Social Support for Centenarians' Health, Psychological Well-Being, and Longevity
MacDonald, Maurice, Annual Review of Gerontology & Geriatrics
As unique survivors, centenarians vary in personal resources and social networks, which may influence the economic burden of supporting them and also affect their well-being. This chapter focuses on what may be learned about social support antecedents and impacts on centenarians' functional and mental health and mortality from a few psychosocial centenarian studies and related analyses of social networks in very old age from samples of normal life span populations. In the studies reviewed here, social support is defined primarily in terms of family living arrangements and kin accessibility, formal paid and informal unpaid caregiving, and social interaction (advice, contact, and confidants). Defining social support this way is appropriate for centenarians, because their disabling conditions limit access to social activities that provide psychological benefits and require daily and often burdensome instrumental support in the form of personal care and help with household and other life management tasks. Social resources available to centenarians supplement what relatives and friends provide.
BACKGROUND AND CONCEPTUAL OVERVIEW
Considering health benefits and various income support and community-level social services, there is a wide variety of social resources that influence the well-being of very old individuals. They may be provided in different ways depending on public governmental budgeting choices and are likely to evolve from market-driven changes associated with population aging and family demographic rearrangement. Soldo and Freedman (1994) assessed support types provided for the U.S. aging population in terms of the division of labor between the family, market, and government sources. Their analysis of potential complementary support among these sources also considered substitution of one provider of time help or financial assistance for another to support disabled elderly persons and identified serious gaps with respect to long-term care. Soldo and Freedman emphasized that more research is needed to understand family responses to changes in consumer prices and government subsidies. Whether expanding government assistance crowds out family support has long been a concern for public policy-oriented economists-a concept so compelling that there is also a literature about the extent to which intergenerational transfers are motivated by exchange versus altruism (e.g., Cox & Rank, 1992). Under exchange, there would be less substitution of government for family support because more altruistic donors care primarily about the level of their relatives' well-being, and if government contributes more, the family does less.
One line of inquiry has connected the role of social networks and participation in U.S. old-age public income assistance programs. Krause and Shaw (2002) analyzed how gender and receipt of public assistance in the United States interact to reduce reliance on social networks by men. Evidently, there is stigma about failure in role expectations for older men (but not women), which makes them less likely to get social support from their family and friends. However, little attention has been paid to gender as a specific factor identified as moderating or critical to the effects of social support among centenarians (except for mortality). Preliminary, unreported tests that may have been conducted about genders influence on social support for functional health and well-being have rejected its importance. Continued marriage is certainly rare in centenarian samples, but the influence of that intimate relationship has received less attention than it probably deserves in studies that compare the young-old and the old-old.
Existing research about social resources for centenarians does not emphasize variation in government-provided income support. There has been some attention to issues of health care access, and, although living with children has been considered to be an important economic resource, there has been very little attention to direct financial support from the family to extremely old people. …