Factors Associated With Health Discussion Network Size and Composition Among Elderly Recipients of Long-Term Services and Supports

Abstract

Social networks play an important role in helping older adults monitor symptoms and manage chronic conditions. People use verbal discussions to make sense of symptoms, determine their seriousness, and decide whether to seek medical care. In this study, problem-specific social networks called health discussion networks (HDNs) are examined over time among older adults receiving long-term services and supports (LTSS). Data were gathered from older adults who had recently moved into a nursing home (NH) or assisted-living facility (ALF) or who had started to receive home and community-based services (H&CBS). LTSS recipients identified people with whom they discussed symptoms or disease information, talked over what their physician said, and considered consulting other health-care providers. Data were analyzed for 216 adults with Mini Mental State Examination (MMSE) baseline scores of 20 or higher, and these individuals were interviewed quarterly over a 12-month period. Generalized Estimated Equations (GEE) were used to model repeated measures of HDN size and composition as a function of baseline age, gender, race, ethnicity, marital status, education, quality of life, setting, number of adult children, and cognitive status. GEE modeling demonstrated that HDN size decreased over time (p=.01) and that the probability of mentioning formal care providers as part of that network increased over time (p=.003). Multivariate predictors of increased HDN size were lower ratings of quality of life (p=.001), having more adult children (p=.04), and higher MMSE scores (p<.0001) after controlling for covariates. Older adults new to receiving LTSS had relatively small HDNs that were mixed networks including family, friends, and formal care providers. This suggests an opportunity for interventions aimed at maintaining and enhancing the HDNs of older adults beyond family members.

Social network activation: The role of health discussion partners in recovery from mental illness

“…That is, as individuals face unfamiliar challenges, periods of elevated support needs, and fundamental disruptions of identity and role performance that accompany illness, social networks become critical (Abbott et al, 2012; Lively & Smith, 2011). Individuals manage, or are managed, through health problems by lay and professional network ties who may recognize, define, or dismiss symptoms; recommend or provide health services; offer emotional or instrumental support; or attempt to regulate health behaviors, appointments, and medication compliance.…”

“…This selective activation of ties during an acute health crisis represents a potentially influential but largely overlooked coping mechanism (Pescosolido, 1991, 1992; Wellman, 2000; Wellman & Wortley, 1989). Only very recently have targeted discussions on topics such as health services utilization, compliance, behaviors, and beliefs been linked empirically to health outcomes (Abbott et al, 2012; Perry & Pescosolido, 2010; Schafer, 2013; York Cornwell & Waite, 2012). Yet, the extent to which individuals with health problems are able to secure access – through activation of certain ties but not others – to information, treatment options, or support that facilitate recovery may, in part, explain why social network characteristics matter for wellbeing.…”

“…In this literature, social interaction is framed, often implicitly, as a central mechanism linking social networks and health. Resources critical for preventing or recovering from illness flow through health discussion networks: advice, information, emotional support, affirmation and belonging, and attitudes about how to define and respond to health problems (Abbott, Bettger, Hanlon, & Hirschman, 2012; Schafer, 2013). Yet, the utility of social network resources depends on successful activation of ties that can provide access to relevant information or support (Lin, 1999).…”

Graphic health warnings as activators of social networks: A field experiment among individuals of low socioeconomic position

“…Health discussion networks , or the set of interpersonal connections with whom individuals discuss health matters, are expected to play an important role regarding the access to resources and supports needed to maintain abstinence among non-smokers and support cessation among smokers. These networks have been shown to impact attitudes; access to services, emotional support, advice, information, and the understanding individuals develop about health issues (Abbott et al, 2012; Perry and Pescosolido, 2010; Pescosolido, 1991, 1992). Interpersonal communication networks can accelerate the spread of new information (Rogers, 2003) and lead to greater exposure to health information (Viswanath et al, 2006).…”

Interactions between patients' experiences in mental health treatment and lay social network attitudes toward doctors in recovery from mental illness

“…Formal and informal social networks are critical for individuals experiencing the onset, response to, and prolonged management of serious health problems (Abbott et al, 2012;Lively & Smith, 2011). An extensive area of scholarship has focused on access to social resources through network ties, including the ways that differing forms of support can directly and indirectly shape mental and physical health outcomes.…”