Social support and mood in elderly populations: research synthesis

Patient-oriented care is a feature of personal, occupational, and organizational relationships. Therefore, efforts that seek to enhance patient-centered care have to consider their focus on patients and their relatives, as well as healthcare professionals and the health systems (Epstein & Street, 2007). Encouraging patients to be active participants in consultations shifts the long-standing paternalistic dialogue, dominated by physicians, to a new type of dialogue where the patient is a more active participant. Training medical doctors to be more aware, helpful, and empathic alters their role from that of paternalism 'order-givers' to one that focuses on cooperation, partnerships, solidarity, and empathy. Changes in the system that relieve the general practitioners from the toil of assembly-line medicine driven by productivity can also help to reduce the cognitive overload and fatigue that makes medical care less patient-centered.

Effect of social support and support groups on elderly people's moods:

In the U.S.A., physical health and mental well-being have repeatedly been linked to the level of social support provided (Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Perceived support is an essential element that enhances one's perception of his or her own capability to handle stressors (Thoits, 1986). Studies among the elderly on social support have proven the beneficial effects of perceived support on psychological and physical well-being. Other studies have also repeatedly shown the benefits of marriage between older couples on emotional and physical health (e.g. Hughes & Waite, 2002); these benefits are believed to originate from the social support that comes with marital relationships. Individuals that are more socially connected generally are more likely to have better physical and emotional health compared to those who are socially disconnected. The fraction of waking hours that is spent daily with others, in community, is positively related to a better mood; however, social time will not act as a buffer between every-day perceived stressors and lower mood. On the contrary, marital satisfaction is what will act as a buffer between every day perceived stressors and lower mood (Waldinger & Schulz, 2010).

Sugisawa et al., (2002) examined the effects of social ties on depressive symptom levels in U.S. And Japanese adults aged 60 and over. It was found that the presence of a spouse and increased interactions with the family and relatives had an overall impact on the mood of the participants. Both groups scored low on depression. This indicates that the social ties and healthy interactions benefit the mood of elderly people in both populations alike, regardless of national origin or societal customs.

Role of the support group for elderly people:

The division between men and women is well defined in a study that examines the link between social support and personal health. Even though the authors, Okamoto and Tanaka (2004), clearly define their objective of examining the difference between males and females, they conclude their study with sex-dependent factors. The same approach can be observed in a study of awareness of social capital (Aihara et al. 2009). Even though these studies don't regard age and gender as problems, they do point out that the living conditions may be different between the elderly men and women in Japan. It was noted that older Japanese women were more likely to be at a higher risk of depression and suicide than older Japanese men (Sukegawa et al. 2003). Even though more elderly women than men knew about available health and support services (Shibusawa et al. 2001), they were more hesitant to make use of these services (Tsukada and Saito 2006).

Women engage in community activities (Aihara et al., 2009) to a greater extent than men and thus generally receive more support (Okamoto and Tanaka, 2004). However there are men for whom these two aspects positively influence their health self-perception (Okamoto and Tanaka, 2004) and cognitive aspect (Aihara et al. 2009). It has been observed that the issues linked to the older people's use of social services include: their health status; having kids whom they could ask for care assistance; old age (over 70 years); and low income status (Takahashi, 1988). It was also reported that if the child who asked for the social support was the oldest son, then the elderly parents were less likely to agree to utilize the support services. Additionally other studies have found that the major issues that were related to the stay and day services were: the well-being of the caregivers, personal continence, and availability of social support (Wakabayashi, 1998).

In the U.S., several million older persons who live in communities still lack adequate emotional support (White, Philogene, Fine, & Sinha, 2009). However, different organizations organize support groups that create awareness of different health issues for elderly. Various psycho-social interventions are used in nursing homes where family-based, staff group and individuals take part in group support programs. This creates a family environment and improves their life by enhancing their morale and staff (Takamura, 2001).

Role of support from their family:

The care given to the elderly is known as social support. Family members can give four fundamental types of social support:

• Emotional: Giving comfort, reassurance, a listening ear, and confiding with their kin.

• Instrumental: Taking care of the house, enabling transportation, and catering for shopping, and personal care.

• Financial and housing: Settling bills or sharing a home.

• Informational: Giving encouragement to seek medical attention, giving referrals to institutions, and sharing family information.

Rook (1984) states that research on social support in the U.S.A. indicates that significant others can be a source of negative interaction as well as a source of support. Research conducted recently in the United State suggests that support enlistment is not a common response to all stressors; when certain stressors arise, older adults may avoid rather than seek out help or support from others (Krause & Jay, 1991). Moreover, research indicates that social network members may even remove support when some (but not all) stressors occur (Krause, 1991).

It is important to indicate that the loss or withdrawal of support is particularly likely to happen when financial problems arise. It is recognized that family members do offer the most support to the feeble and disabled elderly people who are not in institutions; generally it is preferred by both parties that way (Gillen, Mills, & Jump, 2003).

In Japan family ties are very important. The most perceived dependable source of support is family members living together, followed by children living apart (Koyano et al., 1994). The elderly usually depend on family members for assistance. Older people may require assistance with the pressures of their day, to day life due to terminal illness or in case of an emergency. The grown-up children may feel a strong sense of duty towards their aging parents. Many grown-up children offer care and support despite the time, distance, and/or competing responsibilities. Social support directly influences well-being of the elderly.

Role of support that comes from membership in a formal religion:

Because most congregants share religious beliefs and practices, they usually attain a higher level of social connectedness or integration. Participation in religious activities will likely increase social connectedness and as a result decreases suicide rates (Colucci & Martin, 2008).

In the U.S.A., religious settings usually provide an environment in which giving and asking for emotional and social support are both encouraged, and not frowned upon. According to Ferraro and Kelley-Moore (2000), people who are more socially connected in a religious community are more likely to look for religious support when undergoing tough times. Many religious denominations offer official programs for adherents in need (Trinitapoli, 2005). Studies suggest that people ask for help more often in groups when the possible support-providers are certain about each other's responsibilities (Cutrona, Suhr, & MacFarlane, 1990). Many religious denominations emphasize the point that other people also share the same beliefs and have a lot in common (Sosis, 2000). For the above reasons, one of the basic forms of social care the elderly receive from religious participation is emotional support.

If we have a look at the Japanese culture, we see that people become more involved in religion with increasing age. Japanese religion inspires older men to provide support to their social network. As per Krause (2008), the perception that one would receive emotional support if they needed it plays an essential role in the maintenance of mental well-being. His study demonstrated that elderly Japanese men who assisted their "significant others" perceived themselves to be healthier than those individuals whose interaction with their "significant others" was minimal or nonexistent.

Role of support that is founded on individual spiritual values:

According to Koenig, George, & Titus (2004), spirituality is the pursuit of answers in order to understand life's ultimate questions, and by extension, the meaning and purpose of living. This usually but not necessarily leads to the formation of rituals and a community united by their beliefs. Spiritual support may not only involve the sharing of spiritual rituals and/or religious rites, but also the sharing of experiences and feelings. It may also involve active out-reach, where individuals seek to 'convert' others, sharing teachings with them, and urging them to 'change their ways' (Krause, 2008).

In Japan some of the aspects of spiritual support include: seeking spiritual care, engaging in both formal and non-formal religious activities, and showing faith in God (Koenig, 1994). Religious denominations can help to alleviate symptoms of anxiety and depression by providing support groups. According to Koenig et al. (1988), the level of depression is higher in institutionalized old people than is the case for those who live in the community. Koenig and colleagues argue (1988) that the elderly in hospitals and nursing homes are usually under the direction of institutional policies and schedules, thus they do not have personal independence or freedom of choice (Marche, 2006).

In America, religion is a part of traditional behavior, and involves responsibility and accountability. People in the U.S. might not be 'into religion', but they do consider themselves as spiritual. At present, 90% of elderly people in the U.S. declare themselves to be spiritual and/or religious, while only 5% consider themselves to be atheists. The participation of elderly people in the religious community is strong because they consider the religious group as the largest personal avenue of support for themselves. According to different scholars, religion provides a hopeful and positive attitude for elderly people; this also affects their relationships in a positive way (Kaplan, Berkman, 2013).

Care and support for elderly men

In United States, research has shown that efficient social support helps to protect the elderly against mental disturbances and functional incapacity (Golden, Conroy, Lawlor, 2009; Bennett et al., 2006; Stuck et al., 1999). Social support also enables the elderly to practice freedom of choice, and to be independent in their families and communities; both of these are prerequisites for optimal cognitive functioning and their psychological health. Considering that elderly people with cognitive difficulties have a hard time carrying out basic day-to-day activities, and undergo slow degradation of their mannerisms and social capabilities, the above study can provide a contribution to the knowledge in the field of nursing. Additionally, it can also contribute to autonomy via integration of the family care pathway. This approach encourages development of suitable social relationships, and may lead to independence in carrying out day-to-day activities, consequently enhancing the health of the elderly suffering from cognitive alterations.

Depression in elderly:

The Depression care model based on the health system: brings new resources into the entire health sector or into community groups; makes use of the clinical standards for care management; encourages patients to be active participants in consultations; promotes regular checkups, and delivers feedback among healthcare professionals. Depression care models make use of interprofessional relationships between general practitioners and mental health care professionals, in which the knowledge of psychopharmacology in healing depression is provided by a psychiatrist and psychosocial therapies are provided by specialist nurses/social workers. These are particularly promising models to enhancing depression care for the elderly. Random trials have proven that collaborative care approaches are valuable in encouraging patients to be interested in treatment, enhancing the general practitioner's therapy for depression, and improving follow-ups (Kathleen, 2006).

Among the elderly in Japan, there is a positive perception of nursing homes; they are viewed as being better than staying at home alone (Tsugaruya, 2004). According to Rauch, Morales, Zubritsky, Knott and Oslin (2006) the elderly Japanese who thought of themselves as not being in good health were likely to be more depressed. The studies mentioned above point to the fact that poor health affects depression levels. If intimate social relations in Japan are made based on the concept of significant others and social ties, then the emotional and social support provided by their immediate social network members should be considered to be extremely pleasing. As the amount of emotional support provided by others increases, the depressive symptoms in elderly decrease.

Support of American families and support of Japanese families

In Japan, several studies have been done to examine how often family members visit their kin in nursing homes. Studies conducted in the 1970's sought to address the unpleasant idea that most families just 'dumped' their relatives in nursing homes to avoid the shame of leaving them in isolation. For example, the 1973-1974 National Nursing Homes Survey showed that many of the elderly residents received visitors; about 61% were visited about once a week. On the other hand, a quarter of them were visited less than once a week. Only 11% of them did not receive any visitors. Most of the visits were from children (50.3%) (National Center for Health Statistics, 1977, 1979).

In the United States, research done on 1,114 elderly persons from Detroit, Michigan (U.S.) found that a majority of nursing home residents were visited; almost three quarters of the residents had a visitor the month preceding the study (Gottesman, 1974). The research also examined factors that influenced the frequency and duration of visits the elderly in nursing homes received from their families. Nearly all the family members visited the residents at least once a month, and almost 75% stayed for more than an hour on each visit. The above studies confirm that family connectedness to the elderly is still maintained even after institutionalization.

Support from religious groups support a patient in these two countries

Quite a number of studies have shown the relationship between religiousness and mental well-being, among the elderly in Japan and in the U.S. Very religious people have been reported to have a lower likelihood of developing depression; for those who become depressed, symptoms experienced were less intense. However, the nature of this link is disputed by contrary findings that assert that religion may be linked to worse outcomes in some denominations, or that in some settings there is a curvilinear relationship, whereby those who are averagely or moderately religious are at an advantageous position. Some of these disparities can be explained by the complexity of the idea of religion, which includes numerous aspects of belief and rituals including engagement in public worship programs, engagement in private prayer, and the perception of the meaning of life (Hayward et al., 2012).