Social Support and Older Adult Health in China

Abstract

Social support refers to the provision of support through the real or perceived existence of resources in social relationships, which is one of the main mechanisms through which social networks may influence health outcomes. Due to scant long-term care institutions with limited healthcare infrastructure in China, social support and the underlying social networks may be especially pertinent to older Chinese adults. Additionally, rapid population ageing accompanied by reductions in family size and intergenerational co-residence highlights the need to examine social support in relation to older adult health in China. We used the China Health and Retirement Longitudinal Study (CHARLS), which is a nationally representative cohort of community-dwelling Chinese adults modeled after the Health and Retirement Study (HRS) in the United States. We measured social support as received financial support from family members and perceived instrumental support, and we measured social networks as an index of marital status, weekly contact with children, regular contact with friends, and social participation. We assessed older adult health through several outcomes, including functional decline, frailty, and all-cause mortality. We used multivariable logistic generalized estimating equations (GEE) to account for clustering by household to estimate the association between social support, social networks, and various incident health outcomes in prospective analyses. After adjusting for demographic and household characteristics, socioeconomic status, and baseline health, both financial support and perceived support were associated with decreased risk for functional decline, and those with both types of support had the lowest risk in incident ADL limitations compared to those who had none (OR: 0.56, 95% CI: 0.40-0.79). Perceived support was associated with reduced risk for incident frailty (OR: 0.69; 95% CI: 0.52-0.92), while no associations were found with financial support. Greater social connectedness was associated with fewer deaths (p-trend < .001), with a 54% (95% CI: 13-75%) reduction in mortality among the most socially connected compared to the most socially isolated. Overall, social support and greater social networks were associated with several positive health outcomes, which suggests social relationships to be important determinants of health and possible targets for policy interventions for health promotion in Chinese older adults.