. Other research has focused on the role of social engagement in physical disability, cognitive decline, and dementia, as well as overall well-being.
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From page 370... ...
In this study, a number of different forms of social and leisure activity were inversely related to dementia risk, although only a few -- traveling, gardening, or odd jobs or knitting -- remained significantly associated with this outcome after controlling for age and baseline cognitive status. Other studies have found significant positive associations between markers of social engagement and overall well-being (Herzog.
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From page 371... ...
. They suggest further that this protective effect is not entirely attributable to other factors that may be related to both church attendance and mortality, such as socioeconomic status, lifestyle variables, and initial physical health status.
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From page 372... ...
In the most rigorous study of religious involvement and physical disability to date, Idler and Kasl compared the long-term effects of church attendance and subjective religiosity using yearly followup data from the New Haven EPESE cohort study. Subjective religiosity was measured by questions assessing how deeply religious a person feels, and how much strength and comfort they received from their religion.
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From page 373... ...
. Although these results suggest that social support has a protective effect against mortality, the durations of the follow-up periods were relatively short compared to studies of social networks or social engagement and mortality reviewed previously in this chapter.
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From page 374... ...
For example, using 2.5-year follow-up data from the MacArthur Studies of Successful Aging, Seeman and colleagues found that availability of emotional social support attenuated age-related declines in physical function as measured by a series of standard performance tests of function, such as chair stands and walking. However, this effect was only apparent among those with low levels of instrumental support.
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From page 375... ...
. While this study did not specify the type of social support, other studies have focused more specifically on emotional support in recovery from heart disease.
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From page 376... ...
Thus, the use of rigorous methods lends further confidence in the validity of a causal effect of social support, particularly emotional support, on recovery outcomes after acute medical events. Another key area of inquiry has focused on the role of social support on mental well-being.
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From page 377... ...
Although most social support research has been conceptualized from the perspective of the support recipient, a limited number of studies have started to examine the health effects of providing support to others. Generally, this work shows that lending assistance to others is associated with increased well-being (Krause, Herzog, and Baker, 1992; Liang et al., 2001; Silverstein, Chen, and Heller, 1996)
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From page 378... ...
That is, some resources may confer fewer health benefits in subpopulations that are at greater health risks, and hence contribute to observed health disparities between groups. Perhaps partly due to the lack of clear differences in resources among racial/ethnic groups, most studies have followed the second approach by examining the relative health effects of particular social or personal resources in different racial/ethnic groups.
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From page 379... ...
For example, using data from the North Carolina EPESE study, Ellison found that lack of a formal religious affiliation was associated with more depression among blacks, but not whites. This is consistent with the notion that religious involvement may have greater health benefits for blacks than whites.
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From page 380... ...
Another study suggests, however, that socioeconomic resources may be more important, as racial differences in distress were eliminated after accounting for SES-related variables, whereas social support did not seem to mediate this relationship (Kubzansky, Berkman, and Seeman, 2000)
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From page 381... ...
For the purpose of this analysis, we compare the influence of social engagement and of socioeconomic status on racial differences in disability, controlling for the effects of age, sex, and follow-up time. Socioeconomic status is represented by indicators of education (years of formal schooling)
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From page 382... ...
. The association between social networks and health-promoting behavior such as exercise also has been shown to be mediated through self-efficacy (Duncan and McAuley, 1993)
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From page 383... ...
. As mentioned previously, social support, especially perceived emotional support, may buffer the deleterious influences of stressful life events on depression (Lin, Dean, and Ensel, 1986; Paykel, 1994; Vilhjalmsson, 1993)
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From page 384... ...
. Allostatic load has been found to be significantly predictive of a variety of health outcomes among the elderly, including overall mortality, incident cardiovascular disease, and change in physical and cognitive function (Seeman and McEwen, 1996; Seeman et al., 2001b)
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From page 385... ...
identified 15 randomized trials of interventions designed to modify or improve some aspect of social integration (social support, social networks, or social cohesion)
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From page 386... ...
An equally important issue is to examine the degree to which neighborhood contexts and personal social networks are interlinked, and to explore the processes by which they, in conjunction with one another, facilitate access to personal resources of particular relevance to older adults. Furthermore, do these linkages and processes show differences among various racial/ethnic groups?
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From page 387... ...
in their studies of wild baboons. Both sets of investigations lay the groundwork for the study of life stress as a consequence of subordination to dominant groups as well as the potential role of social resources in buffering the deleterious effects of that stress.
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From page 388... ...
In fact, it may be that for some health outcomes such as mortality and physical disability, health disparities do not continue to increase in old age, usually defined as beginning at age 65 (Corti et al., 1999; Mendes de Leon et al., 1997; Sorlie, Backlund, and Keller, 1995)
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From page 389... ...
While the health benefits of social networks have been recognized previously for the overall adult population (House et al., 1988) , it has now become clear that these benefits also apply to the oldest segments of the adult population.
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From page 390... ...
It is possible that some of the health benefits due to social networks are not merely the result of having larger social networks, but may include the effect of social engagement as well, due to the use of composite measures of social networks and engagement in epidemiologic research. More recent evidence suggests, however, that various forms of social engagement, such as social activity, productive activity, and religious participation provide long-term health benefits to older adults in their own right, given their prospective associations with mortality, physical disability, and cognitive decline.
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From page 391... ...
. The mediating effects of situational control on social support and mood following a stressor: A prospective study of dementia caregivers in their natural environments.
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From page 392... ...
. Social support and mortality in an elderly community population.
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From page 393... ...
. Relationship of activity and social support to the functional health of older adults.
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From page 394... ...
. Impact of social support on outcome in first stroke.
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From page 395... ...
. Marshalling social support.
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. Social support, coping, and depressive symptoms in a late-middle-aged sample of patients reporting cardiac illness.
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From page 397... ...
. Chronic financial strain, social support, and depressive symptoms among older adults.
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From page 398... ...
. Social support and depressive symptoms: Differential patterns in wife and daughter caregivers.
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From page 399... ...
. Stability and change in older adults' social contact and social support: The Cardiovascular Health Study.
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From page 400... ...
. The relationship between the perception of social support and post-stroke depression in hospitalized patients.
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From page 401... ...
. Gender, ethnicity, and network characteristics: Variation in social support resources.
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From page 402... ...
. Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging.
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From page 403... ...
. Social support, stress, and blood pressure in black adults.
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From page 404... ...
. Losing and gaining in old age: Changes in personal network size and social support in a four-year longitudinal study.
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From page 405... ...
. Social support and physical disability in older people after hospitalization: A prospective study.
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