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Support networks of older people living in the community

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Aim.  The aim of the study was to identify the social support networks of older people living in the community in Ireland using Wenger’s (1994) network typology.Background.  The population of older people in the community is increasing. With
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  ORIGINAL ARTICLE Support networks of older people living in the community  Jonathan Drennan  BSc, MEd, PhD, RGN, RNID, RNT, RPN Lecturer, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Margaret P. Treacy  BA, MSc, PhD, RGN Professor, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Michelle Butler  BSc, MSc, PhD, RGN, RM Senior Lecturer, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Anne Byrne  BSc, MSc, RGN Research Fellow, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Gerard Fealy  BNS, MEd, PhD, RGN, RNT, RPN Associate Professor, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Kate Frazer  BSc, MPH, RGN Lecturer, School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland  Kate Irving  BSc, PhD, RGN Lecturer, School of Nursing, Dublin City University, Dublin, Ireland  Submitted for publication: 5 October 2007Accepted for publication: 19 June 2008 Correspondence:  Jonathan DrennanSchool of Nursing,Midwifery and Health SystemsUniversity College DublinBelfieldDublin 4IrelandTelephone: (+353) 1716 6404E-mail: jonathan.drennan@ucd.ie DRENNAN JDRENNAN J .,  TREACY M.PTREACY M.P .,  BUTLER MBUTLER M .,  BYRNE ABYRNE A .,  FEALY GFEALY G .,  FRAZER KFRAZER K . & IRVING K.IRVING K. (2008)(2008)  International Journal of Older People Nursing   3 , 234–242 Support networks of older people living in the communityAim.  The aim of the study was to identify the social support networks of olderpeople living in the community in Ireland using Wenger’s (1994) network typology. Background.  The population of older people in the community is increasing. Withincreasing age and changes in family circumstances a substantial proportion of olderpeople will require social, psychological and instrumental support. However a lackof adequate social support networks for vulnerable older people can result in poorhealth, loneliness and isolation. Method.  A national, cross-sectional telephone survey of 683 people aged between65 and 99 years was undertaken using the Practitioner Assessment of Network Typeas the basis for identifying social support networks. Results.  The results demonstrated that the majority of older people were living instable and supportive social networks and reported high levels of contact withfamily, friends and neighbours. However, a significant minority of older people wereliving in vulnerable networks. Older people in these networks are susceptible toloneliness, isolation and poor emotional and physical health. Conclusion.  Through the identification of people in vulnerable networks, nursesworking both in the hospital and community setting can ensure that formal supportis aimed at providing care to older people who do not have access to informal care 234    2008 The Authors. Journal compilation    2008 Blackwell Publishing Ltd  networks. Furthermore, the predictive utility of the Practitioner Assessment Net-work Type (PANT) can enable nurses to identify people at risk of poor socialsupport. Key words:  social isolation, social networks, support networks Introduction As older people increasingly receive care in the community asopposed to hospitals it is important that people’s social aswell as physical functioning is assessed (Wenger & Tucker,2002). Particularly, poor social support networks are a threatto the psychological and physical health of older people. Thispaper describes the results of a survey of older people’s socialsupport networks in Ireland. The findings are important tonurses on a number of levels. Firstly, the assessment of socialnetwork assists nurses in the identification and facilitation of older people who are at risk due to reduced instrumental,emotional and social support. Secondly it describes the use of the Practitioner Assessment of Network Type (PANT)(Wenger, 1994), an effective and practitioner friendly mea-sure that identifies older people’s social networks that allowsnurses working in the community to target appropriate healthand social interventions to support older people withinvulnerable networks. Finally, the identification of the socialnetworks can assist in the development of effective healthinterventions and policies for older people (Keating  et al. ,2003). Social networks and support networks Social network generally refers to the network of acquain-tances and social interactions of an individual. While socialnetworks may be operationally defined differently acrossempirical studies, international research indicates that theaverage size of social networks among older people can varyfrom six to 12 individuals (Wenger, 1996; Moorer &Suurmeijer, 2001). Having good social networks can increasethe likelihood of developing further networks. For example,living with a spouse in later life can result in larger social andfamily networks than those experienced by older peopleliving alone (Kim & Baik, 2002).A concept related to social networks is that of supportnetworks. The literature provides numerous definitions of social support and, while terminology used in defining socialsupport differs, the various definitions possess commoncharacteristics, including the notion of some type of positiveinteraction or helpful behaviour provided to a person in needof support (Wenger, 1994; Hupsey, 1998). Social supportcomprises notions of structure (the existence and extent of relationships) and function (the extent to which socialrelationships provide help and companionship) (Kim,1999). Social support is defined in terms of support providedby others and the intentions of the provider, the perceptionsof the individual receiving support, reciprocity in support-giving and social networks; the concept may include otheraspects, which may determine if social support is requested,accepted and/or received. Social support thus comprises theidea of support networks, supportive behaviours, andsubjective appraisal of support received (Hupsey, 1998).The experience or presence of social support can have a directeffect on the individual’s well-being and it may also have abuffering effect on the detrimental effects of stressful situa-tions such as illness and psychological distress (Andersson,1998).Support networks are considered to be an importantsource of support for older people and consist of peoplewho are available to provide support, help and company ona regular basis and comprise local family, neighbours,friends and, in times of vulnerability, health and social careprofessionals (Wenger, 1994; Wenger & Keating, 2002).Based on a 20-year longitudinal study of ageing in Wales,Wenger developed a typology of support networks of olderadults which were identified as: ‘local family dependent’(primarily local family members), ‘locally integrated’ (localfamily, friends and neighbours and involvement in localcommunity), ‘local self-contained’ (primarily neighbours,some local family), ‘wider community focussed’ (mainlylocal friends, no local family and involvement in localcommunity) and ‘private restricted’ (no local family andminimal contacts with local community) (Wenger, 1994;Wenger & Keating, 2002). These various support networks,are relatively stable but can evolve into ‘care networks’when older people’s circumstances change (Wenger &Keating, 2002).The typology of social networks is the basis of thePANT(Wenger, 1994) used in the present study; theinstrument permits the identification of the support thatindividuals receive within their social network. Thistypology is useful for both hospital and community nurses Support networks of older people living in the community   2008 The Authors. Journal compilation    2008 Blackwell Publishing Ltd  235  in that it presents a structured profile of older people’ssupport networks. It also has predictive utility in that itcan identify vulnerable networks of older people; especiallythose whose networks are undergoing change due to illnessor loss of a partner. Research design The research design was a cross-sectional national telephonesurvey of social networks of community dwelling olderpeople in the Republic of Ireland. Sampling Currently in Ireland, there is no sampling frame thatspecifically identifies older people. Respondents were there-fore randomly contacted by telephone using a techniqueknown as Random Digital Dialling. A total of 874 peopleaged 65 years and older were contacted by this method and683 agreed to take part in the study. The overall response ratefor the study was 78%. The use of telephone surveys has beenfound to be effective in reassuring respondents about a surveyas well as clarifying points that an individual may notunderstand (Dillman, 2000). Due to a free telephone rentalscheme for older people, the majority of households withpeople aged 65 years and older have access to a phone. Data collection Interviewers for the telephone survey were recruited andreceived training prior to conducting the interviews. Inaddition, interviewers were supervised throughout the tele-phone interviews. Each interviewer was provided with aninterview pack outlining the process that the interview shouldtake and describing the system for call-backs, respondentqueries and non-response. All interviewers were female. Themajority of interviews lasted between 15 and 25 minutes.Each respondent was provided with a number to call back toverify the credentials of the study if they wished. Respondentswere also provided with the phone number of the ‘SeniorHelpline’, a national telephone support group for olderpeople run by older people. Measuring support networks The measurement of the support networks of older peoplewas undertaken using the PANT instrument (Wenger, 1994;Wenger & Tucker, 2002). The eight-item instrument identi-fies the core group of people to whom older people rely on foradvice, help and support. Wenger (1994) identified socialnetworks as individuals, family and communities who areinvolved with the person in a significant way. These networksinclude members of the older person’s household, theprovision of companionship and friendship, emotional sup-port and help from individuals and the community. Thesesupports are identified in five network typologies (seeTable 1).This PANT instrument in conjunction with demographicdata (respondents’ age, gender, education level, number of children, marital status and health status), was used to enablethe researchers to identify the social network typology thatthe majority of older people living in Ireland are a part of today. The strength of using the instrument is that it iseffective in identifying groups in society who are living inlow-level support networks as well as predicting those olderpeople who will need health and social care interventions inthe future (Wenger & Tucker, 2002). Table 1  Description of network types (adapted from Wenger, 1994;Bowling, 1997; Wenger & Tucker, 2002)Network type Description of networkFamily-dependentsupport networkOlder people in this network have close familyties, but limited contact with friends orneighbours. There is little communityinvolvement. The majority of support needsare met by the older person’s family.Locally integratedsupport networkOlder people in this network have closerelationships with family, friends andneighbours and have usually lived long-termat their residence. There are high levels of involvement in either religious or voluntaryorganizations.Local self-containedsupport networkOlder people in this network have infrequentcontact with relatives living in the samecommunity (sibling, niece or nephew).Reliance for social contact and support andcontact is mainly on neighbours and lifestyleis focused on the household. Communityinvolvement is very limited.Wider community-focused supportnetworkThis network is classified by an absence of local relatives (including children). However,contact is maintained over a distance andthere is an engagement in community andvoluntary organizations. Individuals in thisnetwork make a distinction between familyand neighbours.Private restrictedsupport networkThis network is characterized by a lack of local relatives and very little contact withneighbours or community involvement.Older people in this group tend to rely ontheir spouse or are withdrawn and havebecome isolated from local involvement.  J. Drennan  et al. 236    2008 The Authors. Journal compilation    2008 Blackwell Publishing Ltd  Data analysis Data were analysed using SPSS version 12.0 (SPSS Inc.,Chicago, IL). Descriptive statistics were used to outline thedemographicprofileofthesampleandtheirsupportnetworks.Chi-square analysis was used to explore differences betweennetwork type and nominal variables whereas analysis of variance ( ANOVAANOVA ) explored differences between network typeand continuous variables. Ethical considerations Care was taken to ensure that participants were adequatelyinformed of the purpose of the research, what participationwould entail for them, and benefits and risks associated withparticipation. Participants were advised that their involve-ment was entirely voluntary and that they had the right towithdraw from the study at any time. Participants were alsoassured that their confidentiality would be protected andfindings reported anonymously. Furthermore, care was takento ensure that individuals were properly supported in theevent that participation in the process unearthed feelings of loneliness or distress. This included training of interviewers,ensuring interviews were not rushed and that there wasadequate time for the researcher to build a rapport with therespondent. Approval to conduct the research study wasgranted by the Human Research Ethics Committee of theuniversity in which the research team were based. Results Profile of the respondents The demographic profile of the sample is outlined in Table 2.Almost 50% of the respondents were married and residedwith their spouse. Of those that were widowed the majoritywere women (80.7%). All of the respondents had completedsome form of formal education. The ‘older old’ ( ‡ 85 years)were significantly more likely to only have completed primarylevel education, whereas the ‘younger old’ (65–74 years) weretwice as likely to have attained a secondary level of schooleducation ( v 2 = 43.9,  P < 0.001). The majority of respon-dents described their health as good or very good, however afifth reported that they were in poor health (Table 2). Social contacts The majority of respondents (81.7%) lived within 5 miles of their nearest child or relative, with a minority (8.7%) livingat a distance of  > 16 miles from a close relative. Frequency of contact with children and other relatives was high. Approx-imately 90% had regular verbal interactions with relatives,and children at least weekly. Slightly more (90.6%) reportedthat they had contact with friends at least weekly, if not moreoften. However, 6.3% only had intermittent contact withfriends (monthly or less often) with 3.1% indicating that theyhad no contact at all with friends. Contact with neighbourswas also high. Over 98% reported weekly or more frequentcontact with neighbours. Relatively few respondents (1.1%)reported no contact with neighbours.The majority of respondents attended church regularly(85.1%); only 10% of the respondents reported that they didnot attend. In relation to attendance at older persons clubs orsocial groups, the respondents were almost evenly split intheir responses with approximately 50% reporting that theyattended these groups on either a regular or occasional basiswith the remainder reporting non-attendance. Table 2  Profile of the respondentsCharacteristic Per cent ( n ) Mean (SD)Participants  (n)  683GenderMales 39.1 (264)Females 60.9 (411)Age groups (years) 73.5 (7.1)65–74 62.475–84 30.285 and above 7.3Marital statusNever married 12.6Married 49.6Divorced/Separated 2.5Widowed 35.3Years married 41.7 (16.04)Years widowed 15.3 (10.3)Number of children 3.27 (2.48)0 19.81 25.52 3.93+ 50.8Highest education levelPrimary school 41.3Secondary school 43.7Trade/technical college 3.6University 10.0Other 1.5ResidencyUrban 60.1Rural 39.9Overall healthFair/poor 20.1Good/very good 75.8Excellent 4.1 Support networks of older people living in the community   2008 The Authors. Journal compilation    2008 Blackwell Publishing Ltd  237  Social network type Network type was determined from an analysis of theindividual’s responses to the PANT and indicated the levelof support received by older people from family and friendsas well as their level of social participation (Wenger, 1994).Overall the vast majority of respondents (73.2%) were inlocally integrated support networks, indicating that they hadclose relationships with family friends and neighbours. Justover 2% of older people were living in a private restrictednetwork type or a locally self-contained network typeindicating that they were socially isolated and had minimalaccess to support. Nearly 10% of respondents were inborderline or inconclusive social networks, indicating thattheir support network may be in a state of flux or shiftingfrom one network type to another because of a change infamily circumstance or increasing age (Table 3). The follow-ing section outlines the profile of older people living withineach of the five network types. Local family-dependent support network The majority of older people in this network have most of their support needs met by their family. Overall this networkaccounted for 7% of the sample. Predominantly the oldestold were in this network; of all respondents aged  ‡ 85 years20% were local family dependent compared with 5.6% of respondents aged between 65 and 74 years and 7.2% of thoseaged between 75 and 84 years. Over 20% of respondents inthis network were living in a relative’s home. Older peoplewho were widowed or divorced/separated were three timesmore likely to rely on a family dependent network forsupport than respondents who were married or who hadnever married.Statistically, people in this network are more likely tobe older than respondents in all other networks (apartfrom private) ( F   = 4.25, df = 5, 639,  P  = 0.001), widowed( v 2 = 61.14,  P  = 0.001) and living in a relative’s home( v 2 = 45.51,  P  = 0.001). Respondents were also significantlymore likely to be in poorer health than other networks( v 2 = 20.83,  P  = 0.022) with 35% of older people in thisnetwork indicating that their health was only poor or fair.Older people in this network had, on average, the highestnumber of children than any other social network,(Mean = 4.83, SD = 2.82). The majority of respondents(81.4%) were unlikely to be involved in community activitiesor social groups. The profile within this network indicatedthat increasing age and declining health resulted in increasingdependence on family (usually daughters) to provide care. Locally integrated support network This network is one in which older people have closerelationships with family, friends and neighbours. Themajority of older people (73.2%) in the survey were identifiedas being within this social support network. Family, neigh-bours and friends lived in close proximity, with the majoritywithin a mile of the older person.The majority of respondents were younger (76.5% of all65 to 74 year olds were in this network type), reportedgreater involvement in social and community groups(60.2%), and had a higher weekly income than older peoplein all other support networks. A statistically significantdifference was found between those who were younger (morelikely to be locally integrated) and those who are older whowere less likely to be locally integrated ( v 2 = 32.96, P  = 0.001). Older people who were married were signifi-cantly more likely to be within a locally integrated socialnetwork than older people who never married or werewidowed ( v 2 = 61.14,  P  = 0.001). Respondents in this net-work had also lived within their community for, on average,40 years and nearly 80% had children living within 5 miles of them. The vast majority (92%) attended religious services,with over half frequently involved in community and socialgroups. Overall, older people in this network had extensivesupport from family, friends and neighbours. Local self-contained support network Older people in this network have infrequent contact withrelatives and limited community involvement. The overallpercentage of older people in this category was small,accounting for just over 2% of the sample. The majorityidentified that their most frequent contact with relatives wasweekly (73.3%) or monthly (26.7%). No respondents in thiscategory indicated that they saw relatives on a more frequentbasis (daily or two to three times per week). In relation tocontact with friends, 46.9% saw their friends daily or two tothree times per week, with a third indicating their mostfrequent contact was weekly, with 13.3% only having Table 3  Network typeNetwork type Per cent  n Local family dependent 6.9 45Locally integrated 73.2 476Locally self contained 2.3 15Wider community focused 5.4 35Private 2.3 15Borderline/inconclusive 9.8 64Total 100 650  J. Drennan  et al. 238    2008 The Authors. Journal compilation    2008 Blackwell Publishing Ltd
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