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0-7 639

 

LIBRARY
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This is to certify that the

thesis entitled

A Descriptive Study of the Differences
In Perceived Emotional Support Received And
Perceived Tangible Aid Available To Elderly Women In
TWo Age Groups

presented by

Carolyn Smith-Adams

has been accepted towards fulfillment
of the requirements for

M.S.N. Nursing

degree in

 

 

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Major professor

Barbara Given

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2/22/85
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A DESCRIPTIVE STUDY OF THE DIFFERENCES IN
PERCEIVED EMOTIONAL SUPPORT RECEIVED AND
PERCEIVED TANGIBLE AID AVAILABLE TO ELDERLY WOMEN
IN TWO AGE GROUPS

By

Carolyn Smith-Adams

A THESIS

Submitted to
Michigan State University
In partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE
IN NURSING

College of Nursing

1984

Copyright by
Carolyn Smith-Adams
c 1984

ABSTRACT
A DESCRIPTIVE STUDY OF THE DIFFERENCES lN
PERCEIVED EMOTIONAL SUPPORT RECEIVED AND
PERCEIVED TANGIBLE AID AVAILABLE
TO ELDERLY NONEN IN Two AGE GROUPS
By

Carolyn Smith-Adams

Elderly persons are often viewed as a homogeneous
group, however as the life span increases there is likely
to be greater differentiation in older people.
Additionally, census data show more older persons are
women, who are healthy and actively involved. Research ls
necessary to study factors that will promote and maintain a
high level of health. This descriptive study based on data
from a larger study was designed to explore whether women,
aged 75 to 89, perceived differences in emotional support
and tangible aid. Results were compared to a similar
sample of women aged 65 to 74 years of age.

The sample was composed of 24 women who completed
items on Norbeck's Social Support Questionnaire. Data were
analyzed using descriptive statistics and i—tests.
Significant differences were found (p<.001) when emotloanl
and tangible aid responses were analyzed for the group aged
75 to 89 and tangible support was perceived to
be less available. Data analysis of responses to tangible
aid items between two age groups indicated a significant
difference on the perception of tangible aid (p<.05). The
older group of women viewed tangible aid less available

than emotional support.

At the end of life we will not be Judged by
how many diplomas we have received
how much money we have made
how many great things we have done.

We will be Judged by
"l was hungry and you gave me to eat
l was naked and you clothed me
i was homeless and you took me in."

This is Christ in distressing disguise.
(Mother Teresa of Calcutta)

II

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finely

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ACKNOWLEDGMENTS

Sincere thanks and appreciation is extended to Barbara

Given,

R.N

., Ph.D., for use of her date, and the many

contributions she has made to this study and my growth as a

clinical
To
persiste

nu
Dr

nt

rse specialist.
. Rita Gallin whose high scholarly standards and

criticism enhanced my development as a beginning

researcher,and the evolution and final writing of this thesis.

grateful to my thesis committee members, Carol

Garllnghouse, Rita Gallin, Sue Haviland, Dr. Barbara and

Charles Given, for their guidance and support throughout the

completion of this study. The assistance of Bryan Coyle in

analyzing the data was much appreciated.

To

”Y

friend, colleague and thesis partner Laurie

Sefton-CoJocel who helped me to learn the process of

collaboration and kept my feet planted on the ground.

To a very special friend, Father Paul Cummings who has

taught me about social support in the most practical sense.

Special gratefulness is reserved for my husband Pat, who

provided

throughout

thesis.

hugs when

love, stability and continued encouragement
my graduate studies and the writing of this
To my sons Shannon and Andrew for their love and

i grew weary. To Todd, my eldest, who grew to

adulthood when I turned my back. He taught me more then I

cared

to know about computer systems.
ill

Chap
LIST

LIST

TABLE OF CONTENTS

Chapter

LIST OF TABLES. O O O O O O O O O O 0 O 0

LIST OF FIGURES. . . . . . . . . . . . .
I. THE PROBLEM. . . . . . . . . . . . .
Introduction . . . . . . . . . . . .
Purpose. . . . . . . . . . . . . . .

Statement of Research Questions. . .

Conceptual Definition. . . . . .
Age . . . . . . . . . . . . .
Social Support. . . . . . . .
Perceived Emotional Support .
Perceived Tangible Aid. . . .

Assumptions. . . . . . . . . . . . .
Scope and Limitations of the Study .
Overview of the Chapters . . . . . .
CONCEPTUAL FAMENORK. . . . . . . . .
Introduction . . . . . . . . . . . .

Rogers' Conceptual System for Nursing
Unitary Man/Person. . . . . . . .
Principle of hellcy . . . . . . .
Principle of resonancy. . . . . .
Principle of integrallty. . . . .

Application of Rogers' Conceptual

to Aging Phenomena . . . . . . . . .

Age. . . . . . . . . . . . . . . . .

Social Support . . . . . . . . . . .
Relationship of Social Networks
Social Support. . . . . . . . . .
The Structural Characteristics. .
The lnteractlonal Characteristics
The Functional Characteristics. .
~Effects of Emotional and Tangible

iv

System

and

O O O 0

Support

O O O O O

O O O O O

‘1

Indoor

10

IO
12
14
16
16
17
17
18
19
19
19
21
26
27
28
31

31
32

 

III I

IV

(Con't)

Effects of Emotional and Tangible Support

Objective and Subjective Dimensions
of Social Support . . . . . . .
Role and Function of Social Support
Nature of the Situation . . . . . .
Personal Resources. . . . . . . . .

The Norbeck Model. . . . . . . . . . . .
Characteristics of Person . . . . . .
Environmental Characteristics . . . .

Integration and Summary. . . . . . . . .

LITERATURE REV'E". O O O I 0 O O O O O O

introduction . . . . . . . . . . . . . .

Age and Differences Among Aging Persons.

Social Support Literature. . . . . . . .
Problems in Conceptuallzation and
Operationalization. . . . . . . . .
Development of the Concept of Social
Perceived Emotional Support . . . . .
Perceived Tangible Aid. . . . . . . .

Summary. . . . . . . . . . . . . . . . .

METHODOLOGY 0 O O O O O O 0 O 0 O O O O O

ov.rVIe' O O O O O O O O I O O O O I O 0

Sample . . . . . . . . . . . . . . . . .

Data Collection Procedure. . . . . . . .

SI+OSO I O O O O O O O O O O O O O O O 0

Training Procedure . . . . . . . . . . .

Special Forms. . . . . . . . . . . . . .

Operational Definitions. . . . . . . . .

instrumentation. . . . . . . . . . . . .

Administration and Scoring . . . . . . .

Normative Data and Validity Testing. . .

Protection of Human Rights . . . . . .

Support.

32
33

39
41

42
44
45
48
50
50
50
65

65
69

80
88
9O
9O
91
92
93
95
96
98
99
100
100
103

IV

VI

(Con't)

Procedure for Data Analysis. . . . . . . . . .
Summary. . . . . . . . . . . . . . . . . . . .
DATA PRESENTATION AND ANALYSIS . . . . . . . .
Overview . . . . . . . . . . . . . . . . . . .

Descriptive Findings of the Study Sample . . .
Demographic Variables . . . . . . . . . . .

Additional Findings Regarding the Study Sample
Summary. . . . . . . . . . . . . . . . . . . .
Data Presentation for the Research Question. .
Description of Statistical Averaging . . .

Research Question. . . . . . . . . . . . . . .
Descriptive Findings in the Comparative Study.

Data Presentation of the Research Question In
the Comparative Study. . . . . . . . . . . . .

summer-Ye O O O O O O O O O C O O O O O O O 0

Data Presentation for the Collaborative
Research Question. . . . . . . . . . . . . . .

Summary. . . . . . . . . . . . . . . . . . .
SUMMARY AND lNPLlCATlONS OF THE RESEARCH . . .
Overview . . . . . . . . . . . . . . . . . . .
Characteristics of the Study Sample. . . . .
Additional Findings Regarding the Study Sample
Research Question. . . . . . . . . . . . . . .
Collaborative Research Question. . . . .
Additional Limitations of the Study. . . . . .

implications for Nursing Practlve. . . . . .
Implications for Staff Nurses . . . . . . .

The Gerontological Clinical Nurse Specialist.

vi

104
105
107
107

108
108

110
115
115
117
120
121

125
127

128
130
131
131
132
137
140
142
145
146

151
154

VI

(Con't)

Implications for Nursing Education.
Undergraduate Education. . .
Graduate Education . . . . .
Continuing Education . . . .

Implications for Nursing Research .
Recommendations for Future Research.

Summary . . .
BIBLIOGRAPHY .
APPENDICES

APPENDIX A:
B:

Consent Form. .

NORBECK SOCIAL SUPPORT

QUESTIONNAIRE .

vii

158
159
160
162

162
163

164

165

166

167

Tab

Tab

Tabl

Tabl

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Table
Table

Table

Table

Table

Table

Table

Table

Table

Table

LIST OF TABLES

Page

Characteristics of Social Networks. . . . 29
Profile of Older Women in the USA:

1970, i980, 1990,‘ZOOOO . . . . . . . . 54
Demographic Variables Concerning Older

Women (age, marital status, race). . .III-IIZ
Correlation Matrix: Relationship Between

Selected Soclodemographic Variables. . . II4
Pearson Correlation Coefficients for 3

Emotional Items On NSSQ . . . . . . . . . 118
Pearson Correlation Coefficients for 2

Tangible Aid items on NSSQ. . . . . . . . 119
Composite Mean Scores for Emotional

Support and Tangible aid (women 75-89). . 122
Demographic Variables Concerning a Young-

Old Population of Women. . . . . . . 123-124
Composite Mean Scores for Emotional Support

and Tangible Aid (women 65-74) . . . . . 127
Composite Mean Scores for Emotional Support

and Tangible Aid Between Two Groups of

Women (65-74 and 75-89) . . . . . . . . . 129

viii

Fig;

Figu

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Figure 1

Figure 2

Figure 3

LIST OF FIGURES

Potential Effects of Social Support. . . . 36

Different Patterns of Effects of
Social Support on Health . . . . . . . 38
Norbeck Model: A framework for Guiding
Research and for incorporating social

Support into Clinical Practice. . . . 43

ix

 

and

will

F8501

CHAPTER I
THE PROBLEM

Older women outnumber older men in the United States
and, as the total elderly population increases, older women
will require a greater share of the nation's health care
resources. In 1900, only two percent of the population, or
1.5 million older women,. comprised the total population.
Where in 1977, 10 percent of the population was over 65,
and a projected increase of 14 to 22 percent is expected by
the year 2000. That is, one In every 14 people will be a
women 65 years or older (Projection of Population, 1977-
2050, I976). Contributing to the Increased number of women
is the fact that life expectancy is greater for women. At
birth there are 120 males to 94.8 females; however, by age
65 there are 68 males to 100 females and at age 85 there
are 50 males to 100 females (U.S. Bureau of Census, 1984).
Given the increasing numbers and greater longevity of
females, health care providers and researchers are only
beginning to recognize the need for determining the
resources or factors that will promote the health of older

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To many the concept of health promotion and wellness
have little application to an aging population. Old age Is
often characterized by illness and dependency. Health
professionals, including nurses, frequently have negative
attitudes toward aging persons. GeIein (1982) noted that
although we all know someone who is elderly, female and
healthy, .we have given little thought to what factors or
characteristics might contribute to this state. Geleln
believes that several factors have formed our perceptions
and attitudes toward the aged. First, the elderly are
viewed stereotypically as a homogenous group on a declining
path. The resulting assumption is that the majority of
those in old age are sick and dependent and while there are
a few notable exceptions they do not contradict the rule of
terminal decline. In truth, statistics show that most
older people live independently in the community and that
85 percent are healthy enough to carry on their normal life
style (National Center for Health Statistics, 1976).
Additionally, developmental and life-span researchers
suggest that differentiation increases with age, with
greater heterogeneity and variability as people advance in
years (Havlghurst, 1957; Maddox and IDougIas, 1974;
Neugarten, I973; Rlegel, 1971 Sarbln, 1954).

Second, health care providers are more likely to see
and treat the III and frail elderly leading to selective

exposure to aging persons. The percentage of frail elderly

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has been estimated to be 15 percent of those over 65 years
of age and only 5 percent are in institutions at any one
time (Patrick, 1979). it is this small percentage that
have become the focus of much of the research on aging
persons. Third, social or psychological phenomena of aging
has only recently attracted the Interest of social
scientists (Maddox, 1977).

This orientation toward the frail elderly has been
the predominant focus of literature and research on aging
that Is, the absence of health, chronic disease and
deterioration with age. Two literature reviews of
gerontological nursing, covering approximately twenty-five
years of nursing literature, reveal that information on
health promotion is missing in publications on aging before
1977 (Basson, 1967; Gunter, 1977). Only recently have
authors begun to challenge the assumptions and myths of
aging and focus on normal physiologic age changes versus
the pathology of age, and to relate the concept of wellness
and factors that promote health to an elderly population
(Geleln,1980, i982; Hickey, I980; Kee, i984; Shanas,
1980). While the study of pathology, diagnosis and
treatment of disease will remain important in the care of
aging persons, the fact is that 80 percent of those
individuals over 65 are well and maintaining themselves in

some fashion in the community.

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4

Nurses in Advanced Practice and particularlly the
Clinical Nurse Specialist in Gerontology have a primary
focus and area of accountability in providing health
promotion and maintenance activities with older adults.
The focus cannot be limited to illness and disease of old
age but rather must seek to identify and understand the
characteristics of health and factors that will enhance the
health and quality of life with aging.

A number of psychosocial variables have been
identified and studied as factors that promote health.
Among these is the concept of social support. Social
support is a term that is implicitly and explicitly central
to clinical nursing. Often It has had different names:
love, caring, friendship or social integration. Most
nurses have an intuitive sense of what constitutes social
support and the term shows up frequently in care plans.
For some purposes, a general and intuitive understanding of
social support may be sufficient. However, to develop a
level of scientific knowledge adequate for clinical
application, nurses and other health care providers must
achieve greater precision In describing, defining, and
measuring social support. Additionally, the literature and
dictionary definition of social support suggests there are
many different types or components of social support. What

Is not clear is what differences make a difference. in

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5
particular, what types or components of support have
important effects on health?

While individuals differ in timing and rate, all older
people face the stress of physical, social, and
environmental changes, many of which challenge their
ability to cope. Unique to old age are the series of
stresses such as, loss of employment and work
relationships, death of spouse/family members, and friends.
All take place at a time when coping ability has begun to
diminish and other physical and mental changes are occuring
as a normal part of aging. How such losses affect elderly
women's capacity to cope is unclear, but the existing
evidence from research would indicate that social support
does contribute to health outcomes ( Caplan & Klliiiea,
1976; Cobb, 1976; House 1981; Kaplan, et. el., 1977;
Kasl, 1978).

in summary, much of the past literature on aging women
has focused on the absence of health or signs and symptoms
of illness considered to be characteristic of aging. This
orientation continues to be prevalent in health care today.
However, women are living longer and growing in greater
numbers. To promote health and quality of life for aging
women nurses in advanced practice must refocus on
"wellness" and identify the characteristics of older women
and the environment that maintain or promote health states.

Without research or publications on health promoting

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6
factors in aging women, myths and stereotypes about growing
older are sustained. These stereotypes affect the
attitudes of women about aging, as well as the beliefs of

health care providers about the potential of elderly women.

income

A large and growing body of research on the effects of
social support on health exists, yet such knowledge Is
still often fragmented and unsystematlc. The conceptual
and operational definitions of support are often not
comparable across studies, and the populations and study
designs vary greatly (lsrael, 1982; House, 1981: Norbeck,
1981). ~ Since an aging population of largely women, are
likely to have multiple losses physically, psychologically,
and socially, the need exists to research demographic
properties and situational/environmental properties that
might influence social support needs. Perception of need
as well as actual and available need for support may also
be quite different. A descriptive study was proposed to
examine the perceptions of a sample of elderly women.

The purpose of this study was to identify if there are
statistical differences in the way older women perceive two
types of social support, emotional and tangible aid. In
collaboration with Sefton-Cojocel (1984), two samples of
women were utilized to determine if there were differences
in perceptions among a sample of old-old women or between a

sample of young-old and old-old women.

 

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Using two sets of data from a larger study,
WWW (Given,
1982) similar and inter-related questions were proposed.
The data from the two studies, analyzed separately,
provided a look at two elderly groups of women and the ways
each perceived emotional support received and tangible aid
available to them.

The question asked in this study is: Is there a
difference in the mean value of perceived emotional support
received and perceived tangible aid available among women
aged 75-89? Sefton-Cojocei asked: Is there a difference
In the mean value of perceived emotional support received
and perceived tangible aid available among women aged 65 to
74? For comparison, the question was asked: Is there a
difference in the mean value of perceived emotional support
received and perceived tangible aid available between two
groups of women aged 65 to 74 and women aged 75 to 89?

These two theses have been written separately, with

the exception of Chapter ill, the Literature Review, and
Chapter IV, the Methodology. it is proposed that the
results of such a collaborative effort will provide

additional scientific data about aging women and social

support.

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Differentiation in social, spiritual, psychological,
and physiological functioning increases with age. The
range of differences become greater, not narrower, as
people move through the adult years (Maddox 8 Douglas,
1974). Given this diversity, it is useful to distinguish
between the various aging groups, a distinction Neugarten
(1981) has characterized as the young-old (65 to 74) and
old-old (75 years and older). For purposes of this study
the sociocultural approach which emphasizes the needs and
age norms dichotomlzed by Neugarten will be utilized. The
following are descriptions of the needs and age norms
within each group of young-old, and old-old.

it Is the young-old who are now, and will continue to
comprise, the large majority of persons over 65. At present
the young-old group numbers roughly 31 million people or
155 of the total population. Because mortalllty rates for
women are lower, females outnumber males by a sizable
proportion. The rates of widowhood are very different for
the two sexes; about 71 of men, but over 30$ of women,
are widowed. The young-old are, for the most part, healthy
and competent men and women, many of whom have retired or
reduced their time in homemaking, but remain integrated
members of their families and community. The young-old see

their children frequently and often live near at least one

 

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child. It is noteworthy that a large proportion of young-
oid have a living parent. The estimate is one of every
three 60 year olds have a living parent In 1972 (Neugarten,
1974). This proportion has increased as the numbers of
old-old have grown faster than the numbers of young-old.
Whether they are working or retired, the young-old play
active roles in their churches, clubs, and organizations,
and an increasingly large number perform volunteer roles.

The old-old (75 years and older) are those persons who
are likely to have undergone major physical and mental
changes. Their needs for meaningful ways of spending time,
for special housing, and for transportation will depend in
part upon their health status. Probably an increasing
number will remain active, productive and independent.
Most, though, will need both supportive services and
special assistive devices in the physical environment to
enable them to function as fully as possible.

Neugarten's sociocultural age groupings based on needs
and norms will be utilized In this study. It is expected
that such a dichotomy, young-old and old-old, will provide
the basis for Identifying diversity among and between
groups of women in each age group, and that the perceptions
of social support need will be quite different between the
two age groups.

Sociai_§nnnnci
Social support ls recognized as a multidimensional

construct and has been defined several ways: support as

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10
relational provisions, support as Information, support as

structure, and support as Interaction (Cobb, 1976; Caplan,
1974; Mitchell, 1969; Weiss, 1974). For the purpose of
this study, the definition proposed by Kahn (1979) will be
used. That Is, social support consists of "interpersonal
transactions that include one or more of the following:
the expression of positive affect of one person toward
another; the affirmation or endorsement of another person's
behaviors, perceptions, or expressed view; the giving of
symbolic or material aid to another" (Kahn i979,p.85)
Ennsnlxnn_fimniinnnl Saunas:

Perception ls defined as an individuals interpretation
of reality (Roger 1970). Perceived emotional support ls
defined as each Individual's Interpretation of the caring
and concern expressed to them by others. Individuals will
perceive that others believe in them, love and respect
them. Emotional support implies the ability to confide.
WW

Perceived tangible aid is defined as the lndivlduai's
interpretation of support provided by others In the form of
material resources, such as money, materials, tools and
skills or services, such as transportation, shopping,
assistance with tasks of daily living.

W
W

1. Unitary Man/person Is a four-dimensional, negentropic

energy field Identified by pattern and organization and

fl

 

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11

manifesting characteristics and behaviors that are

different from those of the parts and which cannot be

predicted from knowledge of the parts (Rogers, 1970).

2. Environment Is a four-dimensional, negentropic energy

field Identified by pattern and organization and

encompassing all that Is outside any given human field.

3. Unitary Man/person and the environment are In

continuous, mutual, simultaneous Interaction, evolving
toward increased differentiation and diversity of

pattern and organization (Rogers, 1970).

4. Change Is always innovative. There is no going back,

no repetition.

5. The complexity and heterogeneity of man as he ages

becomes more evident when he is viewed as an open system.

He is greater than the sum of his parts.

6. Unitary Man/person's perceptions depend on the

conceptual model he holds of the world. His representation

of reality is Influenced by his past experiences and how he

defines his situation.

7. Unitary Man/person's interaction with the social

environment has both direct and indirect effects on his

behavior and his health.

8. Social support has a mediating or buffering effect on

individuals that stimulates the development of coping

strategies or provides direct aid.

field

’1‘.

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12

9. Lack of support may lead to decreased ability to cope
and may result In ill health.

10. The need for social support persists throughout life.
11. As people age, they lose significant others through
death. Major losses may result In an inadequate support
situation for older adults.

Wallace

1. Persons participating in this study will respond
honestly according to their perceptions and understanding
of the questions being asked.

2. In the older age group studied, individuals may have
more actual experience with receipt of tangible support.
Therefore, response of those in the older age group may be
based on actual tangible support received rather than

hypothetical support available.

Scene and Limitations

The scope of this study extends only to the sample
that was studied as a part of the larger preliminary study
of active participation in health care for the elderly.
The following are limitations of this study:

1) No attempt was made in the original study to obtain
a random sample, thereby proscrlbing the generallzabllity
of the reseach findings beyond the study group.

2) This study uses secondary data obtained from the

pretest of Instruments for a larger study. Therefore, data

13

utilized was limited to data collected In the original
study.

3) individuals who agreed to participate In the
larger, preliminary study may be different from those who
refused. The research findings may not be representative of
all elderly persons.

4) The data were collected at one point in time.
Thus, they may not be representative of the usual
perceptions of aging persons. Measurements of perceptions
at various points in time may be more typical.

5) Long-lived persons represent a select group. The
well elderly, particularly above age 75, could be
considered elite survivors. Therefore, generalization of
findings will be limited.

6) Various cohorts will have different historical and
environmental exposures. A longitudinal study would be
necessary to establish how perceptions within a cohort
actually change over time. Rather than age changes, this
cross sectional study will attempt to measure age
differences.

7) Different individual perceptions of the meanings
of the answer choices (represented in a leert Scale) may
have affected Individual responses.

8) The sample sizes were small ( 36 women, ages

65 to .74 and 24 women, ages 75 to 89). The numbers may

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14

have been too small to represent true differences in

perception of social support.

W

This thesis Is presented In six chapters. in the first
chapter the problem was defined and background material,
purpose, research questions and definitions of concepts
were provided. The second chapter builds on the first
chapter with more detailed discussion of concepts. in this
chapter, concepts are placed within the context of Regers
theoretical basis of nursing and the relationships between
concepts and the nursing process are shown within a model
developed by Norbeck (1981).

The third chapter, co-authored with Sefton-Cojocel,
contains a review of the literature. in this chapter, both
classical research In the area of social support and more
recent studies with social support as a health conditioning
variable are presented. Literature and research on the aged
American female and individual differences will also be
presented. Limitations of currently available literature
are also discussed In this chapter.

in Chapter iv, the research design is presented. In
collaboration with Sefton-Cojocel this chapter contains a
discussion of the sample, data collection procedures,
Instrumentation, operational definitions, human subjects

and the statistical analysis utilized.

 

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15

Data and analysis are presented in Chapter V. First
the data specific to the study question are analyzed and
presented. Then, data resulting from the Sefton-Cojocei
study will be summarized, and the comparative results
presented to answer the collaborative question of whether
age differences In perception of emotional support and
tangible aid will be evident between the two study
populations.

The primary focus of Chapter VI Is the Implications
for nursing and the presentation of conclusions. Research

recommendations will also be presented In this chapter.

DI

CHAPTER II

CONCEPTUAL FRAMEWORK

in this Chapter, concepts of age differences and the
aging female will be related to social support as a factor
to promote health. The concepts will be discussed within
the context of the nursing theory proposed by Martha Rogers
(1970). Within this theoretical framework, broader concepts
of holistic man,- environment, pattern and organization of
human behaviors will be presented and then related to the
diversity and complexity of aging behaviors. A
presentation of the multidimensional concept of social
support will follow. The dimensions of the construct,
functional characteristics, lnteractlonal characteristics
and structure of the network properties will be explored.

Finally, a model developed by Norbeck (1981) will be
used to visualize the relationships and the elements of
man, environment and social support to nursing process and
outcome. Although nursing interventions are not a part of
the present study, the conceptual framework will be used as
the basis from which nursing interventions are derived for
professional practice, education and research to be

presented in Chapter VI.
16

17

We

Rogers uses a dialectic method of reasoning In which
nursing is explained by reference to broader principles
that explain man/human. Man, In turn, Is explained by
principles Rogers asserts characterize the universe.
According to Rogers, the science of nursing is directed
toward describing the life process of man, and toward
explaining and predicting the nature and direction of man's
development (1981). Historically, nursing has been used as
a verb meaning "to do”. When the term nursing is perceived
as a science, the word becomes a noun signifying "to know”.
Research in nursing, then, is the study of Unitary
Man/Person, while the practice of nursing Is the use of
this body of knowledge In service to people (Rogers,1980).
The usefulness of Rogers' conceptual system lies in Its
scope and range of applicability to complex nursing
problems. In the following sections, Rogers' basic
assumptions about the nature of man/human and how these
assumptions related to her Principles of Homeodynamics will
be discussed.

WW

Four basic assumptions about human beings are proposed
by Rogers: 1) man/human Is a unified whole and
his oneness can be visualized as observable phenomenon of
organization and patterns; 2) man/human and the enviroment

are continuously exchanging matter and energy with one

18

another and this interchange Is the basis of human growth
and behavior: 3) the life process of humans evolves
unldirectionally along a space time continuum, the result
Is the continuing evolution of the Individual and the
environment; 4) man/human Is characterized by the capacity
for abstraction and imagery, language, thought, sensation
and emotion.

Building on the stated assumptions Rogers proposes
three broad principles that postulate the nature and
direction of unitary human development: helicy: resonancy:
and Integrailty.

Ezlncipla__g1__hgilc¥; The nature and direction of
human and environmental change is continuously Innovative
and probabllstlc. This change is characterized by
Increasing diversity of human and environmental field
pattern and organization because of continuous mutual, and
simultaneous interaction between the human and
environmental fields. Because no two Interchange: between
man and the environment can ever be exactly the same the
evolution ls postulated to be unidirectional. Within this
principle, the life process ls expressed as a dynamic and
constantly evolving series of changes in which past
experiences are Incorporated and new patterns emerge.
Therefore, helicy postulates the direction of the change

occuring between human and environmental fields.

19

fininglnl§__gj_nesgnangy; The relationship between the
human field Is one of constant interaction and mutual
change. The principle of resonancy proposes the nature of
the change occuring between the human and environmental
fields. The change In pattern and organization of both
human and environmental fields occurs as a result of energy
exchange in which energy waves move from lower frequency,
longer waves to higher frequency, shorter waves. As a
result of this exchange, there Is continuous repatterning.
This principle provides the basis for explaining the
creativity of life.

EL1n;131g__g1__1nxag;ailix; The Interaction between
human and environmental fields is continuous, mutual, and
simultaneous. This continuous, mutual and simultaneous
interaction is a result of the lnseparabillty of human

beings and their environment.

WW
Mains—Ennnnmsm

Rogers' principles provides a scientific framework for
understanding the aging process. According to Rogers
helicy, resonancy and Integrallty only have validity within
the context of the conceptual system of Unitary Man. The
interaction that occurs between each Individual and his/her
environment leads to Individuality and increased Individual

variability over time. Other scientists, particularily

20

gerontologlsts support the Idea of age differences and
increased variability as persons age (Lawton, 1977;
Neugarten, 1974, 1981, 1982; Troll, 1977). Aging is a
developmental and therefore continuous process occuring
from birth to death. in the Rogers conceptual system,
aging is considered a developmental process in which humans
grow in diversity and complexity in all spheres,
biologically, socially, mentally, and spiritually. Rogers
does not support a "running down" theory of aging. Her
support of Increasing complexity and unldirectionally is
evidenced by her statements relating to changing sleep and
taste patterns. Aging persons require less sleep and the
patterned frequencies of sleep and wakefulness are more
diverse. Preference in taste is for sharp, distinct
flavors, which Imply an appreciation for a range of taste
phenomena versus the often held premise of deteriorating
taste buds (Rogers, 1980).

Utilizing the conceptual system proposed by Rogers, it
may be assumed that women become more diverse and complex
each day they live and that differences among age levels
will be evident in their perceptions of emotional support
received and tangible support available from the social
environment. This study will be based on three concepts
from Rogers conceptual system: I) wholeness of Unitary
Man/person as reflected In differences and uniqueness among

individuals: 2) helicy, as reflected In changing social

21

man/person and environment over time: and 3)
complementarity, continuous Interaction between and among
individuals and their social environment. These concepts
provide the background for the following theoretical
discussion of age and aging women's perceptions of social

support.

m

In examining elderly women's perceptions of social
support age will be an influencing variable. Norbeck
(1981) argues that age influences the amount and type of
support required for optimal functioning however, how it
does so is unclear. Conceptually old age has a variety of
meanings. if for example, one looks at the debate over
policy for the elderly from the mid-1930's through 1960's,
as well as the programs for the aging that emerged during
that time, the Impression is that old age Is a time of
economic dependency, physical and intellectual decline, and
personal Isolation. The transition to old age was set at
age sixty-five. Chronologic age of 65 may have been an
appropriate transition to old age in the nineteenth century
when life expectancy for men was In the early sixties,
however, It Is presently a poor indicator since old age may
span some 40 years.

Although age 65 remains the transition age guiding

public policy, this definition has not been accepted by

22

older people themselves. When using the term "elderly"
most individual older people regard themselves as
exceptions. Indeed, much of what we know today about the

aging process and the condition of America's older
population suggests that, for most persons between the ages
of 60 and 75, there are few age-determined characteristics
to justify differentiating them from persons between the
ages of 45 and 60.

A persistent theme in gerontological research Is that
chronological age is arbitrary and masks the incredible
amount of variation which cannot be explained by age alone
(Baltes and Goulet i970; Looft 1973; Robin 1971; Wohlwill
I970). Conceptualizlng age by chronology is not useful In
this study because It denies the heterogeneity of aging
persons.

Another method proposed by gerontologlsts, Is to
classify age by functional criteria. Functional assessment
is holistic In that It encompasses psychologlc and social
factors In addition to physical factors. Age Is determined
by levels of performance rather than chronological age.
According to this system of categorization, a 55 year old
person with rheumatoid arthritis may have a much lower
level of functioning than a 90 year old person. This
method has been criticized as a minority position because
it is representative of only the dysfuntional portion of

the aging population.

23

Troll (1982), has suggested age may be better for
research If classified into categories defined by cohort
characteristics. She states that chronological age serves
as a rough index of life stage and aging, while birth year
or entry Into a given system (e.g. age at first marriage,
high school .graduatlon) locates the Individual In
historical context as a member of a particular cohort.
While classifying age into cohorts acknowledges the
interaction of man and envirdnment over time, and the
influence of historical events on life-span development
this method has been criticized on the basis that birth
cohorts may vary greatly in age span according to date
constraints and analytical requirements (Elder, 1975).

Finally, Neugarten (1981) has proposed that age be
dicotomlzed by needs and norms of aging persons into
groupings of young-old (65 to 74 years of age) and old-old
(75 and above). This method provides a sociocultural
approach and places emphasis on the social meaning of age
norms and provides a useful means of defining age for this
study. The sociocultural perspective gives emphasis to the
social meaning of age and its contextural variations:
birth, puberty, and death are biological facts in the life
course, but their meanings in society are social facts, as
seen in the variable formation of age categories, grades,
and classes across societies (Elsenstadt 1956; Gulliver

1968). Neugarten suggests that differences exist between

24

the two categories of young-old and old-old In terms of
needs and norms. Differences may exist in the areas of
health, financial well-being, education, and political
activity. Shanas and Maddox (1976) have demonstrated that
the pattern of morbidity for the old-old Is different from
the young-old. Those In the old-old category manifest more
dental, visual, and hearing problems and higher rates of
chronic disease than those In the young-old categories
(Ferraro, 1980). This approach recognizes the enormous
diversity of life styles among aging persons but Is limited
in recognizing historical time and cultural dimensions of
aging.

Both perspectives, cohort-historical‘ and
sociocultural are complimentary and have been directed to
an understanding of age as an Important aspect of social
organization. Neugarten and Datan (1973), in clarifying
this complimentary, have distinguished three dimensions of
time: life time, social time, and historical time. :Llfe
time Is a series of orderly changes that occur in theilife
cycle, of which chronological age Is an index. Socialitime
is the age-graded system of statuses and norms which

underlie the major periods of life distinguished n a

 

particular setting. Historical time refers to the sodial,
political, and economic events which occur through time and
have Impact upon the lives of people within that system.

Both perspectives consider aging and the life course as

25

developmental processes and obtain insight into
sociological dimensions of aging but do not gain insight
into the cultural dimensions (Fry, 1980).

in summary, age has been classified using four
methods, chronological, functional, cohorts and by needs
and norms. All four methods present unique problems In
terms of conceptualizing and operationalizlng this
variable. The criterion of chronology is largely arbitrary
and may define the population either too narrowly or too
broadly for meaningful results. This criterion also fails
to recognize the heterogeneity of aging individuals. A
functional criterion measures performance and would appear
more meaningful when used with the disabled elderly, but
may be a less appropriate measure with the well-elderly.
Using cohort as a criterion is appropriate for all
elderly because It recognizes their heterogeneity while
emphasizing the influence of historical events.
Delineation by cohort while useful In longitudinal designs
because it permit generational differences to emerge may be
less useful in cross-sectional designs such as this study.
Neugarten's criterion however, provides a meaningful
division for this thesis because the groupings provide
clear delineation of subjects based on their needs and
norms while being consistent with the concept of Increasing

diversity and heterogenity of aging persons.

26

Age has also been identified as an important
variable in determining the amount and type of social
support needed for optimal health in aging women (Norbeck,

1981; Branch and Jette, 1983). In the following sections, a

theoretical framework for social support and the
relationship of social support to health will be discussed.
Wanna

Social support, a functional property of social
networks, is a major variable in this study. in the last
decade, the concept of social support gained recognition
for Its protective properties of physical and psychological
well-being (Cobb, 1976; Gottlleb, 198i: Haggerty, 1980:
Kaplan et. el.,l977). But much disagreement exists in the
literature about the definition, role, and measurement of
the concept of social support. For clarity, the
relationship between social networks and social support
will be conceptualized. A discussion of the role and
function of social support will then follow, as well as, a
discussion of the characteristics of individuals and
environmental situation which jointly determine need for
social support. Although role and function determine
Interventions, which are not the focus of this study, this
Information will be used to discuss nursing implications

and interventions in Chapter VI.

27
Relationship 91 Social Nailnnhi and 525131 SHREQLI

Several authors have attempted to define social
support ( Caplan, 1974; Cobb, 1976; Kahn & Antonuccl,
1980; Weiss, 1974). But operationallzations and
conceptuallzations of social support are frequently
inadequate and there is often a failure to recognize that
social support is a multidimensional construct (Thoits
i98l). A related problem is the lack of consistency in the
measurement that is used, making it difficult to compare
results across studies or to resolve conflicting findings
(Wallston, et. al.,1983).

As researchers attempted to find the link between
social support and health, a broader framework based on
social network analysis was proposed to develop valid and
reliable quantitative measures of support. Network
analysis was originally developed by social anthropologists
(Barnes, 1954; Bott, 1955; Mitchell, 1969) to
operationallze the notion of social structure. Barnes
(1954) and Bottil955) focused on structure of a network or
those lines between a person and network members that
connect. Mitchell (1969) argued that the structure and
lnteractlonal characteristics of personal social networks
influence the behavior of the individuals who are a part of
those networks. For example, It is possible that different
network structural characteristics (such as density, range,

or multiplexity) may influence the nature of social support

28

More recent social scientists have delineated social
networks among three dimensions, structural, lnteractlonal,
and functional (Hamburg A Klliiiea, 1979; Kaplan et.al.
1977; McKinley, 1980; Walker et.al.,1977). Mitchell defined
the lnteractlonal characteristics by content, or the
meanings Individuals In a network give to their
relationships. The disagreement appears to be centered on
whether the content of lnteractlonal transactions is the
role meanings individuals give their relationships or the
type of resource provided, such as, affect, affirmation or
material aid. in this study social support will be
conceptually distinguished as the functional dimension of
social network and relate to the type of social support
provided.

Walker, McBride, and Vachon (1977) built on Mitchell's
(1969) work to define five characteristics of the function
of social networks most revelent to the provision of
social support. Each of these areas of function, along with
the structural and lnteractlonal characteristics can be
seen In Table 1. Each will be discussed briefly to clarify
the multidimentionai nature of social support with emphasis
on the functional properties of the social network which is
the provision of emotional and tangible aid.
W5

Four structural characteristics of social networks
which are relevant to the provision of social support are:

size, density, homogeneity of membership and dispersion of

29

 

Table 1
WWW
u ' N wo o tles)

 

l. Slse: The number at people with whom the lndlvidual maintains
contact.

2. Strength of ties: A combination e! that are likely to be
Intercorrelated. e.g., amount o1 tlae. emotional intensity. mutual
contldlng.

3. Density: The extent to which the members of an lndivxdual network
know and contact one another independently of the individual.

4. homogeneity o! membershlp: the extent to which network members share
soclal attributes, l.e., age, sex, ethnicity, social class, social
values. and lltestyles.

5. Dispersion ot membership: The ease with which network members can

lake lace-to-tace contact.

 

W

1. Content: The meanings that people glve to their relationships.
teedbeck trom others that encourage salt-esteem, validating
behavlors, and telling others thelr strengths. This dlsmnslon
Incorporates aspects or social support suggested by Weiss (l514).
Cobb (1976). and Kahn (1978).

2. Dlrectedness: The amount at reciprocity o1 supportive behavior
between lndlvlduals. The implication of this dimension is that
supportive lnteractlons between lndlvlduals cannot long be sustained
in which interaction is one way. The exchange of supportlve
behavior between lndlvlduals ls described in Helsa's (l974) taxonomy
as I'reassurance or worth” and/or 'opportunlty tor nuturance.‘

3. Intensity: The degree to which individuals are prepared to honor
obligations or feel free to exercise the rights implied In their

llnk to some other person.

 

Wildc-

l. Atlect: Love, respect, the expression of positive attect for another.

2. Altlrmatlon: Acknowledgement of appropriateness of actions or
statements or endorcement of another person's behaviors.
perceptions. or expressed views.

3. Ald (lunctional support): The giving of symbolic or material aid to

another: money, tangible items or information.

 

30

membership (Walker et.al., i980). The network structure
includes different levels of membership, size and quality
of relationships. Ewing (1984) makes the following
distinction between three levels of relationships. The
primary level Ewing defines as the kinship network
which includes nuclear and extended family members.
Confldants or closely connected friends are also included
in this level as there is an ongoing relationship and
mutual exchange of support and concern.

The second level is described as the surrogate kin
network and include friends and neighbors, in which
individuals have frequent face to face contacts as a result
of mutual interests and values.

The third level is the aquaintance network which
includes relationships which are more superficial,
infrequent, or formal. These relationships have no strong
bond or sense of obligation to strengthen or nurture the
relationship. The encounters may occur in business, clubs,
health care agencies or other services. The number of
members in each level may greatly influence elderly persons
ability to obtain support, as might the quality of the
existing relationships. The structural characteristics of
an individual's social network then provide evidence of the
potential availability of social support (Dlmond a Jones,

1983).

31
Wmms

Mitchell (1969) suggests there are three
dimensions of interaction within social networks: 1)
content which refers to the meanings that individuals give
to their relationships. For example, the content may be
neighbor, kin, or friendship. Linkages containing only one
content area are termed uniplex, and linkages containing
more than one content area are termed multiplex; 2)
directedness which is defined as the amount of mutual
sharing or reciprocity between individuals; and 3)
intensity which refers to the strength of the bond between
two people and their willingness to forego other
considerations in order to carry out the obligations of

their relationship.

W
The third component of social networks is the
functional characteristics. Functional characteristics

are: affective support, tangible aid, cognitive support,
maintenance of social identity, and social out-reach.
Although functional characteristics are usually defined in
positive terms, their presence being associated with good
health, the potential for network interactions to have a
negative impact on well-being is an area in which little
attention has been given (Israel, 1982).

Type of support is the central feature of social
support that will be measured within and among the two

groups of elderly women in this study. Emotional support is

32

defined as affect and affirmation. Affect and affirmation
include expressions of liking, admiration, respect, love,
esteem and agreement or acknowledgement of the
appropriateness or rightness of some fact or statement of
another person. Tangible support, in contrast, includes
transactions ln‘whlch aid or assistance is given, such as,
loans or gifts of money and the provision of information
and time.

As a multi-dimensionai construct, all the
characteristics, structure, interaction and functional
aspects of social networks will have a great influence on
the lndlvldual's ability to "repattern' to changes in life.
For complete assessment, the Gerontological Clinical Nurse
Specialist will need to be aware of all three components
of social networks and the impact each has on the well-
being of aging individuals. More research is necessary,
however, to study the properties so that the definition of
essential features of social support may be refined or
situation-specific aspects of support be discovered for
useful clinical application.
E11as1s_n1_EmnIlnnal_and_Ianslbls_§uaaonI

The overt need of tangible support may be more
apparent then the need of emotional support for aging
persons. Financial help, the help with errands, and help
with household tasks, while usually welcome at any time,
would be particularly valued by an older person who may

have limited physical endurance, visual problems, or a

33

chronic disease. Objective tangible support, as well
as subjective support (such as the individual's perceptions
of available financial security and sense of control in the
environment), may help to reduce worry and stress. Tangible
aid may also make it physically easier to comply with
therapeutic regimens (DiMatteo & Hayes, 1981).

Emotional support is primarily an interpersonal
phenomenon. The human environment provides a means for the
individual to engage in "social comparison" (Festinger,
1954). By looking at the reactions of others, individuals
can Judge the appropriateness of their own reactions.
People usually look to others, particularly members of
their primary reference group, for validation of value and
worth, and for feedback about their behavior (Caplan,
i974; Mead, 1934).

in summary, social support involves two types of
transactions, emotional and tangible aid. Each may play a
significant role in the provision of social support. it
will be the task of research and practice to determine the
relative importance of these different types of support to
health and to the prevention of illness.
W

A comprehensive definition of social support has been
provided by Robert Caplan (1979) that delineates two
dimensions of social support: objective-subjective tangible

and objective-subjective emotional. Objective-tangible

34

support is described as "behavior directed toward providing
the individual with tangible resources that are
hypothesized to benefit his/ her mental or physical well-
being" (Caplan 1979; p.85). Objective emotional support is
defined as "behavior directed toward providing the person
with cognitions (values, attitudes, beliefs and
perceptions) and toward inducing effective states that are
hypothesized to promote well-being" (Caplan,i979; p.85).
Objective support, tangible and emotional, are measured by
an outside observer. Subjective tangible support and
subjective emotional support, in contrast, are based on the
individual's perceptions of the degree to which support is
offered and are measured by asking the individual about
their perceptions. (Caplan, 1979).

Emotional support received and tangible support
available are subjectively defined in this study. while
objective assessment provides a basis for standard
comparison across individuals and is less prone to self-
reportlng bias (DiMatteo & Hayes .1981) the subjective
approach can also be valuable (Donald, et el., 1978;
Kiritz a Moos, 1974; Lipowskl, 1969). in support of this
position, Donald et.al. (1978, p.5) notes that "individuals
have different needs and tastes; therefore, the nature and
number of interpersonal contacts with friends, relatives,
and others necessary to achieve social health vary greatly.

These differences may not be adequately reflected in

35

measures of objective social health constructs".
Similarly, Kiritz and Moos (1974; p.109) have suggested
that "the most efficient predictor of a person's
psychological behavior in a given environment may consist
of how he conceives that environment”. The subjective
approach also finds support in the argument that “what an
individual experiences is directly known to him, and we may
learn about it by obtaining his introspective reports”

0

(Llpowski, 1969; p.1198).
Wanner;

Numerous empirical studies have examined . the
association between social support and health status.
Although social support is generally defined in positive
terms it must be recognized that there is a potential for
network interactions to have a negative impact on health.
A relationship with a significant other could be
characterized as domineering, overprotectlve or create
independence and a negative response. The presence and
effects of such negative functions have receive little
attension in research. Social support is generally thought
however, to buffer or protects individuals from the effects
of day to day stressors and helps them to maintain health
(Dimond & Jones, 1983; House & Jackson, 1979; Thoits,
1982).

House (1981) suggests that social support can modify or

counteract the effect of stress in three ways: 1) main

36

effect; 2) buffering effect: and 3) main effect on stress
which indirectly improves health (see Figure 1). First,
social support can directly enhance health and well-being
by meeting important human needs for security, social
contact, approval, belonging, and affection (arrow c).
That is, social support appears to offset or counterbalance
the negative effects of stress.

SOCIAL SUPPORT

 

 

Work”. in“

 

FIG. 2.1 Potential effects of social W

Source: House (1981)

Second, social support may directly reduce levels of
stress (arrow a) and, therefore, indirectly improve health
(arrow d). The repatternlng necessary after retirement is
one example in which a supportive spouse, friends, or
relatives may help reduce personal pressure and tensions by
providing support that encourages self esteem.

A third type of effect has more recently been
described as interactive or buffering (arrow b).
According to this interpretation, social support does not
directly affect either stress or health, but rather

modifies the relation between them.

37

Despite the potential practical importance of the
idea of the buffering effect of social support,
considerable confusion exists about what constitutes
evidence of buffering versus main effects. According to
House (1981), "The need to distinguish main versus
buffering effects arises when considering how stress and
social support may combine to affect health." House (1981)
illustrates three possible ways in which the main and
buffering effects of support may jointly affect health
(Figure 2) Each graph depicted represents the linear
relationship between stress and health for three different
levels of social support: low (...), medium (---), and high

(

 

). Figure 2(a) illustrates a pure buffering effect.
in this example social support has no beneficial effect on
the health of individuals who are experiencing little
stress, But the beneficial effects become increasingly
apparent as stress increases. For example, in Figure 2(b)
illustrates the main effect social support has on health.
The slope of the relationship between stress and health is
unaffected by levels of support, indicating no buffering
effect is occuring. Finally, figure 2(c) illustrates both
main and buffering effects. Note that the three lines are
not parallel. This indicates a buffering effect is
occuring, but that even when stress is low, individuals
with high levels of social support are healthier,

indicating a main effect of support on health.

38

Although the distinctions of main and buffering
effects are clear as depicted in Figure 2, there is

considerable confusion about how to make these distinctions

in empirical research (House 1981).

ii ..... : ::: 3% Maxi:
33 .§:.;”’ // 3 ,,- #-

 

 

 

 

 

 

 

 

 

__ ¥:- up. ~—a>flfll
w ,l“ I." a. r h
IblflkflIOUY hdhmnnhwflfll “'5" adldkn

Fig.2 DIFFERENT PATTERNS OF EFFECTS OF SOCIAL SUPPORT ON
HEALTH

......Low support
- - - Medium support
______High support

Source: House (1981)

Much of the writing on social support has implicitly
or explicitly equated support effects with buffering.
House (1981) states this view is clearly too narrow. To
the extent that social support provides main effects, and
acts to reduce stress, everyone would benefit from enhanced
levels of social support. To the extent, however that
social support provides buffering effects, it will be of
significant value to individuals who are experiencing
moderate to high levels of stress, but of lesser value to
individuals experiencing little or no stress. Further,

existent materials indicate that network properties which

39

effectively meet one need may not effectively meet all
needs, i.e., one kind of support may not appropriate in all
stressful situations (Walker et el., 1977)

Three factors influence the kind of support that is
appropriate during periods of crises: the nature of the
stressful situation; the timing in the crisis period in
which the support is provided: and the resources of the
individual (Weiss, 1976).
flninnm_ni.1hn_§linmilnn

Discontinuity with the past is a common occurance
during stressful periods. A high degree of ambiguity is
usually present for the individual and there is need of
feedback from supportive persons that one's behavior is
appropriate. Weiss (1976) distinguishes three forms of
situational distress and suggests that each is likely to
require different types of social support.

1) .insls: A severe, upsetting situation of limited
duration in which individual resources are quickly summoned
to cope with emotional, social or physical instability. For
older persons, this might be death of spouse or close
friend. it is ilikely that emotional support (empathy,
understanding) would be the most useful type of support
during a crisis.

2) Inanslilons: A period of relational and personal

change. Parkes (1971; p.103) defines transitions as "major

40

changes in life space which are lasting in their effects,
which take place over a relatively short period of time and
which affect large areas of the assumptlve world." The key
features of transitions are that they have lasting effects
and involve major changes. For older persons, a move from
their home to a retirement village or Senior Apartment
Complex, bereavement or retirement from a life-long
occupation can lead to a major transition. 'lt is likely
during transitions that information and tangible assistance
would be appropriate types of social support.

3) Deficit Situations: A state in which relational
provision important to well-being is unobtainable (Dimond &
Jones, 1983). An example may be a widow who becomes
involved with family and church activities but remains
profoundly lonely. Emotional support from a confidant would
likely be appropriate in deficit situations.

While there are there are other types of stressful
situations, Weiss (1976) suggests deficit situations
represent loss. Crisis occurs on first awareness of loss;
and transition follows if the loss is unavoidable; and
transition may lead to new ways of living that create
deficit situations (Weiss, 1976).
liming

The needs of people are likely to change over time,
particularly the needs of older persons and those

experiencing distress. Timing then, is the second factor to

41

be considered in determining the type of social support
most important in a situation. Support that provides
relief and comfort initially in a situation may not be
appropriate at later stages in the adjustment process.
W

A third factor in determining the appropriateness of
social support involves the lndlvldual's resources. Social
support should "fit" the situation. Thus, a spouse or
confidant can provide opportunities for intimacy and
sharing; family and friends can provide assistance and a
sense of security; professionals can provide information
via education and councellng. Careful analysis of existing
resources for social support will help to determine the
appropriate kinds of interventions that may be necessary.

in summary, social support functions to buffer and
protect persons in different situations. The extent to
which this function occurs is likely to be based upon the
type of social support provided. it has been suggested that
the kind of support appropriate to a particular situation
is based on the type of stressful situation, the timing of
support, and the resources available of the affected
individual. in the next section, a model developed by
Norbeck (1981) will be presented to show the elements and
relationships of persons, environment and social support

within nursing practice.

42

lbs accuser Medal

The link between social support and various outcomes
has been established (Cassel, 1976; Cobb, 1976; Heller,
1979), but need for consensus on the conceptual
definitions, its measurement and replication is needed to
gain knowledge with the precision required to guide
clinical practice. According to Norbeck (1981; p.46-47),
"the bulk of the social support research has explored
relations between social support and health". She further
notes, "although these relations imply that interventions
for persons with inadequate social support might reduce
their risk for certain negative outcomes, serious gaps in
knowledge exist that must be studied to provide a
scientific basis for intervention“. Norbeck proposed a
model, therefore, to show the elements and relationships
that must be studied to incorporate social support into
nursing practice. While the model was designed to guide
research, it serves as a useful framework for incorporating
the nursing concepts of person, environment, and nursing
process as it relates to outcome determination. The Norbeck
Model is presented in Figure 3.

Within the model, two major concepts, properties of
individuals and properties of environmental situation are
shown to jointly determine the need for social support

(arrows la, lb, and 2b). The nursing theory of Unitary Man

43

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44

proposed by Rogers postulates this mutual interaction of
person and environment which in turn will determine the
patterns of need for social support. The characteristics
of both man/person and environmental situation will be
discussed in more detail within the context of Rogers'
conceptual system.
We

Age, sex, marital status, religion, and culture all
influence the amount of social support needed by
individuals as well as the degree to which support is
available to them. These characteristics determine the
uniqueness of each human, and together with other
differences in needs, abilities, and orientation reflect
individuality and wholeness. Age influences the amount and
type of social support required for optimal functioning and
these requirements change throughout the lifespan. During
infancy, almost constant support is needed from one or two
persons. in late adulthood, the frequency of supportive
interactions decrease, as roles are relinquished, and
support needs shift to accomadate a variety of losses
(Norbeck, 1981).

Sex and marital status also influence the amount and
type of social support needed. Several studies indicate
females receive more social support than males (Burke &
Weir, 1978; Hirsch, 1979). Elderly women are more likely

to report having a confidant that elderly men, even through

45

there is a greater incidence of widowhood among women
(Lowethal & Haven, 1968).

Individual differences may also influence need for
social support. A person's need for affiliation is an
important human need. Lowenthal and Haven (1968) suggest
there may be various level of need for affiliation. Some
individuals may require high levels of affiliation while
others need moderate to low levels. Differences in
personality, copying styles and income, as well as the
ability of the person to attract and maintain a social
support network, may also influence how much social support

may be needed and available to individuals.

Enxlnnnmannlmmlsncs
Norbeck (1981) proposes that a particular
environmental situation will influence the amount and
availability of social support. Based on theoretical
formulations, it has been predicted that the amount of time
support is required will be based upon whether the need is
short-term, intermediate, or long-term/continuous. For an
example, during a major life change or transition, such as
retirement, an individual might need intense support of
shorter duration. in contrast, during chronic illness
support of medium intensity may be required over a long or
continuous period of time.
The second situational determinant is the type of

support a situation demands which may influence the

46

availability of support an individual will receive. in
other words different situations may demand or require
different types of support, and different situation may
constrain or enhance the possibility of receiving support.
An example of this is the spontaneous support that comes
from friends and relatives during a maturationai crisis
such becoming a new grandparent. in contrast, support for
working through grief is difficult for most members of an
individual support network.

Two specific variables have been presented, personal
characteristics and environmental characteristics as major
determinants of need for social support. Together, person
and environment have been conceptualized within a framework
of continuous and mutual interaction.

Nursing assessment is necessary to determine both the
need for social support and the actual support available.
Comparison of this information allows the nurse to
determine if the level of support is adequate. if the
support is inadequate, the assessment provides a basis for
planning. Because of individual variences, Norbeck
(1981) describes outcomes in terms of greater likelihood or
decreased likelihood of positive or negative outcomes
(arrows 3a and 3b). The actual outcome is determined
through evaluation (arrows 5a and 5b). Persons with
inadequate support or without effective intervention may

have a greater likelihood of a negative outcome (arrow 3b).

47

To summarize, a pervasive fact of life for aging women
is the progressive loss of relationships with spouse and
friends through death or with colleages through retirement.
Additionally, the nature of their relationships change as
they age so the functions and the relationships held
orlglonally probably also change. Take the parent-child
relationship for example, in the early life stage the child
is dependent upon his mother, then a stage is reached where
the relationship is more or less mutual, followed by the
possibility of a stage in late adulthood when the parent
needs more assistance from the child.

To add to the complexity, the aging process may lead
to change within the individual which may alter his/her
relationship needs. The type of relationships that met
earlier needs may no longer meet altered needs in old age.
Cumming and Henry (1961), for example, postulated in the
Disengagement theory that in old age there is a desire for
less demanding relationships. indeed, the major element of
disengagement is parting from the diffuse affective and
obligatory relationships of middle-age. Dean (1962) and
Rosen and Neugarten (1960) provide support for this view
with data that indicate a decline is in affect with ago.

Since the pattern and organization of behaviors are
maintained amidst this constant change between individuals
and the social environment, characteristics of the

individual will reflect differences and uniqueness while

48

continuous interaction between and among individuals
(integrallty) will also reflect changes in social support
patterns over time (helicy). Norbeck's Model draws together
all the concepts within the process and practice of
nursing. in using this model, the nurse in advanced
practice can formulate goals and use interventions that
assist individuals in repatterning. Research on aging women
and perceptions of types of social support can add
important pieces of information needed for more accurate

assessment of clients needs.

W
The integration of the Norbeck Model into Rogers'

conceptual system of Unitary Man focuses this study on
man/human and environmental exchange in the process of
determining perceptions of social support. As aging women
experience multiple losses, social support may be a major
factor in facilitating the achievement and maintenance of
health and sense of well-being.

The Rogerlan conceptual system of Unitary Man provides
and excellent basis for the Gerontological Clinical Nurse
Specialist because it emphasizes increasing complexity in
developmental growth and the essential nature of the
interaction between humans and the environment. The
influence of the environment on elderly persons is

critical in maintaining independence and health.

49

Norbeck's Model places emphasis on the nursing process
and on achieving outcomes and provides a framework for
guiding research for incorporating social support into
clinical practice. Research such as this study may
increase the accuracy of the nursing process through
identification of patterns, such as age differences in
perception of social support, which will add to the
predictive value of the process.

in the next chapter, a review of literature pertient
to the research question is presented. in addition,
literature is reviewed to support the use of the particular

instrument and method used in the present study.

CHAPTER ill

LITERATURE REVIEW

introduction

The literature reviewed in this chapter focuses on the
major variables in this research and provides support for
the instrument and method used to study these variables.
The major variables are: aging females and differences in
perception of two types of support: emotional and tangible
aid. The review will proceed from literature on age and
aging differences that support heterogenity among aging
persons to literature related to social support. This
chapter was written in collaboration with Sefton-Cojocel
(1984).

Women

The relationship between age and differences among
persons as they age is important in understanding the later
years of life and for development of methodologies
appropriate for investigating the life-span. Life-span
theorists and researchers suggest repeatedly that there is
increasing differentiation and variability as one ages
(Neugarten,1973; Sarbln,l954).

Specifically, authors from a life-span perspective

claim that individual differences in life style and
50

51

intellectual functioning observed in the middle years are
accentuated in late life (Bromley, 1966; Havighurst, 1957;
Riegel, 1971; Riegel,Riegel and Meyer, 1967). According to
Neugarten (1964,p.345) "within the social and cultural
realms, we expect differences between individuals to be
accentuated with time, as education, vocational, and social
events accumulate one after another to create more and more
differentiated sets of experiences from one person to the
next".

Authors of life-span studies have focused on
comparative analysis of cohorts. The findings of these
studies support the hypothesis of diferentiation. As Hill
(1970, p.322) has stated, "Each generational cohort
encounters a unique set of historical constraints and
incentives which influence the timing of its crucial life
decisions, making for marked generational dissimilaritles
in life-cycle patterns".

in Hills' three generation study of couples in the
Minneapolis-St. Paul area, the middle generation offers
striking documentation of this thesis. Couples in the
parent generation (N295) actually represented two cohorts
defined by marriage in the 1920's and 1930's. The pre-
depression era couples produced a larger number of children
x- 4.1, and 3.1, respectively, and pursued more varied
careers. The two cohorts were found to be sufficiently

different in life courses. The heterogeneity of the older

52

cohort is a dominant feature of this analysis, from family
and worklife events to use of material resources.
important insights were gained from this comparative data
in terms of identifying the impact of differential
historical and cultural events on patterns of behaviors and
life outcomes. .

There are problems, however, of interpretation with
respect to Hill's cross-sectional research on generations.
As Hill (1970) acknowledges, the "extent historical
circumstances have affected these three generations will be
difficult to disentange from other influences which come
with maturation and aging." Value differences between
parents and adult children could be attributed to their
different life stage or historical experience and
socialization. The limitation of this study is that value
differences and age changes in cross-sectional data are
thus a problem with respect to interpretation.

Uhlenberg (i974, 1969) conducted comparative studies
of women of cohorts. His classic research of the life
patterns of American woman, white and non-white, was
conducted with women from five birth cohorts; 1890-1894 to
1930-1934. Normative data obtained from these women
described their expectations of 1) becoming a wife; 2)
bearing children; and 3) achieving a stable or intact
marriage. Uhlenberg's study made two significant

contributions to the study of woman and the life course of

53

cohorts. First he provided mortality data. Since early
death has declined during this century, a complete picture
of cohort change including mortality was taken into account
in the life patterns of the woman in his study. Second, he
provided a description of the relative prevalence of life
paths followed by woman across sucesslve cohorts.

Uhlenberg's research provided a new perspective on
life-span and age differentiation by depicting the life
course as a series of roles, events, social transitions, and
turning points. Using U.S. Census Bureau Statistics, he
provided a statistical profile of older women in 1970, with
projections for 1980, i990, and the year 2000 (See Table 2).

in analysis Uhlenberg has placed emphasis upon
demographic features of the population of older women in
terms of size, marital status, education, health status and
income and employment. He predicted that the older female
population will continue to grow in numbers and by the year
2000 there will be over 19 million older women. The
special needs and resources of this population are, and
will increasingly become, a factor to be considered in
social policy.

One striking feature described by Uhlenberg is marital

status. Almost 10 million (671) of the total population of

older women are not living with a husband. Over four
million of these women are over 75 years of age. Since
women of this cohort have devoted much of their lives to

being a wife and raising children Uhlenberg raises the

54

Table 1. Profile of Older Women in the USA: 1970, 1980, 1990, 2000.

 

 

 

Year
Characteristic 1970 1980 1990 2000
Number (in thousands)
65+ 11,665 14,819 17,824 19,103
65-74 7,005 8,871 10,052 9,762
75+ 4,660 6,038 7,772 9,341
Marital Status (percentages)
65+ Married, spouse present 33.9 37.0‘ 35.1‘ NA
Widowed, Divorced, 58.4 56.6 58.6
Separated, Single 7.7 6.4 6.3
65-74 Married, spouse present 43.5 47.3‘ 46.1
Widowed, Divorced, 48.7 46.6 47.1
Separated, Single 7.8 6.3 6.8
75+ Married, spouse present 19.1 20.39 20.2 NA
Widowed, Divorced, 73.4 73.1 74.2
Separated, Single 7.5 6.6 5.7
Educational Attainment
65+ Median school yrs. completed 8.8 9.9 12.0 12.3
z high school graduates 30.1 38.9 49.9 56.9
Nativity Status (2 dist.)
65+ Foreign born 14.3 10.3 7.4 7.5
Native born 85.7 89.7- 92.6 92.5
Income (1 dist.)
65+ Below poverty line 28.5 18.1b NA NA
Employment (2 dist.) ,
65+ In labor force 9.7 8.1 7.6 NA
Mobility Limitations (2 dist.)
65+ No limitation 81.4c NA NA NA
Some limitations, not confined 13.3
confined to house 5.3

 

‘Data refer to 1977.

hAssuming no change between 1975 and 1980

cDate refer to 1972

Sources: Derived from U.S. Census of Population, 1970, Characteristics of

the Population; Current Population Reports:
Series P-23, No. 57 and No. 59 (Rev.); Series P-ZS, No. 704;

Series P-60, No. 106, from Uhlenberg (1979), pg. 237.

Series P-20 No. 323;

55

quesTlon: How well equlped wlll women of Thls cohorT be aT
funchonlng lndependenle and enTerlng new soclal roles.
EducaTlonally, almosT Three-fourThs of The older women
had compleTed elghT or more years of formal schoollng. In
1975, for example, The medlan number of school years
compleTed by Those 65 years of age was 10.7, compared To
8.9 for Those over 65. Uhlenberg predlcTs ThaT by The year
2000 almosT 901 of all older women wlll have compleTed 8
years of schoollng, and 571 wlll be hlgh school graduaTes.
Two compeTlng forces affechng The fuTure healTh
sTaTus of The elderly may be seen In Table 1. On The one
hand, The proporTlon of The older populaTlon ln The old-
old age group ls lncreaslng, and healTh problems In Thls
segmenT of The aged are greaTer. As seen, The proporTlon

of all These over age 75 ls lncreaslng from 40$ In 1970 To

491 In The year 2000. In absoluTe numbers The lncrease ls
from 4.7 To 9.3 mllllon women. The hlgh lncldence of
chronlc lllness and chronlc dlsablllTy among The old wlll

challenge The provlslon of adequaTe healTh care.

Flnally, Uhlenbery predlcTs a decrease In The numbers
of women who are below The poverTy llne as a resulT of
Improved coverage by reTlremenT sysTems and Increased
soclal securlTy beneflTs. Women in The work force are
lncreaslng buT lT ls unllkely ThaT employmenT In The labor
force wlll be a major achvlTy for older women In comlng

years (Barfleld & Morgan, 1978; Shepard & Rlx, 1977).

56

In summary, Two observaTlons can be made from
Uhlenberg's sTaTlsTlcaI proflle. FlrsT, There ls a large
group of older women who are lmpoverlshed, who may be
unable To malnTaln Independence because of healTh prbblems,
physlcal llmlTaTlons and loss of a spouse. BuT lT ls
lmporTanT To recognize ThaT Thls group of women consTlTuTe
a small mlnorlTy of all older women In The Uaned STaTes.
The second observaTlon ls The maJorlTy of The older women
are lncreaslngly educaTed, noT lnvallds and have hlgher
levels of Income. The lmporTance of Uhlenberg's
sTaTlsTlcal proflle of Amerlcan women To Thls sTudy ls ThaT
IT was ToTally focused on women and prevldes a normaTlve
deTa base as well as demographlc evldence of
varlablllTy and dlfferenTlaTlon ln aglng females.

Maddox and Douglas (1974), have proposed several
meThodologlcal lssues ThaT need To be consldered ln
research deslgn lf approprlaTe concluslons are To be drawn
on age dlfferences. These meThodologlcal lssues wlll be
dlscussed here and used as The framework for dlscusslng
oTher sTudles relaTed To dlfferences ln aglng.

l. Cross-sechonal deTa seTs. MosT sTudles relaTed To
aglng and lndlvlduals have been obTalned from cross-
sechonal daTa whlch do noT make a clear dlsTlnchon
beTween age dlfferences and age changes. OpTlmal,
deflanlve TesTs of The hypoThesls of varlablllTy In older

lndlvlduals requlre sequenTlal observaTlons of lndlvldual

57

dlfferences ln parTlcular cohorTs.

2. Selechve survlval. Selechve morTallTy confounds TesT
of varlablllTy over Tlme. The effecTs of deaTh and subjecT
loss on The composlTlon of a panel musT be consldered and
accounTed for when sTudylng relaTlonshlps beTween age
changes and lndlvldual dlfferences.

3. Sampllng blas. Less able lndlvlduals In a populaTlon
may refuse re-TesTlng as well as lnTlTlal TesTlng. Thls
dlsadvanTage ls ofTen True of an aglng populaTlon. Such
blas can produce arTlfacTual dlfferences ln observed
varlablllTy (Rlegel eT al.,1967).

4. Termlnal drop or rapld change. A phenomena of rapld
change has been noTed ln soclal, psychologlcal, and
physlologlcal funchonlng JusT prlor To deaTh and Thls may
be lnTerpreTed as lndlvldual dlfferences.- ln sTudylng
elderly lndlvlduals across a wlde age range, The sample ls
llkely To lnclude boTh ellTe survlvors and an undeTermlned
number of persons experlenclng Thls rapld change before
deaTh. BoTh could affecT varlablllTy, alThough Maddox and
Douglas sTaTe Thls ls sTlll a maTTer of conjecTure.

5. Sex dlfferences. There ls much debaTe abouT wheTher
dlfferenTlaTlon by sex Increases wlTh age (Cameron, 1968:
NeugarTen, 1965; Palmore, 1968). The sTudy of sex
dlfferences requlre deslgns ThaT anTlclpaTe The dlsslmllar
paTTerns of males and females. AnoTher conslderaTlon ln

age dlfferences, dlscussed by Maddox and Douglas, ls ThaT

58

dIsTIncTIon should be made beTween The young-old, and The
old-old, as varlablITy and dlsslmllar paTTerns may be
expecTed.

ln llghT of These meThodoIoglcal problems, Maddox and
Douglas deslgned a sTudy In whlch They TesTed Two
hypoThesIs: l) lndlvldual dlfferences do noT Increase wlTh
age, I.e., varlablllTy on a varleTy of IndlcaTors ls aT
leasT malnTalned, If noT Increased, In laTe llfe. and 2)
lndlvlduals Tend To malnTaln The same rank on a varleTy of
IndlcaTors, In relaTIon To age peers, ThroughouT The laTer
years of llfe.

Maddox and Douglas employed daTa from a conTlnuIng
longITudlnal InvesTIgaTIon of human funcTIonlng aT Duke
UnlversITy To examlne age dlfferences In soclal,
psychologlcal, and physlologlcal varlables. From The
orIgInal sTudy, specIfIc IndlcaTors of lndlvldual
varlablllTy were chosen for examlnaTIon. The sample
(N-106) was composed of survlvors from The orIgInal sTudy
(N-Z71). Ages ranged from 60 years To 94 years wlTh a
mean age of 70 years. Slx dlfferenT seTs of daTa from 13
years of observaTIon were used To measure and compare The
varlablllTy observed among non-survlvors, as well as
survlvors from The orIgInal sample. The flrsT hypoThesIs
was TesTed usIng PITman's (1939) TesT for correlaTed
varlances and The second hypoThesls was TesTed by The

Spearman rank order correlaTIon. NIneTeen soclal,

59

psychologlcal and physlologlcal varlables were consldered
In The sTudy. The researchers concluded ThaT when
morTallTy and oTher losses are conTrolled, The observed
varlablllTy of all measures Tend To be sTabIe over Tlme.
In some lnsTances There were slgnlflcanT Increases In
varlablllTy or sTablllTy, conflrmIng The flrsT hypoThesls.
Second, The range of observed lndlvldual dlfferences were
malnTalned and, wlThln The range of observed lndlvldual
dlfferences There remalned a relaTIvely consTanT range
conflrmIng The second hypoThesls.

The sTrengTh of The Maddox and Douglass sTudy Is In
The deslgn of The research. FIrsT, The deslgn was
lonngudInal allowlng for a clearer dlsTlncTIon To be made
beTween age dlfferences and age changes. Second, The sTudy
dealT wlTh selecTIve survlval, and by means of sTaTlsTlcal
analysls The auThors were able To show ThaT The reporTed
decrease In varlance wlTh age Is an arTlfacT of sampllng.
Thlrd, an aTTempT was made To dIsTIngulsh beTween
varlablllTy ln lndlvldual dlfferences, and lnTra-IndIvldual
varlablllTy. FourTh, analysls was compleTed on lndlvldual
dlfferences separaTely for males and females, young-old,
and old-old lndlvlduals. ln Thls sample There was no
varlablllTy on The 19 varlables by elTher sex or age.

The llTeraTure revIewed perTlnenT To psychologlcal
funcTIonlng In laTe llfe also suggesTs ThaT dlfferences

Increase as people age. (BoTwlnlck & Thompson, 1968;

60

ComforT, 1968; OrbrIsT, I953). Dlsperslon of scores on a
varleTy of physlologlcal IndlcaTors, such as reacTIon Tlme,
and audITory reacTIon Tlmes, Increases over Tlme for a
cohorT of older persons, whlch The auThors aTTrIbuTed To
some persons malnTalnIng Thelr earller performance level
thIe oThers gave up acTIvITles because of decremenTal
aglng effecTs.

In The sTudy conducTed by BoTwlnlck 8 Thompson (1968)
lndlvldual dlfferences In reacTIon Tlme In relaTIon To age
was conducTed uslng daTa from a prevlous sTudy. EIghTy-
elghT subJecTs, 44 men and women aged 18-35 years, and an
equal number of men and women aged 60-87 years were
TesTed for audITory reacTIon Tlme. PreparaTory InTervals
varled from one To Two seconds gIven In a Trlal of regular
and Irregular serles. The preparaTory InTerval was deflned
as The lnTerval of Tlme beTween an alerTIng, a warnlng
sIgnal and a sTlmulus response. NITh regular serIes and
wlThIn Irregular serles, reacTIon Tlme varlances assocIaTed
wlTh each of The four preparaTory lnTerval conlelons were
compuTed for The four age and sex subgroups. The F-raTIos
assoclaTed wlTh age (larger varlances dlvlded by smaller
varlances) were compuTed and examlned for sTaTlsTlcal
slgnlflcance, uslng The one-Talled probabIlTy levels glven
In The F-dlsTrlbuTlon Tables.

In all lnsTances The varlance of The older groups were

larger Than The correspondlng ones of The younger groups.

61

In all buT one InsTance The F-raTlos were sTaTIsTIcally
slgnlflcanT aT or below The p<.05 level. These resulTs
demonsTraTed ThaT reacTIon TImes dlffers by age.

One parTIcular problem wlTh The BoTwInIck & Thompson.
sTudy ls ThaT concluslons of Increased personal as well as
group varlablllTy In audITory reacTIon Tlme were based on
cross-secTIonal daTa. As Maddox and Douglas (1974) have
poInTed ouT cross-sechonal daTa may noT make a clear
dIsTInchon beTween age dlfferences and age changes.
AddITIonally, The precIse effecT of such lnTra-Indlvldual
varlablllTy on The assessmenT of lndlvldual dlfferences
wlThIn a group Is unknown slnce relevanT daTa are lacking.

Goebel (I979), conducTed a sTudy In whlch she
InvesTIgaTed The age preferences of older adulTs (ages 61
To 89 years) wlTh lndlvlduals for whom a relaTIonshIp may
poTenTIally affecT llfe saTIsfacTIon. The sample Included
42 wthe older adulTs: 10 males ages 63 To 80 years,
(x-71.9); and 32 females ages 61 To 89 years, (x-71.2). To
IImIT confoundlng of soclal deslrablllTy usually found In
verbal scales, The researcher used phoTographs represenTIng
Three adulT age groups To obTaIn an expresslon of age
preferences. Older persons were asked To sorT phoTographs
lnTo caTegorles by age and aTTracTIveness. PhoTographs of
young, mlddle-aged, and old adulTs (ages from early 20's To
early 70's) conTrolled for sex and aTTracTIveness were Then

raTed by older persons In relaTlonshlps based on facTors

62

lmporTanT To qualITy of llfe, l.e. maTerIal well-belng,
physlcal well-belng, helpIng, achve soclallzlng.

The resulTs IndlcaTed ThaT older adulTs prefered
mlddle-aged and older lndlvlduals In relaTlonshlps ThaT
were lmporTanT To Thelr own llfe saTIsfacTIon. leferences
In older persons cholce of phoTographs of oTher old
persons as compared wlTh Thelr preference for mlddIe-aged
persons reached slgnlflcance relaTIvely few TImes. The
dlrechon varled wlTh sex and aTTracTIveness, and across
facTors, leadlng The auThor To conclude ThaT There Is
elTher a relaTIve lack of blas In evaluaTIng These Two age
groups, (The ImpacT of specIfIc relaTlonshlps on
preferences), or There Is an Influence of lndlvldual
dlfferences In blas. An examlnaTlon of The relaTlonshlps
for whlch The older adulTs In The sTudy expressed
slgnlflcanT age preferences and Those for whlch They dld
noT, suggesTs ThaT The facTors lmporTanT To llfe
saTIsfacTIon used In Thls sTudy represenTed Two Types of
relaTlonshlps based on degrees of equalITy and or
reclproclTy.

Goebel descrlbed Two Types of relaTlonshlps based on
equalITy and reclproclTy, Those relaTlonshlps ThaT are
IndependenT and Those ThaT are InTerdependenT.
IndependenT, Goebel deflned as Those relaTlonshlps ThaT
provIde maTerIal well-belng, physlcal well-belng,

InformaTIon, and InTellecTural developmenT buT whlch Tends

63

To keep The lndlvldual dependenT on The oTher person.
InTerdependenT relaTlonshlps, on The oTher hand, provIdes
relaTIons wlTh relaTIves, frlends, someone To do Thlngs
for, are closer and are more reclprocal In naTure.

The older adulTs In Goebel's sTudy expressed less
preference for mlddle-aged and old lndlvlduals In
IndependenT relaTlonshlps. The facT ThaT Thls sTudy
obTalned less subsTanTlal evldence of age preferences for
InTerdependenT relaTlonshlps may noT be so much be a lack
of age blas as The sTronger ImpacT of lndlvldual
dlfferences In blas. Goebel's sTudy has revelence To The
presenT sTudy as she furTher dellneaTes Types of
relaTlonshlps ThaT requlre dlfferenT Types of supporT.

In evaluaTIng age as a varlable, Seelbach and Hansen
(1977), reporTed slgnlflcanT dlfferences (p-<.005) beTween
The young-old, and The old-old, on saTIsfacTIon wITh
varlous aspecTs of famIIy relaTIons. They examlned The
responses of 160 InsTITuTIonaIlzed, and 207 communITy
dwelllng elderly To 6 survey sTaTemenTs regardlng flIIal
responsIbIlITy expecTaTlons. Age was deflned In Thls sTudy
as young-old, less Than or equal To 80 years of age: old-
old, greaTer Than or equal To 81 years of age. 0Ther
varlables ThaT were cross TabulaTed wlTh saTIsfacTIon
were marITal sTaTus, healTh, lIvIng arrangemenTs and sex.
Thls sTudy deslgn can be crITchzed on several polnTs: I)

There was a severe resTrlcTIon of range, 2) r values were

64

noT reporTed and 3) valIdITy of The InsTrumenT was noT
esTabllshed. DespITe These llmITaTIons, consIsTenT
fIndIngs, lend supporT To The vlew of varlablllTy
among aglng persons. The sTudy also demonsTraTed age
dlferences In varlables closely relaTed To soclal supporT
such as famlly relaTIons and marlTaI sTaTus.

In summary, There are few research sTudles on age
dlfferences and The few sTudles ThaT exIsT are cross-
secTIonal In deslgn. Age dlfferences versus normal changes
ThaT occur In The aglng process are dlfflculT To conTroI
and sequenTIal observaTlons of lndlvldual dlfferences In
parTIcular cohorTs are necessary for defInITIve TesTs of
varlablllTy. From The llTeraTure revIewed, however, There
appears To be conslderable evldence To suggesT age
dlfferences. Such evldence Includes: The ImpacT of
hlsTorIcal evenTs on lndlvlduals, llfe-span paTTerns
changlng over Tlme; demographlc shIfTs, populaTlons Trends,
and The soclal-psychologlcal ImpacT of aglng. The need for
conTInued research In The area of age dIfferenTIaTIon and
varlablllTy Is wIdely acknowledged. AlThough age
sTraTlflcaTIon was noT parT of Thls research deslgn, one
cannoT overlook The llTeraTure on age sTraTlflcaTIon Theory
(ATchley, 1980; Decker, I980; Cockerham eT al., 1983),
These auThors sTaTe ThaT age-speclflc behavlor musT be more
fully undersTood and ThaT relaTlonshlps among members of

The same age group and beTween age groups musT be sTudIed

65

for furTher dellneaTIon of age dlfferences.

leferences In percepTIon of Two Types of soclal
supporT wIThIn and beTween Two groups of elderly women
are addITIonal varlables In Thls sTudy. The llTeraTure
revIewed on The varlable of soclal supporT wlll be The

focus of revelw In The followlng secTIon.

Sociai.§nnnnc1.iiistaiuta

The revlew of The llTeraTure relevanT To soclal
supporT wIlI begln wlTh a dlscusslon of The problems In
concepTualIzIng and operaTIonallzIng Thls mulTldImensIonal
consTrucT. Then, Two classIc sTudles conducTed by Cassel
(1974) and Caplan (1974) wlll be revIewed, as These
relevanT sTudles provIded dIrecTIon for currenT research.
LasT, The llTeraTure perTaInIng To emoTIonal supporT and
TangIbIe aId wlll be revIewed.
Wmmnmunmnaummn

A number of auThors have examlned The role of supporT
In bufferlng or medlaTIng The physlcal or psychologlcal
ImpacTs of llfe evenTs (Cobb & Kasl, 1977); Dean eT el.,
1980; Gore, 1978; Nuckolls eT al., 1972; Walker eT el.,
1977). The resulTs of These sTudles are generally
consIsTenT, however, soclal supporT llTeraTure has been
hampered by a lack of clarITy boTh In deflnTIons of soclal
supporT and In The concepTuallzaTIon of ITs effecTs on
healTh ouTcomes. Much of The presenT ImpeTus for currenT

research Is based on TheoreTIcal sTaTemenTs InTerpreTIng

66

The healTh consequences of soclal dIsconnechon (e.g.,
losIng supporT because of deaTh or separaTIon, belng
unmarrled, or due To geographlcal dIsTance) In llghT of The
hypoThesIs ThaT soclal supporT affecTs healTh ouTcomes
(Cassel, 1976; Cobb, 1976; Dean and Lln, 1977; Kaplan eT
al., 1977; Syme, 1981). Only a few researchers have looked
aT The. effecT of low soclal supporT In negaTlve healTh
ouTcomes such as, neurosIs, (Henderson eT al, 1978),
compllcaTIons of pregnancy (Nuckolls eT el., 1972) and
morTallTy (Berkman and Syme, 1979).

One of The problems IdenTIerd by Schaefer eT.
el.,(1981) Is ThaT mosT frequenle cITed sTudles TreeT
soclal neTwork psychosoclal asseTs, and percelved soclal
supporT as InTerchangeable concest. Many of The heavlly
weIghTed ITems on llfe-evenT scales are closely relaTed To
loss of soclal supporT Through deaTh, dlvorce, loss of a
Job. Thus, These lndlvlduals wlTh low soclal supporT are
also llkely To be persons who are undergolng The severe
sTress of loss. The poInT Is ThaT when low soclal supporT
Is The resuIT of a recenT loss or separaTIon, IT Is
Imposslble To Tell If The resulTIng poor healTh Is due To
The effecTs of The loss or from lack of soclal supporT
ITseIf (Schaefer, eT al., 1981).

NhIIe confoundlng of soclal supporT wlTh oTher
psychologlcal varlables may be a major problem, anoTher

problem occurs when a dlsTInchon Is noT made beTween The

67

number of relaTlonshlps a person has In Thelr neTwork and
The person's percepTIon of The supporTIve value of a soclal
InTeracTIon (percelved soclal supporT). Accordlng To
Schaefer and her assocIaTes, Two quesTIonable assumpTIons
are made when soclal neTwork slze Is used To measure The
beneflTs of soclal relaTlonshlps. FlrsT, beneflTs are
dIrechy proporTlonaI To The slze and range of The neTwork.
Second, havlng a relaTIonshlp Is equIvaIenT To geTTlng
supporT. Thls lasT assumpTIon also applles when a slngle
soclal connecTIon such as marrlage or havlng a confldanT Is
used (LowenThal and Haven, 1968).

Nhlle IT Is llkely ThaT neTwork slze and amounT of
supporT are posITIvely correlaTed, Thls assumpTIon Ignores
The demands, consTraInTs, and conflIcTs assocIaTed wlTh
soclal relaTlonshlps. In facT many problems In daIIy llfe
may be The resuIT of The sTresses ThaT come from slgnlflcanT
soclal relaTlonshlps.

CurrenT researchers (House 1981; Schaefer I981; Dlmond
& Jones 1983) emphaslze The consTrucT musT flrsT be
explIcIle dellneaTed and Then rellable and valld ways of
measurlng wlll follow. Few researchers have provIded valld
or rellable Tools for measurlng The concepT (ThoITs,
I982). Chooslng an InsTrumenT ThaT does noT maTch or
measure concepTual or operaTIonaI defInITIons In The sTudy
can lead To Two problems: I) fallure To flnd whaT was

anTlclpaTed because of The dlscrepancy beTween The

68

InsTrumenT and defInITIons; and 2) mIsInTerpreTIng The
fIndIngs as a resulT of applyIng a dlfferenT
InTerpreTaTIon of soclal supporT Than The one measured by
The InsTrumenT (NallsTon eT al., 1983). OperaTIonaIIzaTIon
of The concepT depends on measures whlch wlll dIsTIngulsh
The Types of supporT measured. A relaTed problem Is The
lack of consIsTency In The speclflc measures used ThaT make
IT dIffIculT To compare resulTs across sTudles or To
resolve conflIcTIng fIndIngs (NallsTon eT al., 1983).
Several researchers have aTTempTed To deflne and
dellneaTe The concepT of soclal supporT. Cobb (I976)
suggesTs, ThaT supporT Is InformaTIon leadlng The
lndlvldual To belleve ThaT he/she Is I) cared for and
loved, 2) esTeemed and valued, and 3) belongs To a neTwork
of communlcaTlon and muTual oblIgaTlon. Such a defInITIon
lImITs The consTrucT To only one Type of supporT, emoTIonal
thIe denylng Tanglble ald and InformaTIon as posslble
dIsTIncT dImensIons. Kaplan eT. al. (1977) proposed a
more general defInITIon whlch sTaTes: supporT Is The
degree To whlch an lndlvldual's needs for affecTIon,
approval, belonglng, and securITy are meT by slgnlflcanT
oThers. The value Thls defInITIon would have In research
depends on developmenT of measureable IndlcaTors of The
concest, such as, affecTIon, approval, belonglng and

securITy (ThoITs, 1982).

69

The concepTual problem In deflnlng soclal supporT
uITImaTely relaTes To The mulTIdImensIonal naTure of The
concepT. Several researchers asserT ThaT supporT Is
mulTIdlmensIonal (Dean & Lln, 1977; Hammer, 1981; House
l98l; Walker eT.al., 1977). Few sTudles, have operaTIonally
dIsTIngulshed The dImensIons of supporT measured. FurTher,
lack of consIsTency In specIfIc measures used, make IT
dlfflculT To compare resulTs across sTudles or To resolve
conflIcTIng fIndIngs. The problems In concepTualIzaTlon
and operaTIonalIzaTIon ouTlIned In Thls secTIon Influence
The concluslons ThaT can be drawn from sTudles and musT be
consldered In The followlng secTIon.

W

In The early I970s, John Cassel, an epIdemoIoglsT, and
Gerald Caplan, a soclal psychologIsT, presenTed semlnal
papers on The naTure of soclal supporT and ITs publlc
healTh ImplIcaTlons (Cassel, 1974; Caplan, I974). Cassel's
early ThInkIng on The psychosoclal process and ITs
relaTIonshlp To sTress was presenTed In a paper devoTed To
a dlscusslon of The conTradIcTory research fIndIngs on The
healTh consequences of urban llfe (Cassel, I974). HIs

fundamenTal concern was how envIronmenTal condITIons such

as crowdlng, lnadequaTe houslng, and deTerloraTIng
nelghborhoods exerclsed Ill effecTs on people. Thls effecT
had been demonsTraTed In a serIes of sTudles whlch llnked

envlronmenTal condITIons To hlgher InfanT morTallTy raTes,

70

hlgher lncldence of Tuberculosls and gasTroInTesTlnal
dlsease. Cassel asked: why do some persons fall vIchm To
The envlronmenT whlle oThers are unaffecTed? He
hypoThesIzed ThaT changes In The ImmedlaTe soclal
envlronmenT are capable of alTerIng lndlvldual's resIsTance
To dlsease.

Cassel was able To IdenTIfy a general caTegory of
psychosoclal processes whlch he deslgnaTed as healTh-
proTecTIve. He loosely referred To These processes as
Involvlng "The sTrengTh of The soclal supporTs provIded by
The prlmary groups of lmporTance To The lndlvldual”
(Cassel, 1974; p.478). Cassel made no aTTempT To defIne
soclal supporT or psychosoclal process, buT InsTead cITed a
dlverse serles of sTudles To IllusTraTe hIs meanlng. To
summarlze, Cassel's maln legacy resTs on Two lInes of
ecologlcal Inqulry, 1) InquIrIes devoTed To analyzlng how
InTeracTIon wlTh The soclal envlronmenT augmenT The
lndlvldual's vulnerabIlITy To Illness, and 2) how soclal
forces can be moblllzed In These sITuaTIons To proTecT
healTh.

Caplan, sTlmulaTed by Cassel's TheoreTIcal
formulaTIons, developed an elaboraTe scheme for classlfylng
Types of soclal supporT sysTems. He ouTlIned a varleTy of
acTIvITIes ThaT communITy menTal healTh workers could
pursue boTh To InITIaTe and To sTlmulaTe The developmenT of

supporTIve aTTachmenTs In Thelr local areas. In an ofTen

71

cITed quoTaTIon Caplan IdenTIerd Three major conTrIbuTIons
To an lndlvldual's well-belng; ”The slgnlflcanT oThers help
The lndlvldual moblllze hIs/her psychologlcal resources and
masTer hls/her emoTIonal burdens; They share hIs/her Tasks;
and They supply hlm/her wlTh exTra supplles of money,
maTerlals, Tools, skIlls, and cognITIve guldance To Improve
The handllng of hIs/her slTuaTIon" (Caplan, I974,p.6).

Nhlle Caplan used The Term "sysTem" In referrlng To
supporTIve neTworks he does noT elaboraTe on any of The
sTrucTural properTIes or boundarles of supporT sysTems.
Caplan neverTheless, dld aTTempT To deflne The concepT and
make IT clInIcalIy useful.

STudIes ThaT followed Cassel's and Caplan erTIngs
have been largely exploraTory and descrIpTIve (BoTT, I957;
EpsTeIn, I969; Palmore, I979). Flndlngs have provIded The
background from whlch dellneaTIon of The sTrucTural
properTIes or neTwork characTerIsTIcs have evolved.

NallsTon eT.al. (1983), In revlewlng pasT sTudles
abouT soclal supporT and physlcal healTh, poInTs ouT ThaT
concepTuallzaTlon of soclal supporT has derlved from Two
prlmary dIrecTIons. FIrsT Is quanTITaTIve versus
qualITaTIve. Donald eT al. (1978) noTed ThaT soclal
supporT can be operaTIonalIzed In Terms of amounT, such as
The number of people one InTeracTs wlTh, The frequency of
conTacTs; or In. Terms of adequacy measures, such as

percepTIons abouT The adequacy of InTerpersonal conTacTs.

72

The second dIrecTIon leads To dlfferenTlaTlon beTween
The Type of supporT, InsTrumenTal versus expresslve supporT
(Lln, Dean, and Ensel, (I981). PInneau (I975) furTher
dellneaTed lnsTrumenTal/Tanglble supporT as The provlslon
of assIsTance, from InformaTIon and emoTIonal supporT. He
ldenTIfled InformaTIon as separaTe from The oTher Two.
Schaefer eT al., (1981) found Indlces of emoTlonal and
InformaTIonal supporT were hIghly correlaTed, whereas The
measure of Tanglble supporT was quITe dIsTIncT. Her
fIndIng would suggesT ThaT The Indlces of emoTIonal and
InformaTIonal supporT may have been measurlng The same
consTrucT.

In summary, The lInk beTween soclal supporT and
varlous ouTcomes are beglnnlng To be esTabllshed. buT There
Is need for consensus on The concepTual and operaTIonal
defInITlons of soclal supporT. Thls sTudy focuses Is on
Type of supporT and dIchoTomIzes The concepT InTo emoTIonaI
supporT and Tanglble old. In addITIon, alThough IT Is
recognlzed ThaT There Is a need To dellneaTe beTween
lndlvldual's percepTIon of supporT and acTuaI supporT
avallable Thls sTudy Is focused on percepTIon of supporT.
In The followlng secTIon llTeraTure wlll be organlzed lnTo

sTudles relaTed To percelved emoTlonal supporT and sTudles

of percelved Tanglble aId.

73

When

Comparlson of sTudles whlch aTTempT To measure some
aspecT of emoTIonal supporT demonsTraTe The problems In
concepTualIzIng and measurlng The concepT. LowenThaI and
Haven (1968) sTudIed a sample of survlvors (N-280) from a
panel of elderly commuany resldenTs To evaluaTe lnTImacy
as a crITIcal varlable In The InTeracTIon and adapTaTIon of
elderly persons. The orIgInal sTudy sample (N-600) was
composed of lndlvlduals 60 years and older and was drawn
from a sTraTIerd-random sample of persons lIvIng In 18
census TracTs In San Franclsco. The analysls of lnTImacy
resTed largely on responses To The quesTlon: 'Is There
anyone In parTIcular you conflde In or Talk To abouT
yourself or your problems?" lnTImacy was measured by The
presence or absence of a confldanT and psychIaTrIc sTaTus,
role sTaTus, soclal InTeracTIons, oplnlon of own age and
morale were used as IndlcaTors of adapTaTIon. DaTa were
collecTed In Three InTervlews aT approxImaTely annual
InTervals.

LowenThal and Haven demonsTraTed ThaT malnTenance of
a sTable lnTImaTe relaTIonshIp Is more closely assocIaTed
wlTh "good" menTal healTh and hlgh morale Than Is hlgh
InTeracTIon role sTaTus, or sTabIIITy In InTeracTIon and
role. The loss of a confldanT had more adverse effecTs on
morale, Though noT on menTaI sTaTus, Than dld a reducTIon

In elTher role sTaTus or soclal InTeracTIon. LowenThal and

74

Haven also observed ThaT In The youngesT group (60-64
years), women reporTed havlng nearly 501 more lnTImaTe
companlons Then dld men. Flndlngs from The LowenThal and
Haven sTudy are perTlnenT To The presenT sTudy In Two ways.
FIrsT, The fIndIngs demonsTraTed The presence of an
lnTImaTe relaTIonshIp whlch serves To buffer agalnsT The
losses of old age, l.e. wldowhood, reTlremenT. Second, The
fIndIngs suggesT dlfferences among sexes, wlTh women more
llkely To reporT close confldanT relaTlonshlps, lendlng
supporT To The sTudy of men and women separaTely. A
lImITaTIon of The sTudy Is relaTed measuremenT of oTher
llfe evenTs whlch can lead To confoundlng of The varlables,
l.e., deaTh of a spouse can lead To losses of soclal
supporT.

Fuller and Larson (1980), sTudIed a sample of 50 older
communITy resldenTs who all had recenle experIenced a
relocaTIon To a newly consTrucTed senIor complex In a small
wesTern cITy of Illlnols. The sample was drawn randomly
from 100 resldenTs and an aTTempT was made To malnTaln
a represenTaTIve proporTIon of men. The ages of subjecTs
were 51 To 89 years wlTh a mean age of 69 years. Fuller
and Larson employed muITIple-regresslon correlaTIon
analysIs uslng a hlerarchlcal model, To examlne The effecTs
of llfe evenTs, emoTIonal supporT, InTeracTIon of llfe
evenTs, and age on The varlables of funcTIonal healTh,

dIsTress resulTIng from chronlc healTh problems, comblned

75

morale Index, and Three dImensIons of morale (agITaTIon,
aTTITude Toward own aglng, and lonely dIssaTIsfacTIon).

In Fuller and Larson's sTudy, emoTIonal supporT was
measured on a Ten poInT scale developed by graduaTe
sTudenTs In nurslng and lndlvlduals In non-healTh relaTed
professlons. The followlng quesTlons were asked: "NhaT
klnds of Thlngs do people do To show anoTher person
emoTlonal supporT?" "Durlng The pasT year, how common has
IT been for oTher people, Ilke frlends or relaTIves, To
show Thelr InTeresT In you?" AlThough emoTIonal supporT
was found To have a posITIva effecT on morale on The lonely
dIssaTIsfacTIon dImensIon, Fuller and Larson (1980,p.87)
sTaTe ThaT "resulTs clearly IndlcaTed ThaT no general
sTaTemenT abouT The effecTs of llfe evenTs and emoTIonal

supporT on The physlcal and psychologlcal healTh of older

people In The sTudy would be approprlaTe."
Several lImITaTIons may have lead To The Inconcluslve
resulTs obTalned by Fuller and Larson. FIrsT, IT would

appear ThaT The InsTrumenT choosen To measure soclal
supporT may noT have maTched The TheoreTIcal and
operaTIonaI defInITIons of soclal supporT. Second, as
TholTsIl98I) has noTed, measuremenTs of llfe evenTs are
parTIcularIly suscepTIble To confoundlng wlTh soclal
supporT, because The occurance of The llfe evenTs, such as

loss from deaTh, may have alTered The resulTs.

76’

In a sTudy deslgned by Babchuk (I979) prlmary
relaTIons were InvesTIgaTed among a sample of 800 non-
InsTITuTIonalIzed adulTs. All members were 45 years or
older and were resldlng In Llncoln and Omaha, Nebraska.
Based on hls prevlous work, Babchuk chose To enumeraTe all
prlmary Tles In an aglng populaTlon. To accompllsh Thls,
he examlned Two neTworks whlch he argues IncorporaTes all
prlmary resources, l.e., kln and very close frlends. Tles
wlTh These people were characTerlzed lnTo four Types: 1)
prlmary relaTIves, 2) confldanT relaTIves, 3) prlmary
frlend, 4) confldanT frlend. RespondanTs were flrsT asked
To lIsT all relaTIves and To speclfy These persons To whom
They were very close; These he deslgnaTed as prlmary
relaTIves. Among prlmary relaTIves llsTed he furTher
requesTed respondenTs To IdenTIfy Those who served as
confldanTs, and were labeled‘ confldanT relaTIves. A
parallel procedure was compleTed To obTaIn a lIsT of
prlmary frlend and confldanT frlend.

The opporTunITy To conflde Is a componenT of emoTIonal
supporT, and examlnlnaTIon of The resulTs of Babchuk's
sTudy, provIdes a proflle of resources for emoTlonal
supporT In an elderly populaTlon. The resulTs IndlcaTe
ThaT elderly persons are noT lsolaTed from famlly. Only 30
respondanTs ouT of 800 reporTed belng lsolaTed from famlly.

The remalnlng 770 respondanTs ldenTIfled several prlmary

77

relaTIves (X=5.6) wlTh whom They had conTacT. In
comparlson, 117 respondanTs sTaTed They lacked prlmary Tles
wlTh frlends (X84.2).

SIgnIfIcanT dlfferences were found beTween Those under
55 and older Than 55. Fewer of The younger lndlvlduals
IndlcaTed lack of a confldanT however, one lndlvldual In
flve above 70 years of age was wlThouT a prlmary frlend.
The resulTs seem To IndlcaTe ThaT Those who were older had
fewer resources Than Those who were younger whlch would be
expecTed. SIgnIfIcanT sex dlfferences were also found. A
greaTer proporTIon of men (25.11) Than women (11.61) llsTed
only one lndlvldual as a confldanT relaTIve and a
subsTanTlally greaTer proporTIon of women (20.41) Than men
(1.51) llsTed st or more relaTIves as confldanTs.
LowenThaL and Haven (1968) also found ThaT elderly women
are more llkely To reporT havlng a confldanT Than elderly
men, despITe a greaTer lncldence of wldowhood among women.
HheTher females acTualIy need more soclal supporT Than
males, raTher Than obTaIn more however Is noT clear from
These sTudles.

Flndlngs from Babchuk's research on age and sex
dlfferences In an elderly populaTlon have ImplIcaTlons for
The presenT sTudy. FIrsT, These resulTs supporT The Idea
of expecTed age dlfferences In percelved emoTIonal supporT.
Second, The slgnlflcanT fIndIngs In sex dlfferences provIde

supporT for IImITIng The sTudy populaTlon To females only.

78

Blazer (I983) conducTed research on The ImpacT of
laTe-llfe depresslon on The soclal neTwork. The sample
(N8331) Included lndlvlduals 65 years and older who were
assessed for The presence of sympToms of a major depresslve
dlsorder and The avallablllTy of adequaTe soclal supporT.
ThIrTy monThs afTer The InTervlew, a subseT of The sample
(N-275) was conTacTed by Telephone and The respondanTs
asked abouT Thelr soclal supporT. Blazer's fIndIngs
IndlcaTed ThaT older adulTs expresslng sympToms of
depresslon were more llkely To be members of a non-
supporTlve soclal neTwork. The follow-up daTa suggesT
however, ThaT The depressed lndlvlduals dld noT suffer a
relaTIve decrease In soclal supporT over Tlme, when
compared To non-depressed persons. Blazer measured supporT
from The subJecT's percepTIon and greaTer emphasls was
placed on The quanTITaTIve aspecTs of supporT. Blazer dld
noT, however, IdenTIfy The quesTIons he used In daTa
collecTIon, maklng IT dlfflcuIT To deTermIne If The
InsTrumenT used In Thls sTudy maTched The TheoreTIcal and
operaTIonaI defInITIons deflned by The auThor.

Schafer eT.aI. (I981), conducTed a sTudy of 100
persons 45 To 64 years of age To examlne healTh-relaTed
funcTIons of soclal supporT. The sTudy sample was drawn
from parTIclpanTs In a prevlous survey of Alameda CounTy,
Callfornla, carrled ouT by The Callfornla STaTe HealTh

DeparTmenT. Schaefer relaTed soclal neTwork slze and Three

79

Types of percelved soclal supporT - Tanglble, emoTIonal, and
InformaTIonal - To sTressful llfe evenTs, such as,
psychologlcal sympToms and morale. Among oTher resulTs,
Schaefer demonsTraTed ThaT low Tanglble and emoTlonal
supporT were Independenle relaTed To depresslon and poor
self esTeem. Thls sTudy Is noTabIe because of The
dellneaTIon of soclal supporT lnTo Three Types of supporT.
The IImITaTIons however, are relaTed To meThodologlcal
problems In The sTudy. FIrsT, a causal role of supporT and
ITs relaTlonshIp To healTh cannoT be Inferred because The
daTa was reTrospecTIve. Second, measuremenTs of llfe
evenTs parTIcularIly depresslon makes The sTudy resulTs
more suscepTIble To confoundlng wlTh soclal supporT.

Two sTudles conducTed by Gore (1978) and Nuckolls eT.
al. (1972) provIde examples of well deslgned sTudles of
soclal supporT. AlThough These Two sTudles dId noT use an
elderly sample, They deserve a brlef revlew. Gore uTIlIzed
a unlque opporTunITy To sTudy unemployed subjecTs and The
relaTlonshlp beTween soclal supporT and healTh.

In a sample of 100 men, all InvolunTarIly unemployed
as a resulT of a planT shuT down, dlfferences beTween
lndlvlduals wlTh hlgh levels of soclal supporT or low
levels of soclal supporT from famlly and frlends were
deTermIned and compared To several physlcal Indlces of
healTh. ResulTs IndlcaTed ThaT whlle unemployed, The

unsupporTed lndlvlduals had slgnlflcanTIy hlgher elevaTIons

80

and more changes In measures of cholesTerol, Illness
sympToms and affecTIve responses Then dld The lndlvlduals
wlTh hlgher levels of supporT.

Nuckolls eT al. (1972) also Included obJecTIve ouTcome
measures To demonsTraTe The relaTIonshlp beTween supporT
and healTh ouTcomes. In a sample of 170 prlmapara women,
Nuckolls sTudIed The role of psychosoclal asseTs and llfe
changes on The ouTcome of pregnancy. The measure of
psychosoclal asseTs conTaIns elemenTs of emoTIonal supporT.
Flndlngs IndlcaTed ThaT 911 of The women had hlgh llfe
change scores wlTh one or more compllcaTIons; whereas 331
of The women, wlTh equally hlgh llfe change and hlgh asseT
scores dld noT have compllcaTIons. Thls seems To supporT a
posITIve healTh proTecTIve effecT of soclal supporT.

The sTudles by Gore & Nuckolls serve To poInT ouT ThaT
emplrlcal evldence on The lmporTanT role of soclal supporT

and healTh Is avallable, and ThaT well deslgned sTudles

such as These need To be repllcaTed. In Thls secTIon,
llTeraTure on one dImensIon of soclal supporT, l.e.
percelved emoTIonaI supporT has been revIewed. In The
followlng secTIon llTeraTure perTaInIng To percelved
Tanglble ald wlll be revIewed.

Eaccaixan_lansihia_Ain

Branch and JeTTa (1983) examlned daTa from a unlque
survlvor sample of old-old (71 To 97 years) people lIvIng

In a communITy In MassachuseTTs. The daTa were drawn from

81

The Thlrd wave of The MassachuseTTs HealTh Care Panel STudy
(Branch, 1977), a IongITudInal InvesTIgaTIon of The healTh
and soclal needs of The non-InsTITuTIonaIlzed elderly.
Through personal InTervlews wlTh a sample of 825 survlvors
from The orlglnal panel (N81,625), Branch and JeTTe
InvesTIgaTed The exTenT To whlch subjecTs used long Term
care (LTC) assIsTance To malnTaln Themselves Independenle
In The communITy. The Informal supporT neTwork of subjecTs
was sTudIed as a source of LTC assIsTance.

The use of LTC assIsTance, boTh formal l.e.,
governmenTal, volunTary servlce agencles or healTh care
provlders and Informal l.e., famlly, frlends or nelghbors,
was examlned for 11 dlfferenT acTIvITIes of daIIy lIvIng
(AOL). These ADL were dlvlded lnTo Two caTegorIes: baslc

AOL-assIsTance In walklng, Transfer, dresslng, baThIng,

feedlng, and groomlng; and InsTrumenTal ADL such as
assIsTance In housekeeplng, TransporTaTIon, food
preparaTIon, grocery shopplng and personal buslness

affalrs. Branch and JeTTe found ThaT over 801 of The
sample were enTIrely self-sufflclenT In performlng baslc
acTIvITIes of dally lIvIng, buT ThaT 821 used some form of
assIsTance In InsTrumenTal acTIvITIes of dally lIvIng.
Women were more llkely Than men To use help for baslc ADL.
Men used more long Term care assIsTance In InsTrumenTaI
acTIvITIes of daIly lIvIng Than women. The proporTIon

uslng assIsTance In ADL Increased wlTh age. The

82

overwhelmlng majorlTy (681) uslng assIsTance wlTh
InsTrumenTal acTIvITIes of dally lIvIng rolled on Informal
sources (Branch 6 JeTTe, I983).

The lmporTance of Branch and JeTTe's research To The
presenT sTudy Is ThaT IT emphaslzes The lmporTanT role of
The Tanglble ald dImensIon of soclal supporT In The daIly
lIves of non-InsTITuTIonaIlzed elderly. Branch and JeTTe
aTTempTed To demonsTraTe ThaT The need for Tanglble ald
Increases wlTh age, and ThaT women used Thls Type of
supporT dIfferenle Than do men. A lImITaTIon of The sTudy
however, Is relaTed To The lnTerpreTann of fIndIngs. lT
Is noT sTaTed In The sTudy If deTermInaTIon of need was
asked of respondenTs or was assumed. Two addITIonal sTudles
by Branch and JeTTe supporTTed Thelr InTlal fIndIngs and
wlll be dlscussed below.

In a second sTudy conducTed by JeTTe and Branch
(1981), an examlnaTIon was made of a sample of 2,654
lndlvlduals, aged 55 To 84 years of age, from The orlglnal
Framlngham cohorT. None-InsTITuTIonaIlzed elderly were
InTervlewed In person or by Telephone To evaluaTe physlcal
dIsabIlITy. The Framlngham DlsabIIITy STudy (FDS) was a
componenT of The HearT DIsease Epldemlologlcal STudy In
Framlngham, MassachuseTTs. Prevalence of physlcal
dIsabIlITy among The sTudy subjecTs was evaluaTed by The
respondenT's abIIITy To Independenle perform slx

acTIvITIes of dally lIvIng (ADL). Sex, age and age

83

speclflc gender comparlsons were reporTed and sTaTIsTIcal
slgnlflcance was TesTed by chI-square. The slx acTIvITIes
of daIIy lIvIng were groomlng, baThIng, walklng across a
small room, Transfer from bed To chaIr, dresslng, and
feedlng. MosT of The sTudy subjecTs were able To perform
The st ADL wlThouT assIsTance. For all acTIvITIes excepT
eaTIng, The 75 To 84 year old group was slgnlflcanle more
llkely To use help In dolng The acTIvITy, compared To Thelr
younger counTerparTs. NeverTheless, over 901 of The 75 To
84 year olds were sTlll IndependenT In all st acTIvITIes
of dally lIvIng.

The abIIITy To perform Three gross moTor acTIvITIes,
l.e., heavy housework, walklng one-half mlle, and clImbIng
sTaIrs, was found To be sIgnIfIcanle relaTed To age. Only
501 of Those aged 75 To 84 years of age were able To
perform heavy household Tasks, In comparlson To 791 of
Those aged 55 To 64 years who could do such work. In The
75 To 84 year old group, 771 were able To walk a half-mlle,
In comparlson To 961 of The youngesT age group (55 To 64).
EIghTy-Tlve percenT of The lndlvlduals 75 To 84 years of
age reporTed ThaT They could cllmb sTaIrs, compared To 961
of Those 55 To 64 years of age. HITh few excepTIons, These
daTa revealed a consIsTenT Increase In physlcal dIsabIlITy
wlTh advanclng age. The daTa resulTs IndlcaTe ThaT women
are no more llkely Than men To reporT funcTIonal

lImITaTIons.

84

Recognlzlng The unlque characTer of Thls Framlngham
cohorT, JeTTe and Branch compared poInT esTImaTes of
physlcal dIsabIlITy obTalned from The Framlngham group To
Branch's (I976) MassachuseTTs HealTh Care Panel STudy
parTIclpanTs. The Two sTudy populaTlons were found To be
slmllar In reporTed level of physlcal dIsabIlITy. The few
dlfferences ThaT emerged suggesTed The Framlngham cohorT
was somewhaT less dIsabIed Than The MassachuseTTs sample, a
fIndIng whlch. Branch and JeTTe aTTrIbuTe To The unlque
characTer of The Framlngham cohorT and The effecT of
ongolng healTh research for ThaT sample.

In a second parT of The Framlngham DIsabIlITy STudy,
uslng The same sample as descrlbed for physlcal dIsabIlITy,
Branch and JeTTe (1981) reporT on soclal dIsabIlITy among
The aged. Soclal dIsabIlITy was deflned as lImITaTIon In
performlng, or InabIlITy To perform, soclal roles or
oblIgaTlons. The daTa on soclal dIsabIlITy prevalence
was depIcTed by sTudy cohorTs as belng adequaTely
performed In flve essenTlal soclal Tasks: 1) housekeeplng,
2) TransporTaTIon, 3) soclal InTeracTIon, 4) food
preparaTIon, 5) grocery shopplng. Only 61 of The cohorT
had unmeT needs In one or more of These areas. One-fourTh,
was consldered aT rIsk however, for developlng an unmeT
soclal need In one or more areas. JeTTe and Branch sTaTe
The daTa supporT Two observaTlons. FIrsT, IT revealed The

well known Increase In percenTages of people needlng, or aT

85

rIsk of needlng, assIsTance In performlng soclal roles as a
funcTIon of age. Housekeeplng was The area shown To have
The largesT age-relaTed Increase In unmeT needs. TwenTy-
flve percenT of The 75 To 84 year old cohorT, compared wlTh
151 of The 55 To 64 year old cohorT, were aT rIsk, or had
an unmeT need In housekeeplng. The second observaTIon ls
ThaT women had more unmeT housekeeplng and TransporTaTIon
needs and were aT greaTer rIsk for developlng unmeT needs
In These areas Than men. Thls slgnlflcanT gender
dlfference was found wIThIn each cohorT.

ResulTs of The JeTTe and Branch sTudy on physlcal and
soclal dIsabIlITles are relavanT To Thls sTudy In Three
ways. FIrsT, In depIcTIng The prevalence of dIsabIlITy
among non-InsTITuTIonaIlzed elderly, The role of Tanglble
supporT In malnTalnIng Independence becomes clearer. The
fIndIngs supporT IndependenT lIvIng, buT one cannoT Ignore
The many avenues open To provlslon of Tanglble supporT In
AOL. The second poInT, Is ThaT as lndlvlduals age They
have Increase Thelr rIsk of unmeT needs, whlch lends
supporT To The need for more research on age dlfferences
and soclal supporT as a facTor promoTIng healTh.

Nhlle The above sTudles used large samples There are
several lImITaTIons ThaT musT be consldered. FIrsT, IT Is
quesTIonable how unmeT need and needs were operaTIonalIzed.

ResulTs could be mIslnTerpreTed If need was assumed versus

86

asklng The respondenT. Second, a causal role of soclal
supporT and relaTIonshIp To healTh cannoT be Infer when
reTrospecTIve daTa Is used (NallsTon eT al., 1983)

The followlng sTudy employed In-depTh InTervlews and
parTIclpanT observaTlon To InvesTIgaTe aspecTs of supporT
neTworks In an elderly populaTlon (HenTowskI I981). The
presence or absence of an Informal supporT neTwork has been
recognlzed as a cruclal predIcTor of The well-belng and
auTonomy of older people (Brody ef al., 1978). HenTowskl
uTIlIzed a sample composed of 50 Amerlcans ages 55 To 83
(x-7l) lIvIng In Three SouThern urban communITIes. In a

descrlpTIon of The "helplng ouT' funTIon of Informal

supporT neTworks she sTaTes:

For all buT a few of The older people observed,

The neTworks are a major source of rellable help.
SupporT In These neTworks revolves around The
provlslon of goods and servlces ThaT conTrIbuTe
To The daIly managemenT of The households.
People share all klnds of rouTIne dally Tasks and
problems, such as cleanlng house, TransporTaTIon
To and from needed servlces. Swapplng and
sharlng makes households IndependenT. The
neTworks dIsTrIbuTe goods and servlces beTween
household accordlng To need. The neTworks also
provIde soclal and emoTIonaI supporT; a number of
cusToms such as dally Telephone calls,IeT members
know ThaT They are cared for by oThers and
provIde a conTInual moanorIng of physlcal

and emoTIonal sTaTe. Tlmes of crIsIs or speclal
sTress, such as deaTh of a loved one or an
Illness, brlng InTensIfled supporT from The

neTwork (HenTowskI, 1981,p.601).

NenTowskI's dlscrlpTIon of These Informal supporT
neTworks poInTs up The lmporTance of Tanglble supporT found

In supporTIve relaTlonshlps. In her prellmlnary fleld

87

work, WenTowskI dlscovered a complex exchange sysTem. The

exchanges of supporTIve assIsTance were dIrecTed by

cuITural rules. Such rules are a seT of shared

InsTruchons for puTTIng TogeTher elemenTs of behavlor

(Spradley, 1972). HenTowskI's InvesTIgaTIon lnTo The use

of culTuraI rules whlch govern reclprocITy provIdes In

In-depTh look aT The exchange wlThIn an elderly person's
soclal neTwork.

In examlnlng lmporTanT supporTIve relaTlonshlps
ouTsIde The famlly sysTem. NenTowskl, descrlbed The regular
exchange as lmporTanT for deflnlng responsIbIlITy of non-
kln for one anoTher. EIghTy-Two percenT of persons In
HenTowskI's sample reporTed have "good" frlends ouTsIde The
nelghborhood. SIxTy percenT had ”close" and 'besT'
frlends, who were Involved In a number of funcTIons
lmporTanT To dally lIvIng. A majorlTy had helpful conTacTs
wlTh nelghbors; 641 reporTed havlng "frlends In The
nelghborhood," and 561 reporTed havlng "speaklng nelghbors"
wlTh whom They swap and exchange. Nelghbors are especlally
responslve In sITuaTIons Involvlng dally observaTIon, such
as checklng on a sIck person; because of Thelr proxImITry
(HenTowskI, 1981).

HenTowskI's research Is relevanT for several reasons.
FIrsT, The anThropologIcal meThod ylelds a rlch, IndepTh
perspecTIve on supporTIve relaTlonshlps among The elderly.

The IndepTh examlnaTIon Includes descrlpTIons of speclflc

88

exchange mechanlsms Through whlch supporT Is elIclTed by
older people, and how Thls supporT Is developed over Tlme.
HenTowskl's observaTlons made evldenT The concepT of
reclprocITy as an essenTIal componenT of self-esTeem and
prlde of elderly persons. Second, The cruclal role of
Tanglble ald was demonsTraTed In observaTlons of daIIy llfe
paTTerns among The elderly. Flnally, The lmporTance of
non-kln neTwork In The provlslon of Tanglble aId was
demonsTraTed. Valuable InformaTIon can be obTalned by The
survey meThod. Whlle Thls meThod provIdes IndepTh
InformaTIon IT looks aT only one slde of a supporT
relaTIonshIp and aT one poInT In Tlme. Use of a survey
InsTrumenTs, wlThouT addITIonaI measures To vaIIdaTe
responses of subjecTs, only measure one slde of a
reclprocal relaTlonshIp.

In summary, Tanglble aId, as percelved by elderly
lndlvlduals was shown To have dally lmporTance In
malnTalnence of Independence and ongolng relaTlonshlps.
Tanglble ald llkely plays a cruclal role In The lIves of
aglng persons.

Summon
In Thls chapTer, llTeraTure relaTIng To The sTudy
varlables, age, percelved emoTIonaI supporT, and percelved
Tanglble ald have been revIewed. Several meThodologIcal
problems were dlscussed relaTIng To reseach on age and

varlablllTy assoclalTed wlTh aglng. Several meThodologIcal

89

Issues were ldenTIfled and used as crITerla for crIquulng
several sTudles on age dlfferences. LongITudInal deslgns
provIde opporTunITy for sequenTIal observaTlons of
lndlvldual dlfferences In parTIcular cohorTs and defInITIve
TesTs of The hypoThesIs of varlablllTy versus age change.
Only one sTudy was ldenTIfled (Maddox and Douglass 1974)
ThaT was of a IongITudInal deslgn.

Lack of agreemenT on The concepTual defInITIons of
soclal supporT and meThods of measuremenT have made IT
dIffIculT To compare sTudles. In Thls chapTer evldence has
been presenTed whlch supporTs The Idea of The elderly as a
group To whom soclal supporT Is cruclal In delly lIvIng.
The followlng chapTer wIlI conTaIn a descrlpTIon of The
meThodology employed In Thls sTudy, and llTeraTure

supporTIng The use of The daTa collecTIon InsTrumenT.

CHAPTER IV

METHODOLOGY AND PROCEDURES

Oxecxisw

Thls descrlpTIve sTudy was deslgned To IdenTIfy
dlfferences In mean values of percelved emoTIonal supporT
and Tanglble aId avallable among aglng women 75 To 89 years
of age. Age, percepTIon of emoTIonal supporT recelved and
percepTIon of Tanglble supporT avallable are The major
sTudy varlables. In collaboraTIon wlTh SefTon-CoJecel
(1984), The JoInT quesTIon of wheTher There Is a dlfference
In mean values of percelved emoTIonal supporT and Tanglble
ald avallable beTween Two groups, aged 65 To 74 and 75 To
89 years, Is examlned. IT was expecTed ThaT The resulTs
of daTa analysls would descrlbe a group of aglng women 75

To 89 years of age and deTermIne Thelr percepTIons of The

Types of supporT recelved and avallable. Soclodemographlc
InformaTIon abouT Thls group of aglng women wlll be
presenTed To descrlbe The sTudy sample. DaTa were used

from The preTesT of seven InsTrumenTs prevlously deslgned

for use In a larger sTudy. Aciixe_£atiicinaiinni__flsai1n
ann_ign_1ne_fiidnnix, dIrecTed by leen (1982) and funded
Through a MIchlgan STaTe UnlversITy All UnlversITy Research

90

91

GranT. Speclflcally, daTa collecTed uslng The Norbeck
Soclal SupporT OuesTIonnaIre and a soclodemographlc survey
were uTIlIzed In Thls sTudy.

A dlscusslon of The meThods and procedures uTIlIzed In
Thls research sTudy Is presenTed In Thls chapTer.
InITIally, a dlscusslon of The sample Is presenTed followed
by daTa collecTIon procedures, operaTIonalIzaTlon of sTudy
varlables, InsTrumenTaTIon, human subjecTs and daTa
analysls.

Semis

In The orlglnal sTudy, As1ixa__Enniisinniinna__hnnlih

Cann_jgn_1ne_fiinenly (leen 1982) a convenlence sample was

selecTed for evaluaTIon of The qualITy of seven
psychosoclal InsTrumenTs as applled To an elderly
populaTlon. ATTemst were made To obTaIn The followlng
Types of lndlvlduals In The sample: cITy-rural, senIors
from senIor aparTmenT complexes, lndlvlduals lIvIng In
Thelr own homes, young-old and old-old, Those wlTh low
Income and and Those more affluenT. To do Thls,
lndlvlduals In Grand Raplds, and The GreaTer LansIng area
of MIchlgan were chosen as a convenlence sample durlng
March, Aprll and May of 1983. There were 101 subJecTs, 15
males and 86 females beTween The ages of 59 To 95 years In
The orlglnal sample.

All women aged 65 To 89 years of age were chosen for

Incluslon In The presenT sTudy. The raTlonale for Thls

92

cholce was boTh pragmaTIc and TheoreTIcal. FIrsT, for
pragmaTIc reasons, all women wlThIn each age group were
Included In The sample because The numbers were small. The
preTesT sample In The orlglnal sTudy dld noT conTaIn
suffIcIenT daTa for analysls of males. Second, and for
TheoreTIcal reasons, There Is a dIsporTIonaTe Increase In
females afTer age 65. There Is evldence In The llTeraTure
also ThaT women uTIlIze soclal supporT dIfferenle from men
(Norbeck 1981).

Because The sample was volunTary and noT The resuIT of
random selecTIon, The resulTs of Thls sTudy can be
generallzed only To The elderly women possesslng
characTerIsTIcs whlch are slmllar To Those of The sample.
ResulTs should noT be consldered To be represenTaTIve of
all elderly women.

MW

DaTa were collecTed by four GraduaTe AssIsTanTs, all
sTudenTs In a Cllnlcal Nurse SpeclalIsT program. SITes
selecTed were based on The conTacTs These four lndlvlduals
made wlTh coordlnaTors of nuTrlTIon sITes for older
persons, resldenT managers of Senlor AparTmenTs, and
personnel wlTh oTher programs, such as EasT LansIng Older
Persons AssocIaTlon. In Thls secTIon The sITes wIlI be
descrlbed and The procedure for Tralnlng and supervlslon of

InTervlewers wlll be dlscussed.

95

51135

SubjecTs were obTalned prlmarlly from senIor
nuTrlTIons sITes, resldenT cenTers and cenTers for acTIvITy
programs for The elderly. No aTTempT was made To randomly
selecT The sample. A descrlpTIon of each sITe and number
of subjecTs obTalned from The sITe follows:
I) Hilliamsign; MllllamsTon Is a rural communITy locaTed
some TwenTy mlles easT of LansIng. ParTIpranTs were drawn
from a Senlor nuTrlTIon sITe whlch Is one of The flrsT
esTabllshed In The area. ParTIpranTs are older, mosT were
pasT 85 years, and aTTend The nuTrlTIon program regularlly.
Of The 50-60 lndlvlduals who regularlly aTTend, 8
volunTeered for The proJecT. All lndlvlduals were
InTervlewed In Thelr homes.
2) Etiennahin_flnnnna Frlendshlp Manor Is a senIor
aparTmenT complex locaTed aT The border of LansIng-EasT
LansIng. Elders IIve In lndlvldual aparTmenTs wlTh access
To laundry facIlITIes and shopplng. VolunTeers were
solIcITed from The nuTrlTIon program from whlch They
recelve Thelr noon meal. ApproxlmaTely 60 persons aTTend
Thls program and 10 volunTeered To parTIclpaTe In The
InTervlews In Thelr own aparTmenTs.
3) Senlgn_genien_ign§ing; The Senlor CenTer, In addITIon
To belng The organlzaTlon cenTer for TrI-CounTy Senlor
Plannlng (Ingham, EaTon and ClInTon CounTIes), IT Is also a

LansIng Parks and RecreaTIon acTIvITy sITe for Senlors.

94

Unllke oTher nuTrlTIon sITes whlch offer meals and
acTIvITIes for a consIsTenT group of nelghborhood elders,
The CenTer serves as a meeTIng place for oranlzed groups,
l.e., A.A.R.P., reTlrees from unlon groups, or women's
groups. ApproxlmaTely 15 volunTeers were obTalned aT Thls
sITe and InTervlews were conducTed In small groups aT The
cenTer.

4) BLngLLgn1_Apanimen15; Thls sITe Is a senIor
aparTmenT complex In whlch a resldenT meeTIng group was
used To soIIcIT volunTeers. Four volunTeers parTIclpaTed
and were InTervlewed In Thelr own aparTmenTs.

5) finnnga_A£L£§a Thls sITe Is a senIor houslng complex
of IndependenT, ground level unITs. Thls deslgn and The
lack of a nuTrlTIon program on The grounds made IT
dIffIculT InITlally To obTaIn volunTeers, buT approxlmaTely
20 volunTeers were obTalned and InTervlewed In Thelr own
houslng unITs.

6) lnxeziy_Acea_Lan§1ng; SubjecTs were soughT To obTaln a
group of elders who were lIvIng Independenle. SubjecTs
were elTher known by The InTervlewers or were referred by
frlends. ApproxlmaTely 5 volunTeers were InTervlewed In
Thelr own homes.

7) Mllle;_figag; Thls Is a nuTrlTIon sITe operaTed by The
LansIng Parks and RecreaTIon. Thls group whlch Is an older
populaTlon and four volunTeers. chose To compleTe

quesTIonnalres aT The sITe and Two requesTed InTervlews In

95

Thelr own homes.
8) Eas1_Lansins_Qinec_£stsons_Associaiiona Thls sITe was
selecTed wlTh The hope of Includlng a subseT of senIors who
were beTTer educaTed, more affluenT and physlcally and
soclally acTIve. VolunTeers numbered 15, of whom 2 were
InTervlewed aT home and I3 aT The sITe.
9) Haniih_flnnntimnnia Thls group was Included To obTaIn a
subseT of relaTIvely young senIors who were sTIlI employed.
Only 3 volunTeered and were InTervlewed on The sITe.
Wants

Tralnlng sesslons were held wlTh four GraduaTe
AssIsTanTs. Dlscusslon and procedures for admInIsTraTlon of
a quesTIonnaIre packeT was dlscussed and The followlng
proTocoI was presenTed.
I. InTervlewers were InsTrucTed To Telephone respondenTs
who had earller agreed To parTIclpaTe In The sTudy. The
InTervlewers were InsTrucTed To InTroduce Themselves as
GraduaTe AssIsTanTs wlThIn The College of Nurslng aT
MIchlgan STaTe UnlversITy.
2. AT conTacT wlTh The respondenTs, a brIef explanaTIon
was To be glven concernlng The naTure of The research and
The purpose. RespondenTs were Told ThaT parTIclpaTIon
would requlre Them To compleTe erTTen quesTIonnalres
Involvlng some personal oplnlon ITems, and would requlre
approxlmaTely one hour of Thelr Tlme. ConfldenTlaIITy was

explalned and respondenTs were assured ThaT Thelr names

96

would noT appear on The quesTIonnalres or In The research
analysls. RespondenTs were Then asked If They had any
chronlc dlseases whlch were Then recorded.

3. InTervlewers were InsTrucTed To be prompT and To supply
packeTs and penclls. The quesTIonnalres were To be
explalned separaTely and collecTed afTer each was
compleTed. RespondenTs were To be asked If They had any
quesTIons or concerns before sTarTIng, and were Told They
could sTop parTIclpaTIon aT any Tlme If They so deslred.
In The evenT a respondenT declded noT To parTIclpaTe, The
InTervlewer was To Thank The respondenT for hIs/her Tlme
and conslderaTIon. .

W

A. Conseni_fignm; InTervlewers revIewed The consenT form
wlTh The respondenT and he/she was assured ThaT The
quesTIonnalres would be kepT anonymous. InTervlewers were
InsTrucTed To allow parTIclpanTs To see ThaT consenT forms
were noT kepT wlTh Thelr packeTs.

B. Sgcinnemggzaphic; InTervlewers revIewed The baslc
dIrecTIons wlTh The respondenT. When The respondenTs had
compleTed Thls survey They were provIded wlTh The followlng
quesTIonnalres: HealTh HabITs; How I Feel AbouT Myself;
lnvolvemenT In HealTh Care; Llfe EvenTs; Soclal AbIlITy;
MedlcaTIon Survey: and Soclal InTeracTIon. The Soclal
InTeracTIon form was Norbeck's Soclal SupporT OuesTIonnaIre

from whlch daTa were drawn for Thls sTudy. The Norbeck

97

Soclal SupporT OuesTIonnalre Is descrlbed In The followlng
secTIon.
C-Nncnsclsis Social Sumac: Questionnaire mm The NSSQ
Is The InsTrumenT uTIlIzed In Thls sTudy. lnsTrucTIons for.
use of Thls quesTIonnalre are provIded here. FIrsT,
respondenTs were asked To lIsT each slgnlflcanT person In
Thelr lIves on The full sheeT provIded on The rIghT slde of
The folder. They were Told To conslder all The persons who
provIded personal supporT or who are lmporTanT To Them now.
In IlsTIng These neTwork members, respondenTs were Told To
use only flrsT names or IanIals. RespondenTs were Then
InsTrucTed To speclfy The caTegory of The relaTlonshlp wITh
each person as provIded In The lnsTrucTIons. RelaTIonshlps
llsTed were spouse/parTner; famlly/relaTIve: frlends:
work/school assocIaTes; nelghbors; healTh care provlders:
counselor/TherapIsT; mInlsTer/rabe/prlesT; and oTher.

AfTer IlsTIng up To TwenTy neTwork members,
respondenTs were dIrecTed To Turn To The IefT slde of The
folder where each full sheeT would conTaIn Two quesTIons.
In each quesTIon, The respondenT was asked To raTe each
neTwork member They llsTed on The rIghT uslng a flve poInT
leerT scale (Norbeck eT al.,1981,p.265)

AnTIpraTIng The sensory changes of Thls age

populaTlon, The procedure from The orIgnlal Norbeck

research was modIerd. InTervlewers were InsTrucTed To

provIde guldance In use of The quesTIonnalre such as

98

readlng The quesTIonIs) and assIsTence wlTh erTlng as
necessary. ResponsIbIlITy for quesTIons was IefT To The
respondenT. RespondenTs were also gIven 3x5 cards wITh The
response alTernaTIves (LIkerT Scale) To refer To as They
answered The quesTIons. OuesTlonnalres were admInIsTered
boTh Indlvldually and In small group seTTIngs.
ngmpiailgn_ann_nebzlefing; The InTervlewer was InsTrucTed
To ask for and answer any quesTIons or concerns ThaT The
respondenTs mlghT have. The respondenT was Thanked for
hIs/her Tlme and assured ThaT Thelr efforTs would be of
greaT value To Thls research proJecT.
ancniinnni_flniiniiinnfi

The varlables under sTudy are age, and The percepTIon
of Two Types of soclal supporT, are operaTIonalIzed In The
followlng secTIon:
Age was operaTIonalIzed as a quesTIon ThaT asked
respondenTs To lIsT Thelr bIrThdaTe and currenT age. For
purposes of analysls, respondenTs were classlfled as
young-old (65 To 74 years) and, old-old, (74 To 89 years).
Eacsaixsn_£meiionai_§unnoti was operaTIonalIzed uslng The
followlng Three ITems on The Norbeck Soclal SupporT
OuesTIonnaIre:
1. How much does Thls lndlvldual make you feel Ilked or

loved? (effecT)
2. How much does Thls lndlvldual make you feel respecTed

or admlred? (afflrmaTIon)

99

3. How much can you conflde In Thls person?
Eensaixed_langlbie_Aid; was operaTIonalIzed uslng Two ITems
on The Norbeck Soclal SupporT OuesTIonnaIre.

1. If you needed To borrow $10, a rlde To The docTor, or
need ImmedIaTe help, how much could Thls person
usually help?

2. If you were conflned To bed for several weeks, how much

could Thls person help?

instrumentalist:

The Norbeck Soclal SupporT OuesTIonnaIre (NSSO) was
uTIlIzed In Thls sTudy as one of The seven InsTrumenTs In
The larger sTudy Aciixs_£atiisinaiinna Beaiih_21ts_iot_ibe
E14321; (leen, 1982). The NSSO Is a self-reporT
quesTIonnalre whlch ls deslgned To measure mulTIple
dImensIons of soclal supporT. Kahn's (I979) defInITIon of
soclal supporT was used as The concepTuaI defInITIon of
soclal supporT. AffecT, afflrmaTIon, and aId are proposed
as Three componenTs of supporTIve Transachons. Kahn's
concepT of soclal neTworks, whlch he Terms a ”convoy” 15
measured by assesslng The number of persons In a neTwork,
duraTIon of relaTlonshlps, and frequency of conTacT wlTh
neTwork members. Change In an lndlvldual's convoy over

Tlme, Is measured by quesTIons

100

regardlng recenT losses of neTwork members (Norbeck ef al.,
1983). See Appendlx A.
W

The NSSO can be self-admInIsTered In groups or
Through maIlIngs. The average sTaTed Tlme for compleTIon
of The NSSO Is 10 mInuTes, (range: 5-20 mInuTes). UsIng an
elderly populaTlon,The lengTh of Tlme was one hour (range:
30 mInuTes To Two hours). The NSSO was The lasT
quesTIonnalre To be admInIsTered In The packeT of seven
oTher InsTrumenTs and The Increased Tlme probably reflecTs
1) decreased concenTraTIon, and 2) faTIgue.

The NSSO can be scored dIrecTIy from The quesTIonnalre
or The responses may be Transfered To a one-page scorlng
sheeT. For each of The InITIaI elghT quesTIons, The
respondenTs raTIng for each neTwork member on a gIven
quesTIon are added To deTermIne The score for ThaT
quesTIon. The number In The neTwork Is deTermIned by The
number of lndlvlduals llsTed by The respondenT on The
neTwork lIsT; l.e., If Ten people are llsTed, The number Is
Ten (Norbeck eT al.,1981).

MW

In The flrsT phase of TesTIng The Norbeck Soclal
SupporT InsTrumenT hlgh levels of TesT-reTesT rellabIlITy
and InTernal conslsTency were esTabllshed, and soclal
deslrabIIlTy response seT was ruled ouT (Norbeck, Llndsey,

and Carrlerl, 1981). Thls was accompllshed by

101

admInIsTerIng The NSSO To 75 GraduaTe Nurslng STudenTs
IanlalIy and reTesTIng The InsTrumenT wlTh 67 of The same
sTudenTs one week laTer. The one week InTerval reduces The
IIkelIhood of Tapplng True changes In The sTudenTIs soclal
neTworks as They became beTTer acquaInTed. Means, sTandard
devIaTIons, range of scores, and TesT-reTesT Pearson
correlaTIons were Then compuTed for all The ITems on The
NSSQ. The mean scores represenT The raTIngs on each lTem
for The ToTal neTwork lIsT. The average raTIngs for
members of The neTwork IIsTs were calcuIaTed by dIvIdIng
The mean score by The number In The neTwork. These average
raTIngs were; effecT, 4.14: afflrmaTIon, 3.81: ald, 3.07.
Each of The funcTIonal ITems and neTwork ITems had a hlgh
degree of TesT-reTesT rellabIllTy (range: 0.85 To 0.92).

lnTernal conslsTency was TesTed Through
InTercorrelaTIons among all ITems. The correlaTIon beTween
The Two afflrmaTIon ITems was 0.97, and beTween The Two aId
ITems, 0.89. The affecT and afflrmaTIon ITems were also
hlghly correlaTed (range: 0.95 To 0.98), suggesTIng ThaT
The Two dImensIons are noT dIsTIncT.

In esTabllshIng valIdITy of The InsTrumenT, response
blas was ruled ouT. In uslng any psychologlcal or
psychosoclal InsTrumenT The respondenT's answers may
reflecT a reporTIng of soclally deslrable answers raTher
Than honesT self-reporTs. To rule Thls ouT, Norbeck and

assoclaTes admInIsTered The Marlowe-Crowns TesT of Soclal

102

DeslrabIlITy concurrenle wlTh The NSSO To 76 respondenTs
of The InITIaI group. None of The ITems of The NSSO were
sIgnIfIcanle relaTed To The soclal deslrabIlITy measure.
The correlaTIons ranged from 0.01 To 0.17. Thls suggesTed
ThaT The NSSO responses are relaTlver free from The
Influence of The soclal dlslrabIlITy response blas.

In The Ianlal phase of TesTIng The basls of conTrucT
valIdITy was descrlbed, and moderaTe levels of concurrenT
valIdITy were found. The InITIal approach To sTudyIng
consTrucT valIdITy was To examlne The relaTIonshIp beTween
The Norbeck Soclal SupporT InsTrumenT (N880) and a
TheoreTIcally relevanT varlable. The Proflle of Mood
STaTes was admInIsTered In conjuncTIon wlTh The NSSO To 75
subjecTs from group one. None of The mood subscales or The
ToTal negaTlve mood score were sIgnlfIcanle relaTed To The
NSSO funcTIonal subscales.

ConcurrenT valIdITy TesTIng was done To deTermIne The
degree To whlch The NSSO colncldes wlTh a known measure of
soclal supporT. The Soclal SupporT OuesTlonnaIre developed
by Cohen and Lazarus (1982) was admInIsTered concurrenle
wlTh The NSSO To 42 subjecTs from group one. Each
InsTrumenT deflned Thelr componenT subscales dlfferenle,
buT There were rough parallels beTween Tanglble supporT and
ald, InformaTIonal supporT and afflrmaTIon, and emoTIonaI

supporT and affecT.

103

In The second phase of TesTIng of The NSSO, normaTlve
daTa were developed for employed adulT respondenTs, and
consTrucT vaIIdITy was TesTed Through correlaTIons wlTh
relaTed and unrelaTed InTerpersonal consTrucTs. FurTher
TesTIng of concurrenT valIdITy was done wlTh anoTher soclal
supporT InsTrumenT (Personal Resource OuesTlonnalre; BrandT
and WelnerT, 1981) and TesTIng of predIcTIve vaIIdITy was
compleTed by assesslng The bufferlng effecT of soclal
supporT on measures of negaTlve mood followlng llfe sTress.

In a follow-up sTudy, Norbeck and AssocIaTes
readmInIsTered The NSSO To The same group of graduaTe
sTudenTs seven monThs laTer. The sTabIIITy of The
InsTrumenT was found To be hlgh, buT lower Than The TesT-
reTesT resulTs from The one-week InTerval.

The resulT of The second phase of TesTIng of The NSSO
lend supporT for The conTInued use of The InsTrumenT To
deTermIne speclflc parameTers of soclal supporT ThaT may

have clInIcal relevance.

Winn:

SpecIfIc procedures were followed To assure ThaT The
rIghTs of sTudy parTIclpanTs were noT vIolaTed. The rIghTs
of The parTIclpanTs were proTecTed uslng The sTandards from
The UnlverslTy CommITTee on Research Involvlng Human
SubjecTs (UCRIHS). A consenT form was slgned by each

respondenT (see Appendlx B). Assurance of anonymITy and

104

confldenTIallTy were provIded as parT of The daTa
collecTIon procedure. An IdenTIfIcaTIon number was assIgned
To each quesTIonnalre, and InformaTIon was Then Transcrlbed

In aggregaTe form for compuTer analysls.

WW1:

DescrlpTIve sTaTIsTIcs were used To analyze
soclodemographlc daTa abouT Two samples of aglng women.
Tables summarlzlng The dIsTrIbuTlons and percenTages of
subjecTs by demographlc varlables are presenTed In ChapTer
v. Flve ITems from The Norbeck Soclal SupporT
OuesTIonnalre, Three effecT/afflrmaTIon ITems and Two aId
ITems, were used In Thls sTudy. CorrelaTIons were
compleTed uslng The Pearson ProducT MomenT coeffIcIenT.
Thls coeffIcIenT Is compuTed when The varlables belng
correlaTed have been measured on an InTerval or raTIo
scale. The values of The correlaTIon range from -1.00 for
a perfecT negaTlve correlaTIon, Through 0.0 for no
relaTIonshIp, To +1.00 for a perfecT posITIve relaTlonshIp.
CorrelaTIons were slgnlflcanT for all Three
effecT/afflrmaTIon quesTIons (p<.001), and beTween The Two
aId quesTIons (p<.001) level. The level of slgnlflcance of
The Three emoTIonal quesTIons provIde raTIonale for
comblnlng The ITems lnTo one "robusT" emoTIonal supporT
score, and The Two Tanglble aId quesTIons lnTo one Tanglble

aId score.

105

Responses To The quesTIons were made on a 5-poInT
LIkerT scale ranglng from "noT aT all" To "a greaT deal".
The responses were comblned and mean value for percelved
emoTIonal supporT recelved and percelved Tanglble ald
avallable was calcuIaTed.

InferenTIal sTaTIsTIcs uslng The STudenT's T-TesT were
uTIlIzed To answer The quesTIon: Is There a dlfference
beTween percepTIon of emoTIonal supporT recelved and
percelved Tanglble ald avallable wlThIn each group of
elderly women? An addITIonal T-TesT was compuTed for The
mean values of percelved emoTlonal supporT recelved and
percelved Tanglble ald avallable beTween Two groups of
women aged 65 To 74 and 75 To 89.

Shaman:
A dlscusslon of The meThods and procedures uTIlIzed

for The prellmlnary TesTIng of seven psycho-soclal InsTru-

menTs In The sTudy. Aciixa.£acIicinaiinni__flsaiin_flaca
Lon_1he_£idenl¥, and for use of a subseT of daTa To answer

Three research quesTIons was presenTed In ChapTer IV. A
deTaIled dlscusslon of The sample, daTa collecTIon
procedures, InsTrumenTaTIon, operaTIonalIzaTIon of The

sTudy varlables concernlng aglng women and dlfferences In
percepTIon of emoTIonal and Tanglble supporT, procedures
for daTa analysls was presenTed. In ChapTer V, daTa

descrlblng The sample of elderly women uTIlIzed In Thls

106

research and daTa perTaInIng To each quesTIon were

presenTed.

DHAEIEB_1

DATA PRESENTATION AND ANALYSIS

antxiea

DaTa presenTed In Thls chapTer descrlbe The sTudy
sample and The percepTIons of aglng women abouT The
emoTIonal supporT They recelved and The Tanglble aId
avallable To Them. The daTa were orlglnally collecTed for
a larger sTudy, As1ixn_EALIisifiniinna__flaniih_flnnn inn—Inn
Elnenly (GIven, 1982). In collaboraTIon wlTh SefTon-
Cojocel (1984) Two groups of women, a young-old populaTlon
aged 65 To 74 and an old-old populaTlon aged 75 To 89 were
selecTed for sTudy. For organlzaTIonal purposes,
demographlc varlables and descrlpTIve fIndIngs of The old-
old sample of women 75 To 89 years, The focus of Thls
sTudy, wlll be presenTed flrsT. NexT, The rellablllTy of
The scale uTIlIzed In Thls sTudy wlll be presenTed.
Flnally, demographlc varlables and descrlpTIve fIndIngs of
The young-old sample, 65 To 74 years of age (SefTon-
Cojocel, 1984) are presenTed. Followlng The secTIon on The
sTudy samples The JolnT research quesTIon concernlng
percepTIons of emoTIonal supporT recelved and Tanglble aId

avallable among The Two groups of women wlll be dlscussed.

107

108

DescLin1i1e_Eindinns_ni_iha_fiiud¥_fiamaia
W
The demographlc varlables uTIlIzed In The presenT
sTudy To descrlbe a populaTlon of old-old women were: age,
marITaI sTaTus, race, employmenT sTaTus, Income level,
educaTIon, and household headshlp. The frequency

dIsTrIbuTlons are presenTed In Table 3.

Age. The age of The older parTIclpanTs ranged from 75

To 89 years. The mean age was 79 (n324). Thls age range
Is referred To as The old-old (NeugarTen, 1974). Thelr
needs are ofTen deflned by mulTIple losses assoclaTed wlTh
deaTh of Thelr maTes, sIblIngsand frlends. Decreaslng
physlcal abIlITles are relaTed To chronlc dlseases
assoclaTed wlTh aglng, l.e., arThrITIs, necessITaTIng more

frequenT need for assIsTance ouTsIde one's self.

Mani:ai_§1a1n§. Two-Thlrds (671) onghe women In The older
group were wldowed. Fewer Than; one-fIfTh (171) were
marrled. ThIrTeen percenT (n83) fidenTIerd Themselves as
slngle and four percenT (n81) llsTed Themselves as

dlvorced. Thls fIndIng Is closely relaTed To The naTIonal

 

sTaTIsIc on marlTal sTaTus for women Thls age.

Race. All of The women In The sTuhy were Caucaslan.
Thls Is noT represenTaTIve of The ToTaI populaTlon.
MInorITIes, especlally black women and hIspanIc women, have

llfe expecTancles of 3-5 years shorTer Than Caucaslon

109

women (U.S. Census Bureau, 1982). The dlfferences In need
for soclal supporT may be quITe dlfferenT wlThIn each race
as a resulT of values and eThnIc background. IT Is llkely

ThaT boTh would Influence percepTIon and need for supporT.

Empigymen1_fiiaxus. WITh buT one excepTIon all of The

women were reTIred. Thls fIndIng was expecTed for The age

range of 75 To 89.

income. FIny seven percenT (n-IZ) of The older group of
women llsTed Thelr Income as beTween $5,000 and $9,999.
FourTeen percenT (n83) llsTed Income beTween $10,000 and
14,999. Ten percenT (n82) llsTed Incomes beTween 15,000-
19,000; 20,000-24,999: and 25,000-29,999 respecTIvely. No
one llsTed Income above $30,000 per year. The mean Income
of The older age group was 3.190 or beTween 510,800 and

$15,000 per year.

Enunniinn. AlmosT one-Thlrd (301) of The women had
graduaTed from college and Three (131) had recelved
professlonal Tralnlng. TwenTy-nlne percenT (n87) had aT
leasT one year of college educaTIon. SevenTeen percenT
(n=4) were ngh School graduaTes. Four percenT (n81) had
compleTed ngh School 10-11; SevenTeen percenT (n-4)
compleTed 7-9: and four percenT (n21) had compleTed less
Than seven years of schoollng.

flann_gi_1ne_flgusengld. NoT unexpecTedly, elghTy-Three

percenT (n-20) of The lndlvlduals In The older group descrlbed

110

Themselves as head of The household. Those females who
were marrled, sevenTeen percenT (n-4), responded ThaT They

were noT The head of The house.

WW

Pearson ProducT MomenT correlaTIons were uTIlIzed To
calculaTe The degree and The dIrecTIon of relaTlonshlps
beTween selecTed socIodemographlc varlables concernlng The
old-old group of women (age, Income, and educaTIon) and
each scale uTIlIzed In Thls sTudy. The correlaTIon maTrIx
Is presenTed In Table 4. CorrelaTlon coeffIcIenTs (r)
range from -1.00 for a perfecT negaTlve correlaTIon,
Through zero for no relaTIonshIp, To +1.0 for a perfecT
posITIve correlaTIon. The hlgher The absoluTe value of
The coeffIcIenT (ThaT Is, The value dIsregardIng The slgn),
The sTronger The relaTIonshIp. A correlaTIon of -85, for
InsTance, Is sTronger Than a correlaTIon of +35 (PolIT 6
Hungler, 1978). A negaTlve relaTIonshIp Is one In whlch
hlgh values on one varlable are relaTed To low values on
The oTher. When a mlnus slgn Is noT presenT The
relaTIonshIp Is posITIve and Is obTalned when hlgh values
on one varlable are assoclaTed wITh hlgh values on The
second varlable. The maganude of The relaTIonshIp Is also
IndlcaTed by The absoluTe value of The correlaTIon

coeffIcIenT (r).

Table 3. Demographlc Varlables concernlng older
women (age, marITal sTaTus, eThnIc
background, employmenT sTaTus, head of
household) (N824).

 

 

 

Number of
Varlable RespondenTs PercenT
Age 75-89 24 100.0
MarITal STaTus
Marrled 4 17.0
SeparaTed 0 0.0
Dlvorced 1 4.0
SIngle 3 13.0
Wldow 16 67.0
Race
WhITe 24 100.0
Black 0 0
Mexlcan Amerlcan 0 0
lndlan 0 0
OrlenTal 0 0
OTher 0 0
EmploymenT STaTus
ReTIred 23 96.0
Unemployed I 4.0
Employed 0 0

Head of Household
No 4 17.0
Yes 20 83.0

 

112

Table 3. CpnTInued.

 

 

 

Number of
Varlable RespondenTs PercenT
EducaTlon
College graduaTe wlTh
professlonal Tralnlng 3 131
College graduaTe 4 171
AT leasT one year of
college 7 291
ngh School graduaTe 4 171
CompleTed 10-11 years
of ngh School I 041
CompleTed 7-9 years
of ngh School 4 171
CompleTed less Than
7 years of school 1 041
Income Level
0 - 4,999 0 0
5,000 - 9,999 12 571
10,000 - 14,999 3 141
15,000 - 19,999 2 101
20,000 - 24,999 2 101
25,000 - 29,999 2 101
30,000 - 34,999 0 0

 

113

CorrelaTIons were InTerpreTed as:

value of (r) sTrengTh of relaTIonshlp
0.00 To 0.20 no meanlngful relaTIonshIp
0.20 To 0.35 very sIIghT

0.35 To 0.65 moderaTe To falr

0.65 To 0.85 marked To falrly hlgh

0.85 To 1.00 hlgh To very hlgh

(Borg & Gall, 1979)
CorrelaTlon coeffIcIenTs can be TesTed for sTaTIsTIcaI
slgnlflcance. The mInImum level of slgnlflcance consldered
accepTable for Thls sTudy was The .05 level. The followlng
sTaTemenTs summarlze The sTaTIsTIcaIly slgnlflcanT

correlaTIons ThaT are depIcTed In Table 4.

1. There Is no sTaTIsTIcaIly slgnlflcanT relaTIonshIp
beTween age of The old-old female sample and emoTIonaI
supporT recelved. The analysls dld show, however, an
Inverse relaTlonshlp beTween age and emoTIonal supporT.
ThaT Is, as females age They reporTed recelvlng less
emoTIonal supporT ( p< .15).

2. No sTaTIsTIcally slgnlflcanT relaTlonshIp was found
beTween Income and emoTIonal supporT (Pe<.40). scale. A
correlaTIon coeffIcIenT of .0331 (p=.40) was obTalned.
Thls sample of older women had hlgher Than average Incomes
and percelved They were recelvlng emoTIonal supporT.

3. There was no meanlngful relaTIonshlp beTween educaTIon
of The old-old female sample and The emoTIonal supporT
scale. A correlaTIon coeffIcIenT of .0707 (p=.30) was

obTalned.

114

Table 4. CorrelaTIon MaTrIx: RelaTlonshIp BeTween
SelecTed Soclodemographlc Varlables
of The Old-Old Women and EmoTlonal SupporT
And Tanglble Ald Scale.

 

 

 

Scale Age Income EducaTlon
EmoTIonal SupporT -.1349 .0331 .0707
Tanglble SupporT -.2856* -.0787 .0820

* P-<.1

4. A very sIIghT relaTlonshIp exlsTs beTween age of The
old-old female sample and The Tanglble supporT. A
correlaTIon coeffIcIenT of -.2856 (p-<.Ol) level was
obTalned. Such an Inverse relaTlonshIp may Imply ThaT
as women age They percelve less Tanglble aId Is avallable

To Them.

5. No meanlngful relaTIonshIp beTween Income of The old-
old sample and The Tanglble supporT scale was found. A
correlaTIon coeffIcIenT of -.0787 (p-.28) was obTalned.
Thls Inverse relaTIonshIp may mean ThaT older women may noT

feel money Is relaTed To wheTher Tanglble aId Is avallable.

115

6. There was no meanlngful relaTIonshIp beTween educaTIon
of The old-old sample and The physlcal supporT scale. A

correlaTIon coeffIcIenT of .0820 (p-.27) was obTalned.

5.0mm

The descrlpTIve fIndIngs of The sTudy sample were
presenTed In Thls secTIon. The sample was found noT To be
represenTaTIve of older women In The general populaTlon In
several ways. FIrsT, Thelr educaTIonal levels were much
hlgher wITh nearly 30 percenT aTTendIng college. Second,
Thelr reTlremenT Incomes were hlgher whlch correlaTes wlTh
The hlgher levels of educaTIon.

AddITIonaI fIndIngs were also presenTed wlTh selecTed
soclodemographlc varlables (age, Income, educaTIon) belng
correlaTed wlTh each of The emoTIonal supporT and Tanglble
ald scales used In Thls sTudy. Only one slgnlflcanT
correlaTIon was found beTween age and percepTIon of
Tanglble supporT avallable. Thls was noT unexpecTed as
women In The old-old range are more llkely To requlre more
Tanglble assIsTance and be unable To flnd IT avallable.
DescrlpTIve daTa and The research quesTIon; Is There a
dlfference In The mean value of percelved emoTlonal supporT
recelved and percelved Tanglble aId avallable among women
aged 75 To 89?, Is presenTed In The nexT secTIon.

W
In Thls secTIon The research quesTIon wIll be

presenTed wlTh ITs assoclaTed daTa. A brlef explanaTIon of

116

The rellabIlITy of The InsTrumenT and sTaTIsTIcal
Technlques uTIlIzed To analyze The daTa Is addressed
IanIally. Followlng The presenTaTIon of The reseach
quesTIon wlTh The old-old sample, demographlc varlables and

descrlpTIve fIndIngs from The parallel sTudy by SefTon-

CoJocel (1984) wlll be presenTed.
W
W

The rellablllTy of The Norbeck Soclal SupporT

OuesTlonnalre has been esTabllshed In Two sample
populaTlons; graduaTe nurslng sTudenTs and worklng adulTs
(Norbeck 1981, 1982). To esTablIsh The rellabIlITy In an
aglng populaTlon, The lnTernal conslsTency of emoTIonal end
Tanglble supporT ITems were evaluaTed uslng Cronbach's
alpha. The Cronbach's alpha Is a measure of The exTenT To
whlch all ITems conTrIbuTe To a slngle common dImensIon or
facTor. The Cronbach alpha Is used To IndlcaTe The
rellabIlITy or unIformITy of scale ITems by comparlng The
obTalned values wlTh each ITem successlvely deleTed. The
daTa used To calculaTe Cronbach's alpha come from The
Pearson ProducT MomenT CorrelaTIons beTween Three emoTIonal
ITems and Two Tanglble ald ITems for The flrsT Three
slgnlflcanT oThers llsTed by each respondenT In The sTudy.
The Pearson CorrelaTIon CoefflclenTs are presenTed In
Tables 5 and 6. AnalysIs of The Cronbach alpha on The
Three emoTIonal supporT (affecT and afflrmaTIon) ITems for

Three slgnlflcanT oThers ylelded a high rellabIlITy

117
coeffIcIenT for The nIne ITems (alpha 8 .87). The range of
alpha values (.83764 To .87347) demonsTraTes conslsTenle
hlgh correlaTIons among The emoTIonal ITems.

Analysls of Two Tanglble ald (physlcal supporT) ITems
for Three slgnlflcanT oThers ylelded a rellabIlITy
coeffIcIenT for The st ITems of .79 (range .73628 To
.78856). Thls fIndIng shows conslsTency beTween The Two
ITems and provIdes The raTIonale for comblnlng The Tanglble
aId ITem responses lnTo one Tanglble aId score.

In summary, evaluaTIon of The Norbeck Soclal SupporT
OuesTIonnaIre ITems of soclal supporT and Tanglble old by
The Cronbach's alpha provIded sTaTIsTIcaI supporT for
comblnlng ITems lnTo one score for each Type of supporT.
The followlng secTIon descrlbes The sTaTIsTIcal averaglng
-process for comblnlng ITems To geT a mean value on The
emoTIonal supporT score and one mean value on The Tanglble
aId score.

Dsscciniion_oi_Siaiisiicai_Axscasins

An averaglng process was used To compuTe lndlvldual
mean scores for percelved emoTIonal supporT and for
percleved Tanglble ald for each sTudy subjecT. These
scores :IndIcaTe The amounT of supporT each lndlvldual
percelved They recelved from The flrsT Three slgnlflcanT
oThers They llsTed. Only The flrsT Three slgnlflcanT
oThers were chosen for analysls because They llkely

represenT The closesT members of The neTwork, and because

1.113

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n00. at
n0nn.

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.0008 en mesa. .eco.ucla n no. aucu.u...eou so.u:.euue0 meanest

 

u auaa<h

119

Table 0

Pearson Correlation Coefficients for 2 Tangible Aid
Items on NSSQ. Data from Responses about 3 Significant
Others (5.) (N -60 in all conditions

Tangible Aid 1 Tangible Aid 2
(Tangible Help) (Help When Ill)

 

5.0.1 $00.2 8.0.3 5.0.1 5.0.2 5.0.3

Tangible Aid 1
(Tangible Help)

5.0 1 1.000

P.**.

5.0.2 .3589 1.000
P=.002 P=***

3.0 3 .3968 .5431 1.000
P-.001 P=.001 P=***

Tangible Aid 2
(Help When Ill)

3.0. 1 .3644 .1431 .3700 1.0000
p-.002 p=.129 92.002 P=***

3.0. 2 .1278 .5987 .4041 .5052 .1.000

P=.165 92.001 p=.001 P=***
5.00 3 .2236 .3398 .4023 .4244 .5393 1.000
P=.043 p-.001 p=.001 P=.001 p=.001 p.***

120

The non-response raTe rose rapIdly afTer The flrsT Three
slgnlflcanT oThers were llsTed.

The mean scores were derlved uslng lndlvldual response
daTa. from each of The lndlvldual's responses. For
example, each respondenT answered Three emoTIonal supporT
quesTIons for each slgnlflcanT oTher named. The values of
The response on each emoTIonal supporT ITem for one
slgnlflcanT oTher (Three scores) were added TogeTher and
dlvlded by 3, formlng one slngle value. The averaglng
process ylelded Three emoTIonal supporT scores and Three
Tanglble aId scores (one from each slgnlflcanT oTher). The
mean of These composITe values for each Type of supporT was
Then used In TesTs of slgnlflcance To evaluaTe dlfferences
beTween The mean percepTIons of soclal supporT of Two
Types, emoTlonal supporT and Tanglble aId. In The nexT
secTIon The research quesTIon for The old-old sample wlll
be addressed.

W

The research quesTIon for The presenT sTudy: "Is
There a dlfference In The mean value of percelved emoTIonal
supporT recelved and percelved Tanglble ald avallable among
women aged 75 To 89?" was examlned by a T TesT comparlson
of composITe means for each subjecT In The old-old group
(N-24). The resulTs of The T TesT are presenTed In Table
6.

121

In Thls sample of old-old women, a large dlfference
(1.0995) was found In The mean for percelved emoTIonaI
supporT recelved (x- 4.4120) and for percelved Tanglble ald
avallable (x- 3.3125). The sTandard devIaTIon for
percelved emoTIonal supporT was .522 whlle The sTandard
devIaTIon of percelved Tanglble aId avallable was 1.213
(Table 7). The sTandard devIaTIon Is an Index of how
varlable The scores In a daTa seT are and can be
InTerpreTed as an IndlcaTIon of The degree of error when a
mean Is used To descrlbe a daTa seT (PolIT A Hungler,
1978). In compuTIng The means and sTandard devIaTIon In
large samples from a populaTlon The dlsTrIbuTIon of Those
sample means wlll be approxlmaTer normal. When The sample

Is small (less Than 30), as In Thls sTudy, crITIcal values

are Taken from a Table of dIsTrIbuTlons called STudenT's T ,

dIsTrIbuTlons. These dIsTrIbuTlons are symmeTrIcal and
clusTer abouT The mean, buT Thelr graphs Tend To be flaTTer

Than normal curves (Nalman eT al.,1972).
025921£111£_Einnins§-ni_Ihn lnnns:flln_fiimnis 5100100
hx.§aiinn.£ninaal_ilflflil

The demographlc varlables uTIlIzed by SefTon-Cojocel
(1984) To descrlbe a populaTlon of young-old women, ages 65
To 74 were: age, marITal sTaTus, eThnIc background,
employmnmeT sTaTus, Income level, educaTIon, and wheTher
They were head of The household. The frequency

dIsTrIbuTlons are presenTed In Table 8.

122

Table 7. ComposITe Mean Scores for EmoTlonal SupporT
and Tanglble aId In Women Aged 75 To 89

 

 

 

(N-24).
Number STandard STandard DIfferences T
Varlable Cases Mean DevIaTIon Error (Mean) Value
EmoTlonal 24 4.4120 .522 .106
1.0995 5.08
Tanglble 24 3.3125 1.213 .248

 

Degree of Freedom . 23
Z-Tall ProbabIIITy (p<.001)

Age. The age of The younger parTIclpanTs ranged from
65 To 74 years, referred To as The young-old (NeugarTen,

1974).

Haniiai_fiiains. TwenTy-flve percenT (n-9) of The
young-old group were marrled. SevenTeen percenT (n-6)
women were dlvorced. FIny-slx (n=20) women were wIdowed,
and one lndlvldual or Three percenT of The populaTlon, was
slngle.

Rage. Of The younger group of women, nIneTy-four
percenT (n=34) were caucaslan. SIx percenT (n-2) women

were Black.

123

Table 8. Demographlc Varlables concernlng a young-
old populaTlon of women (age, marlTal
sTaTus, eThnlc background, employmenT
sTaTus, head of household) (N-36).

 

 

 

Number of
Varlable RespondenTs PercenT

Age 65-74 36 100.0
MarlTal STaTus

Marrled 9 25.0

SeparaTed 0 0.0

Dlvorced 6 17.0

Slngle 1 3.0

Mldow 20 56.0
EThnlc Background

Mthe 34 96.0

Black 2 6.0

Mexlcan Amerlcan 0 0.0

lndlan 0 0.0

OrlenTal 0 0.0

OTher 0 0.0
EmploymenT STaTus

ReTlred 32 91.0

Unemployed 1 3.0

Employed 2 6.0

Head of Household
No 9 25.0
Yes 27 75.0

 

124

Table 8. ConTlnued.

Number of
Varlable RespondenTs PercenT
EducaTlon ,
College graduaTe wlTh
professlonal Tralnlng 4 113
College graduaTe 2 65
AT leasT one year of
college 8 22!
ngh School graduaTe 16 441
CompleTed 10-11 years
of ngh School 3 BS
CompleTed 7-9 years
of ngh School 3 8S
CompleTed less Than
7 years of school 0 01
Income Level
0 - 4,999 5 151
5,000 - 9,999 10 291
10,000 - 14,999 5 155
15,000 - 19,999 5 15¢
20,000 - 24,999 7 213
25,000 - 29,999 1 31
30,000 - 34,999 1 31
35,000 and above 0 0

125

Emainxmnni_fiiaius. Slx percenT (n-Z) of The women

were employed. NlneTy-one percenT (n=32) were reTIred and
Three respondenTs were unemployed.

income. Income levels are varled among Thls group,
wlTh TwenTy-nine percenT (n-10) of The women IlsTlng Thelr
lncome beTween $5,000 and $10,000. FlfTeen percenT (n-5)
had lncomes below $5,000, and beTween 310,000-315,000 and
$15,000 and $20,000 respecTIvely. TwenTy-one percenT (n-7)
had lncomes beTween $20,000 and $25,000. Three percenT had
lncomes beTween $25,000 To $30,000 and $30,000 To £35,000.

Educailnn. Eleven percenT (n84) women were college
graduaTes wlTh professlonal Tralnlng. Slx percenT (n-Z)
had a college educaTlon, whlle TwenTy-Two percenT (n'8) had
aTTended college for aT leasT one year. ForTy-four percenT
(n-16) had graduaTed from ngh School. ElghT percenT (n=3)
had compleTed 10-11Th grade and 7-9Th grades respecTIvely.
All respondenTs 1n The young-old group had educaTlon To The
7Th grade.

Hsafi_gi_1nn_flgusgnoid. SevenTy-flve percenT (n-27) of
The women In Thls group had llsTed Themselves as head of
The household. TwenTy-flve percenT (n39) were noT head of

Thelr households.

W
W

In This sechon The research quesTIon asked by SefTon-

Cojocel wlll be presenTed wlTh lTs assoclaTed daTa. The

126

research quesTIon asked by SefTon-Cojocel (1984) Is: "Is
There a dlfference In The mean value of percelved emoTlonal
supporT received and percelved Tanglble ald avallable among
women aged 65 To 74?" was examlned by The STudenT's T TesT.
Comparlson of composlTe means were made for each
parTIclpanT ln The younger age group (n-36). The resulTs
of The T TesT are presenTed In Table 9.

Analysls of The daTa uslng The sTudenT-T TesT showed a
sTaTlsTlcal dlfference beTween percepTIon of Tanglble
supporT avallable and emoTlonal supporT recelved. The mean
was X a 3.95 for Tanglble supporT wlTh a level of
slgnlflcance of P< .001. The dlfference ln sTandard
devlaTlons .544 for emoTlonal supporT and .998 for Tanglble
ald represenTs a 0.5 dlfference. There was a dlfference
beTween The mean for percelved emoTlonal supporT recelved
and percelved Tanglble ald avallable In This sTudy
populaTlon of women aged 65 To 74, and ThaT only one Tlme
In one Thousand Thls greaT a dlfference would have occured

by chance.

127

Table 9. ComposlTe Mean Scores for EmoTlonal SupporT
and Tanglble Ald In Women Aged 65 To 74 (N-36)

 

 

Number STandard STandard DIfferences T
Varlable Cases Mean DevlaTlon Error (Mean) Value
EmoTlonal 36 4.5617 .544 .091
.6034 3.68
Tanglble 36 3.9583 .988 .165

 

Degree of Freedom 8 35
2-Tall ProbablllTy (p<.001)

Sumau
The descrlpTIve flndlng of The parallel sTudy

conducTed by SefTon-CoJocel was presenTed ln Thls sechon
as well as The descrlpTIve daTa and research quesTIon: "Is
There a dlfference ln The mean value of percelved emoTlonal
supporT recelved and percelved Tanglble ald avallable among
women aged 65 To 74?". Flndlngs IndlcaTed ThaT women ln The
young-old age group percelved emoTlonal supporT and
Tanglble ald dlfferenle, and These Two Types of supporT
are llkely dlsTlncT. Adlelonally, Tanglble supporT was

percelved To be less avallable by The young-old. In The

128

lasT secTIon The JolnT collaboraTlve reseach quesTlon
concernlng percepTIons of emoTlonal supporT recelved and
Tanglble ald avallable among The Two groups of women wlll

be dlscussed.

Wm
W

In collaboraTIon wlTh SefTon-Cojocel (1984), daTa
comparlng emoTlonal supporT and Tanglble ald beTween The
young-old group aged 65 To 74, and The old-old group, 75 To
89 are presenTed In Table 10. A comparlsons of The Two age
groups percepTIons of emoTlonal supporT revealed a
dlfference 1n means of .1497, ThaT ls The mean of percelved
emoTlonal supporT In The younger group was x-4.5617 and
ThaT of The older group was X 84.4120. The T-TesT was use
To compare The Two groups on The dependenT varlables. The
older group had a lower mean value for percelved emoTlonal
supporT recelved buT The T-value was noT sTaTlsTlcally
slgnlflcanT.

Comparlng The composlTe means for percelved Tanglble
ald avallable beTween The groups, The daTa shows a greaTer
margln beTween The dlfference of means (dms .6458).
The sTandard devlaTlon of The young-old group was
(SD-9.88) and The old-old group (SD=1.213). The 2-Tall
probablllTy lndlcaTes Thls dlfference ln means To be valld
971 of The Tlme aT (p=.027). Thls can be lnTerpreTed as

The maganude of The dlfference beTween means would be due

129

Table 10. ComposlTe Mean Scores for EmoTlonal SupporT and
Tanglble Ald BeTween Two Groups of Women aged
65 To 74 and 75 To 89.

 

 

 

Number STandard STandard DIfference T
Varlable Cases Mean DevlaTlon Error (Means) Value
Percelved
EmoTlonal
SupporT
Group 1 36 4.5617 .544 .091
(65-74) ,
.1497 1.06
Group 2 24 4.4120 .522 .106
(75-89)

 

Percelved
Tanglble
Ald
Group 1 36 3.9583 .988 .165
(65-74)
.6458 2.26
Group 2 24 3.3125 1.213 .248
75-89)

Degrees of Freedom = 58

2-Tall ProbablllTy =(p=.293) for emoTlonal (pooled
varlance esTlmaTe).

2-Tall ProbablllTy =(p-.027) for Tanglble (pooled varlance
esTlmaTe).

130
To chance only 3 ouT of 100 Tlmes. The large dlfference
suggesTs ThaT The respondenTs In The Two groups percelve
Tanglble ald dlfferenle. The women In The older group
also percelve slgnlflcanle less Tanglble supporT ls
avallable To Them. Thls flndlng was expecTed slnce older
women In Thelr sevenTles and elgthes are experlenclng

greaTer need for Tanglble supporT.

Sumac:

In summary, The daTa analysls for Thls sTudy revealed
Three major flndlngs:

l. The rellablllTy (lnTernal conslsTency) of The emoTlonal
supporT lTems and Tanglble ald lTems ln The Norbeck Soclal
SupporT QuesTlonnalre was conflrmed wlTh an elderly sTudy.
2. SIgnIfIcanT dlfferences were found wlThln each age
group beTween The mean of percelved emoTlonal supporT
recelved and The mean of percelved Tanglble ald avallable.
3. A slgnlflcanT dlfference was found beTween The younger
and older group of women on The mean percepTIon of Tanglble
ald avallable.

In ChapTer VI, The sTudy flndlngs will be lnTerpreTed
and summarized. ImplIcaTlons wlll be dlscussed ln relaTlon
To The concepTual framework uTlllzed as The TheoreTlcal
basls for The sTudy and In relaTIon To nurslng prachce,

nurslng educaTIon, and furTher research.

CHAPTER VI

SUMMARY AND IMPLICATIONS

(Innis:

Thls lasT chapTer conTaIns a revlew of The Thesls
conTenT. FIrsT, The flndlngs are presenTed and concluslons
dlscussed. Then, ImplIcaTlons and recommendaTlons for
nurslng prachce, nurslng educaTIon and research are
presenTed.

The purpose of Thls sTudy was To examlne The
characTerIsTIcs of an aglng sample of women and To
sTaTlsTlcally deTermIne If They percelved emoTlonal or
Tanglble supporT dlfferenle. The resulTs have been
compared To a slmllar sTudy underTaken by SefTon-CoJocel
(1984) who measured The Same varlables ln a young-old
sample of women. Analysls of The comblned daTa lndlcaTes
ThaT There were slgnlflcanT dlfferences wlThln each age
group (young-old and old-old women) beTween The mean of
emoTlonal supporT recelved and The mean of percelved
Tanglble ald avallable. Adlelonally, a slgnlflcanT
dlfference was found beTween The younger and older sample
of women on The mean percepTIon of Tanglble ald avallable.
The appllcaTlon of These flndlngs wlll now be dlscussed as

|31

132

They relaTe To The samples and Those of The general

populaTlon of elderly women.

Chanac1eLlsilcs_oi_1bs.fiiun¥_5amnls

Sax._Aoes_MaLliai_Siaius. All parTIclpanTs In This sTudy

were females beTween The ages of 75 To 89, wlTh an average
age of 79 years; The span of years referred To as The old-
old (NeugarTen, 1974). IT Is well known ThaT females
ouTlIve males and wlTh The changes ThaT have occurred In
decreased InfanT morTallTy The older populaTlon has
Increased In numbers wlTh proporTIonaIly more women.
Concern over Thls growlng number of aglng females has
InITIaTed a number of conferences and dlscusslons relaTed
To ways To Improve healTh and qualITy of llfe for women
(HhITe House Conference on Aglng, 1981; chkey, 1980;
NaTlonaI lnsTlTuTlon on Aglng, 1982).

Nurslng responds To socleTaI Trends In an efforT To
meeT The percelved healTh needs of The cuITure In whlch IT
exIsTs. UsIng sTaTIsTIcal daTa and emplrlcal research as
The basls of cIInIcal lnTervenTIon IT Is evldenT ThaT age
and belng female may be a sTrong predIcTor of healTh
pracTIces and prevenTIve healTh care (Gallln, 1980; Harrls
eT al., 1975). Among facTors sTudIed ThaT have been
relaTed To healTh, soclal supporT has become a major focus.
Several researchers have ldenTIfled ThaT age and sex (belng

female) Influences The amounT and Type of soclal supporT

133

requlred for opTImal funcTIonlng (Branch and JeTTe, 1983;
Cobb, 1976; HaggerTy, 1980; Norbeck, 1981).

In Two sTudles soclal supporT needs were sTudles In
relaTIonshlp To sex. In The flrsT sTudy, females reporTed
havlng more soclal supporT avallable from peers buT also
more llfe sTress Than males (Burke and Nelr, 1978). In The
seCond sTudy conducTed by LowenThal and Haven (1968)
elderly women reporTed havlng a confldanT whereas The males
In The sTudy dld noT. AddITIonaI research Is needed To
deTermIne The soclal neTwork paTTerns esTabllshed by boTh
men and women and as women's roles change soclal supporT
paTTerns may Take on a dlfferenT pIcTure.

In Thls sTudy sample of old-old women Two Thlrds or 67
percenT of The sTudy parTIclpanTs were wldowed whlch Is
represenTaTIve (691) of women In The general populaTlon
(U.S Census Bureau 1980). Among older adulTs, marITaI
sTaTus has been relaTed To wheTher or noT The person
reporTed havlng a confldanT: marrled persons were more
llkely To have a confldanT Than wldowed, wldowed more Than
dlvorced or separaTed, and dlvorced or separaTed more Than
slngle perons (LowenThal and Haven, 1968).

In summary, age, sex, and marITaI sTaTus, are
properTIes of The person whlch Influence how much soclal
supporT may be needed by an lndlvldual, as well as how much
may be avallable To Them. In Thls sTudy sample of 24 old-

old women longevITy and wldowhood -are llkely To have

134

Influenced The need for supporT and Therefore The
percepTIon of Tanglble ald avallable. OTher sTudles cITed
appear To supporT Thls, however The exTenT To whlch These
varlables Influence soclal supporT are noT well deflned.
ConTInued research ls necessary To lsolaTe speclflc
characTerIsTIcs ThaT may Influence soclal supporT needs so
ThaT lnTervenTIon sTraTegIes can be Tallored To parTIcular
soclal supporT defIcITs.

Raga. All parTIclpanTs In The sTudy were Caucaslan.
NaTIonaI daTa based on U.S. Census Bureau (1984) sTaTIsTIcs
IndlcaTe ThaT females over The age of 65 were 12.7 percenT
of The ToTal populaTlon. 0f Thls 12.7 percenT 13.5 mllllon
are wthe females and 1.3 mIllIon are black. No
comparlslons can be made wlTh oTher races from Thls sTudy.
Research on elderly mInorITIes have been noTorlously
negIIgIble In The pasT (NhITe House Conference on Aglng,
1981). Census daTa, however IndlcaTe ThaT elderly
mInorITIes more ofTen have lower llfe expecTancles and are
poorer Than elderly thTe females. These facTors are
llkely To affecT need and avaIIabIITy of soclal supporT.
E.cl.|.l.c:.a.‘l:.l_.924:1..__.E1n.:2_I,.cz,y1na.n.:l:_..___l_.n.c;521n_e_.|_.e;;.a_l__.L Nearly one-Thlrd or
30 percenT of The female parTIclpanTs In ThIs sTudy were
college graduaTes and Three parTIclpanTs had compleTed
college and professlonal educaTIon. In addITIon nearly
one-half (475) had compleTed HIgh School. Compared To

naTIonaI daTa The medlan number of school years compleTed

135

for females over 55 years of age Is 12.1 years. Only 7.4x
of all aglng females over age 65 have a college degree.

The hlgher Than average educaTIon levels found In Thls
sample may be relaTed To The facT ThaT The sample was Taken
In close proxlmlTy To a major unIversITy where values,
aTTITudes and avallable opporTunITIes may be greaTer.
AddITIonally, educaTIon and Income have been posITIvely
correlaTed, lncreaslng The IIkelIhood ThaT The sample would
have hlgher levels of Income.

NlTh The excepTIon of one woman all respondenTs In
Thls sTudy were reTlred as would be expecTed. Over one-
half (57$) reporTed Incomes up To 10,000 per year whlle 44$
reporTed Incomes up To $30,000 per year. Compared To
naTIonaI sTaTIsTIcs The average Income for females In 1982
was $5,607 (Bureau of The Census, 1984).

In 1959, one-half of all elderly women fell below The
poverTy IIne. AlThough The offlclal governmenT "poverTy
Index" was noT developed In The 1960's, poverTy among The
aged was consldered serlous. Accordlng To daTa .prepared
for delegaTes To The 1961 Nthe House Conference on Aglng,
6-mIlIIon elderly persons were lIvIng on Incomes ThaT were
consldered lnadequaTe. lnadequaTe was noT deflned.
CurrenTIy The poverTy level Is seT for below $3,400 per

year (Hasblnsion Social Lesisiaiinn Buiieiin 27. I982)-

Slnce 1959, elderly thTe women have made remarkable galns

136

and The poverTy raTe has dropped To 16 percenT (KuTz 1982).
Of speclal concern are elderly women lIvIng alone. The
poverTy raTes for Thls group of women are very hlgh. One-
quarTer of all elderly thTe women lIvIng alone, one-half
of Hlspanlc women, and Two-Thlrds of aglng black women have
Incomes below The poverTy llne.

The affluenT elderly, on The oTher hand, may be
vlchmlzed by greaT dIscrlmInaTIon (Alford, 1978). Alford
worked wlTh old people of The upper mlddle class who were
dIsTressed over legal baTTles and szndles and had Traveled
greaT dIsTances In search for healTh remedles. Because
They had money They were ofTen overcharged and underserved
by professlonals. Many had fears ThaT someone would Take
advanTage of Them.

To summarlze, women In Thls sTudy have hlgher
educaTIonaI levels and hlgher reTlremenT lncomes Then Thelr
cohorTs In general. These characTerIsTIcs need To be
consldered when lnTerpreTlng The sTaTIsTlcaI flndlngs In

percelved emoTlonal supporT and Tanglble aId avallable as

They wIII llkely Influence The women's percepTIons of need.
Thls wlll be dlscussed furTher In The nexT secTIon. SInce
The sample was small and deflned by race addITIonal
research Is necessary wlTh a randomlzed sample To

generallze The flndlngs, however The flndlngs In Thls sTudy
wlll add To The overall flndlngs In women's and soclal

supporT research.

137

WWW

SelecTed soclodemographlc varlables concernlng The
elderly women In Thls sTudy (age, educaTIon, and Income)
were correlaTed wlTh each scale uTIlIzed In The sTudy. In
ChapTer V, resulTs of The Pearson ProducT MomenT
CorrelaTIons were reporTed beTween These relaTlonshlps
(Table 4). In Thls secTIon daTa wlll be summarlzed and
ImplIcaTlons presenTed.

Age. There were negaTIve relaTlonshlps found beTween
age of The respondenTs and boTh scales for emoTlonal
supporT and Tanglble ald. As women age They may be more
llkely To percelve ThaT They need emoTlonal and Tanglble
ald dlfferenTIy. AlThough, only The relaTIonshlp of age and
Tanglble ald reached sTaTIsTlcal slgnlflcance, The
pracTIcal slgnlflcance of boTh musT be consldered along
wlTh oTher descrlpTIve flndlngs from The presenT sTudy.

The majorITy of The sTudy sample were wldows. Nldows,
parTIcularlly The old-old are llkely To have a dlfferenT
llfe pIcTure Than oThers. CohorTs dle or age aT such
varlable raTes ThaT They may be unable To provIde The
lnTImaTe exchange of earller years. TerrITorIes shrInk and
secondary neTwork members may be less avallable To an
lndlvldual. Adlelonally, elders In The old-old range may
have chIIdren In The young-old caTegory, l.e., 60-70.

Nhlle They may percelve ThaT Thelr chIldren are able To

138

provIde sufflcenT emoTlonal supporT They may noT be able
To provIde enough Tanglble aId. Branch and JeTTe (1983)
found ThaT 79 percenT of The women In Thelr sTudy over 85
years requlred addITIonel assIsTance wlTh InsTrumenTal
acTIvITIes of dally lIvIng. MosT of Thls assIsTence was
provIded by chlldren, especlally daughTers. Chlldren may
yeT be worklng and Tlme lImlTs Thelr avallablllTy To asslsT
In Tanglble supporT, or healTh problems may llmIT Thelr
capebllITles To provIde Tanglble supporT.

Enugailgn, There were posITIve relaTlonshlps
correlaTed beTween educaTIon and percepTIon of emoTlonal
supporT and Tanglble aId. Whlle These relaTlonshlps cannoT
be lnTerpreTed as sTaTIsTIcally slgnlflcanT observaTlons
would Imply ThaT lndlvlduals who are more hlghly educaTed
Than non-educaTed lndlvlduals may assess and percelve need
dlfferenle. EducaTlon has been consldered To have a
dlrecT or lndlrecT Influence on longevITy. The hlgher The
educaTIon The fewer The physlcal hazards and job rIsks.
ngher paylng poslTlons afford The lndlvldual beTTer
opporTunITIes for healTh care especlally healTh malnTence,
whlch Is recognlzed as a IongevlTy facTor.

A posITIve relaTlonshlp beTween educaTIon and
percepTIon of emoTlonal supporT mlghT be explalned aT a
TheoreTIcal level. Self-acTuaIlzaTlon Is The hlghesT level
of human funcTIonlng deflned by Maslow (1970). EducaTlon

wheTher obTalned formally or self-TaughT Influences ones

\

139

abIllTy To achleve slgnlflcanT llfe goals and To become
self-acTualIzed. Self-acTuaIlzaTlon Implles ThaT The soclal
surroundlngs are no longer of uTmosT lmporTance.
NeugarTen's (1964) Theorles embrace Thls bellef. Persons
begln In mldllfe To be Increaslngly lnTeresTed In Thelr
InTernal sTaTus and self-deTermIned needs. They begln To
explore Thelr Inner selves and aTTempT To flnd conTInulTy
To Thelr lIves. EmoTlonaI lnvesTmenT In persons and
objecTs may recelve less aTTensIon and ofTen older persons
become more egocenTrlc. Thls emoTlonal deTachmenT has been
observed and lnTerpreTed by some as dlsengagemenT (Cummlngs
and Henry, 1961). OTher TheorlsTs however, feel ThaT
emoTlonal deTachmenT does noT Imply a lack of InvolvemenT
or lnTeresT buT a greaTer focus on Inner sTrengTh ThaT
allows one To rely more on Inner resources raTher Than
oThers for supporT and sTrengTh. Thls may accounT for why
In parT, elderly women In Thls sample percelved emoTlonal
and Tanglble supporT needs dIfferenle.

Income, Income correlaTes hlghly wlTh educaTIon. ln
Thls sTudy sample women were more hlghly educaTed and had
hlgher reTlremenT Incomes Then females In The general
populaTlon. The correlaTIons, Though noT sTaTIsTlcally
slgnlflcanT, beTween Income and emoTlonal supporT was
posITIve whlle The relaTlonshIp beTween Income and Tanglble
aId was negaTlve. In oTher words, Thls sample of older

women wlTh hlgher Incomes percelved They were recelvlng

140

less Tanglble supporT, buT hlgher amounTs of emoTlonal
supporT.

In summary, only one correlaTIon, age and Tanglble
supporT was sTaTIsTIcaIly slgnlflcanT. Old-old women In
Thls sample percelved Tanglble ald To be less as They age,
whlch was expecTed. Several Trends were ldenTIfled among
Income and educaTIon and The emoTlonal and Tanglble ald
scales. In The nexT secTIon, The research quesTIons wIlI

be presenTed wlTh ImplIcaTlons for nurslng.

W

The research quesTIon In Thls sTudy was: Is There a
dlfference In The mean value of percelved emoTlonal supporT
recelved and percelved Tanglble ald avallable among women
aged 75-89? In a parallel sTudy SefTon-Cojocel asked: Is
There a dlfference In The mean value of percelved emoTlonal
supporT recelved and percelved Tanglble ald avallable among
women 65 To 74? A collaboraTlve quesTIon was Then asked Is
There dlfferences In These same percepTIons beTween The Two
groups. In Thls secTIon a summary and ImplIcaTlons of The
flndlngs for The sTudy populaTlons wlll be presenTed.
NexT, The flndlngs from The collaboraTlve research quesTIon
wlll be summarlzed and ImplIcaTlons dlscussed.

In The sTudy sample of old-old women a large mean
dlfference (1.0995) was found beTween percelved emoTlonal
supporT recelved and Tanglble aId avallable (See Table 6,

ChapTer 7). In oTher words, Thls sample of old-old women

141

percelved Tanglble ald To be less avallable To Them Than
They percelved emoTlonal supporT To be recelved. SefTon-
Cojocel, (1984) found a hlgh mean dlfference wlThIn her
young-old sample as well, however, The mean dlfference was
noT as hlgh (.6034) as In The old-old sample.
ConcepTualIy, The hlgh mean dlfferences among Two dlfferenT
age groups demonsTraTes ThaT boTh samples dIsTIngulshed
beTween The Two Types of supporT, as emoTlonal and TangIble
ald. IT ls llkely ThaT emoTlonal and Tanglble supporT are
Two dIsTIncT dImensIons. Thls has been supporTed In oTher
research. Schaefer eT al., (1981) found ThaT Indlces of
emoTlonal and InformaTIonal supporT were hlghly correlaTed,
whereas, The measure of Tanglble supporT was dIsTIncT.

AT a pracTIcal level, several facTors may have
Influenced older women's cholces. In boTh samples
educaTIonal and Income levels were hlgher Than The levels
reporTed for The general female populaTlon of The same
ages. BoTh educaTIon and Income levels are llkely To
Influence The need for, avallablllTy, and use of soclal
supporT. A second facTor relaTes To The complex Issue of
dependence/Independence. PercepTIons of Tanglble ald may
seem more dlffIculT To obTaIn parTIcularlly In The old-old
populaTlon. An example of Thls Is when old-old persons glve
up drlvlng as a resuIT of sensory deflclTs or chronlc
Illness and musT depend on oThers To asslsT Them. If They
use oThers In The kln-neTwork To ofTen They are afrald Thls

wlll be lnTerpreTed as dependency.

142

SafeTy and securITy Issues may also cloud Thelr
percepTIons by ralslng fears ThaT hlrlng someone To help
wlTh Tanglble needs may brlng Them harm. The old-old
especlally feel more vulnerable and whlle They percelve The
need more Tanglble supporT may as a resulT of fear noT
percelve IT avallable.

In summary, The flndlngs show slgnlflcanT dlfferences
wIThIn The young-old sample, and The old-old sample ThaT
women percelve less Tanglble supporT To be avallable To
Them Then recepTIon of emoTlonal supporT. Such flndlngs can
be generallzed To women wlTh slmllar characTerIsTIcs.
Several oTher conTrIbuTIons have been made by Thls sTudy:
I) hlgh mean dlfferences were shown beTween emoTlonal
supporT and Tanglble supporT wIThln each of Two aglng
samples, demonsTraTlng ThaT emoTlonal and Tanglble ald are
Two dIsTIncT dImensIons of soclal supporT, and 2)
valldaTIon of The rellabIlITy (InTernal conslsTency) of The
emoTlonal and Tanglble ITems on The Norbeck Soclal SupporT

Scale was accompllshed wlTh samples of elderly women.

WW1:

Analysls of The comblned daTa from Two samples of
aglng women aged 65 To 74 and 75 To 89 years, demonsTraTed
a slgnlflcanT dlfference (p<.001) In The mean value of
Tanglble ald percelved To be avallable beTween The Two age

groups, wlTh The old-old respondenTs reporTIng less

143

percelved Tanglble ald avallable Then The young-old
respondenTs.

Several facTors may accounT for The dlfferences seen
In percepTIon of emoTlonal supporT and Tanglble supporT
beTween The Two samples of aglng females. One parTIcular
facTor noT conTrolled for In Thls sTudy was changes ThaT
occur beTween The earller and laTer decades of leTe llfe.
Murray eT al. (1980), has noTed ThaT The young-old are more
flexlble In personallTy and are less vulnerable To The
harsh reallTy of aglng. The young-old person ofTen
manlfesTs self-respecT wlThouT concelT; ToleraTes weakness
whlle uslng sTrengTh To The fullesT; regulaTes, dIverTs, or
subllmaTes baslc drlves and lmpulses InsTead of Trylng To
suppress Them. The young-old are llkely To respecT oThers
even If he/she does noT agree wlTh Thelr behavlor; and
dIrecTs energles and creaTIvITy To masTer The envlronmenT
boTh soclal and physlcal (GlTelson, 1975).

For The old-old, aglng Is a Tlme for medITaTlon and
conTemplaTlon, noT camaraderle. Old-old people may be
frlendly and pleasanT, buT They are also egocenTrIc
(Render, I964; Rosen & NeugarTen, 1964, 1981).
EgocenTrchTy Is a physlologlc necesslTy, a proTecTIve
mechanlsm for survlval. The llfe space shrInks for Thls
age group. When old-old people geT TogeTher, cerTaIn

facTors block camaraderle, even If They wanT To be

144

soclable: varylng sTages of deafness, bllndness, oTher
faulTy sense percepTIons, and The facT ThaT They may have
IlTTle In common oTher Than age and pasT hIsTorIcaI evenTs.
FurTher, The old-old have less energy To deal wlTh
challenglng sITuaTIons.

To summarlze, The well young-old are ofTen more In
synchrony wlTh The envlronmenT and have The physlcal and
menTal energy and reserves To repaTTern when defchTs
occur. On The oTher hand, The well old-old experIence more
sensory and physlcal changes as a normal parT of aglng ThaT
ere llkely To affecT Thelr percepTIons of need for,
avallablllTy, and use of emoTlonal and Tanglble supporT.

AnoTher facTor ThaT may have conTrIbuTed To The old-
old respondenTs percepTIon of less percelved Tanglble
supporT belng avallable ls ThaT wlTh Increased age persons
are llkely To have fewer neTwork members To supply
emoTlonal and Tanglble supporT and Therefore have less
opporTunITIes for recelvlng Tanglble supporT.
AddITIonalIy, slgnlflcanT dlfferences may have occured as a
resulT of wordlng of The quesTIons wlThln The Norbeck
Soclal SupporT QuesTIonnaIre. For lnsTance, all Three
emoTlonal supporT quesTIons ask The respondenT To IndIcaTe
"how much" The slgnlflcanT oTher mades you feel
loved/respecTed, or"how much" you are able To conflde In
The slgnlflcanT oTher. Responses To These quesTIons whlle

based on percepTIon also recall pasT experIences wlTh a

 

145

slgnlflcanT oTher. Tanglble ald quesTIons are more
hypoTheTlcal and ask The respondenT, "If you needed 810,
or e rlde To The docTor, or some oTher ImmedIaTe help, how
much could Thls person usually help? RespondenTs may
respond wlTh more cerTaInTy In descrlblng Thelr percepTIons
of whaT They have recelved buT wlTh less cerTaInTy for
fuTure orlenTed sITuaTIons, parTIcularIly The old-old who
are more presenT orlenTed.

In summary, a slgnlflcanT dlfference was observed
beTween The mean for percelved emoTlonal supporT recelved
and percelved Tanglble ald avallable. The women In The
old-old sample noT only percelved Tanglble ald dIfferenle
buT percelved ThaT Tanglble supporT was less avallable To
Them. Whlle The research quesTIon only addresses mean
value dlfferences In The percepTIons of emoTlonal supporT
and Tanglble aId among and beTween aglng women, several
facTors ThaT many Influence These percepTIons have been

dlscussed.

ammummmummm

In addITIon To The elghT lImITaTIons of The sTudy
ouTlIned In ChapTer I, resulTs may have been affecTed by
oTher lImITaTIons. I

1. The flndlngs of Thls sTudy are IlmITed To The
sample or slmllar samples of young-old or old-old women

slnce selecTIon was noT random.

146

2. The sample of old-old women conslsTed of hlghly
educaTed persons wlTh a hlgh socloeconomlc sTaTus.
Flndlngs from Thls sTudy may noT be relevanT To oTher
samples of elderly women who have lower educaTIonal levels

and lower socloeconomlc sTaTus.

WW3

The resulTs of Thls sTudy Include a descrlpTIon of 24
women beTween The ages of 75 and 89 years, and Thelr
percepTIons of emoTlonal supporT recelved and Tanglble ald
avallable To Them. STudy flndlngs wlll be consldered flrsT
In relaTIon To Roger's TheoreTIcal basls of nurslng and
Then wlThln The nurslng process as depIcTed In a model
developed by Norbeck (1981). ImplIcaTlons of The flndlngs
relaTed To pracTIce wlll be dlscussed In Terms of sTaff
nurslng Then In relaTIon To nurses In advanced pracTIce.

Nurslng's professlonally educaTed members have a
responsIbIIITy for elaboraTIon and subsTanTIaTlon of
nurslng's sclenTlfIc base. Nurslng Is boTh a sclence and
an arT. The pracTIce of nurslng encompasses The erT of
nurslng and Is The uTIlIzaTlon of sclenTlfIc and concepTual
knowledge In servlce To people. Accordlng To Rogers
(1970), lndlvlduals are The focus of nurslng who musT be
vlewed holIsTIcally and In consTanT InTeracTIon wlTh The

envlronmenT. Rogers provIdes a concepTual basls for

 

147

undersTandlng cllenTs and a frame of reference for
envlslonlng relaTlonshlps beTween humans and evenTs.

Rogers characTerlzes cllenT and envlronmenTal
exchanges as, "conTInuous repaTTernlng of boTh men/human
and envlronmenT" (p. 53). ConcepTualIy, The sTudy flndlngs
can be consldered paTTerns of aglng women In relaTIon To
Thelr percepTIons To soclal supporT. The facTors ThaT may
Influence soclal supporT need, avallablllTy, and use
Involve complex dynamlc InTeracTIons beTween such varlables
as age, sex, marlTal sTaTus, educaTIon, Income, rellglon,
and culTure. Slmllarly, lndlvldual dlfferences In needs,
abIlITles, and orlenTaTlon To The envlronmenT have dIrecT
ImpacT on soclal supporT needs.

ComplexITy Is a greaTer Issue wlTh aglng lndlvlduals
because The range of dlfferences becomes greaTer, noT
narrower, as older persons move Through The years of
adulThood. Thls Is acknowledged In Rogers' concepTual
sysTem by The Prlnclples of Homeodynamlcs. SInce The
prlnclple of hellcy subsumes wIThIn IT The prlnclples of
resonancy and InTegraIlTy flndlngs wlll be relaTed To The
prlnclple of hellcy. The prlnclple of hellcy ls based on
The assumpTIon ThaT The change whlch comes abouT Through
The InTeracTIon of humans and The envlronmenT Is
conTInuous, and InITIaTes behavloral paTTerns whlch are
ever changlng. In relaTIng The flndlngs of Thls sTudy To

The prlnclple of Hellcy The prachTloner cannoT assume ThaT

148

The percepTIon of all older women are The same. The facT
ThaT Two dlfferenT age groups of women percelved
dlfferences In emoTlonal and Tanglble supporT lends supporT
To Thls assumpTIon. PercepTIons of emoTlonal and
Tanglble supporT needs of aglng women musT be assessed
separaTely and The nurse's assessmenT should be
sufflclenle deTaIled so as To dIfferenTlaTe need,
avallablllTy, pasT and presenT use of soclal supporT.

The concepTual use of The Term envlronmenT Is used by
Rogers To denoTe anyThlng exTernaI To The cllenT.
lndlvlduals wlThIn The neTwork of a cllenT Is parT of ThaT
person's soclal envlronmenT. Whlle percepTIon of The
cllenT was a major varlable and acTual supporT was noT
measured The Two varlables are lmporTanT To assess.
ProjecTIng beyond The scope of Thls sTudy, The llTeraTure
would suggesT ThaT percepTIon and acTual supporT may be
quITe dlfferenT. Nurses should assess noT only The aglng
cllenT's percepTIon of supporT needs buT assess who The
slgnlflcanT oThers are wIThIn The neTwork and Thelr
abIlITles and wllllngness To supply emoTlonal and Tanglble
supporT.

AdlelonalIy, The nurse In advanced pracTIce should
uTIlIze InformaTIon galned from assessmenT To facIlITaTe
cllenTs and slgnlflcanT oThers To IdenTIfy paTTerns of
soclal supporT needs, avallablllTy, and how The cllenT uses

neTwork members To meeT Thelr needs.

149

In summary Rogers' concepTual sysTem provIdes a
framework for vlewlng cllenTs and Thelr InTeracTIon wlTh
The envlronmenT In Terms of ldenTlfylng behavlor paTTerns.
Observlng paTTerns raTher Than lsolaTed evenTs provIde a
useful means of vlewlng The cllenT Indlvldually and
ToTaIly, and Increases The IIkelIhood of accuracy In
assessmenT. Flndlngs from Thls sTudy were dlscussed
brlefly In Terms of The paTTerns ThaT were observed from
daTa collecTed and were applled To Roger's prlnclple of
hellcy. In The nexT secTIon The baslc assumpTIons of
man/human and envlronmenT wlll be dlscussed In relaTIon To
elemenTs of assessmenT, plannlng, InTervenTIons, and
evaluaTIon of The nurslng process. Norbeck's model
IncorporaTIng soclal supporT lnTo cllnclal pracTIce wlll be
uTIlIzed To show These relaTlonshlps. ImplIcaTlons of The
sTudy fIndIng wlll be InTegraTed lnTo The dlscusslon.

CharacTerlsTIcs of The cllenT such as, age, sex,
educaTIon, Income and characTerIsTIcs of The envlronmenT,
neTwork slze, paTTerns of InTeracTIon, have been shown To
jolnTIy deTermIne The lndlvlduals needs. Comprehenslve
assessmenT Is nececessary To deTermIne relevanT facTors
from boTh The cllenT and The envIrOnmenT and To welgh
percepTIon of need and acTuaI avallablllTy of soclal
supporT. WITh Thls InformaTIon The nurse can Then make
cllnlcal judgemenTs wheTher The exIsTIng supporT ls

adequaTe or lnadequaTe.

 

150

To daTe, rellable and valld InsTrumenTs To measure
soclal supporT for cllnlcal assessmenT have noT been
developed, alThough Norbeck's Soclal SupporT QuesTIonnalre
could be adapTed for cllnlcal use. Murawskl and assoclaTes
(1978) proposed ThaT cllnlcal assessmenT of soclal supporT
should Include: an lnvenTory of The lndlvldual's
InTerpersonal supporT sysTem and some measure of The
naTure, sTrengTh, and avallablllTy of Thls supporT; a
deflnITIon of The Indlvlduals's roles; and IndlcaTIon of
The amounT of supporT avallable To meeT These roles durlng
Illness; a measure of The lndlvldual's paTTerns of soclal
affIlIaTIon; and a measure of The lndlvldual's need for
soclal affIlIaTIon.

The descrlpTIve flndlngs In Thls sTudy can only be
generallzed To a Ilka sample, however, IT was found ThaT
dlfferences In percepTIon of emoTlonal supporT and Tanglble
supporT exIsT and ThaT Two sample populaTlons percelve
These Two Types of supporT To be dIsTIncT. Research
flndlngs, supplemenTed wlTh cllnlcal judgmenT, can gulde
The nurse In deTermlnIng wheTher The level of soclal
supporT ls adequaTe or lnadequaTe for a gIven person. The
elderly are noT a homogenous populaTlon. DIsTlnchons were
found In Thls sTudy In The way young-old and old-old
females percelve Thelr needs for soclal supporT. The

quesTIon of how much or whaT Types of supporT are needed

flu .Ll' ' 3.. I

 

151

has noT been ToTally answered and wlll requlre addITIonal
research.

Plannlng and lnTervenTIon are The nexT phases of The
nurslng process When soclal supporT Is assessed To be
lnadequaTe The nurse musT conslder several areas In her
plannlng. Can The exIsTlng neTwork members provIde The klnd
of supporT ThaT Is needed In The sITuaTIon. LITwak and
Szelenyl (I969) conTrIbuTed emplrlcal daTa ThaT suggesT
ThaT dlfferenT funcTIons are carrled ouT by speclflc
prlmary groups. Because of nearness, nelghbors are ofTen
beTTer suITed for assIsTIng In emergencles. Famlly members
ofTen provIde assIsTence on a long-Term basls whlle frlends
are chosen To assIsT on The basls of muTualITy.

AT Thls poInT In Tlme research has noT been conducTed To
evaluaTe The effecTIveness of lnTervenTIon sTraTegIes.
Norbeck (1981) provIdes The followlng guldeIIne for
lnTervenTIon. Nurses should produce mlnlmal dlsrupTIon or
alTeraTIon In The naTural supporT sysTem, unless IT Is a
paThoIoglcal sysTem, whlle enhanclng The capacITy of ThaT
sysTem To provIde supporT.

We:

STaff nurses comprlse The largesT proporTIon of
workers In The healTh professlon, and Those worklng In
acuTe care seTTIngs are mosT numerous. EducaTlonal level

ofTen deTermInes The value lndlvldual nurses place on The

 

I52

sclenTIfIc approach versus an InTuITlve approach. Those
nurses who have been soclallzed To regard research based
pracTIce wlll seek ouT research InformaTIon and IncorporaTe
IT lnTo Thelr pracTIces. Thls socIaIIzaTIon formally
occurs aT The BaccalaureaTe level.

One problem area ldenTIfled In acuTe care seTTIngs Is
The long held myThs of aglng ThaT mosT elderly persons are
sIck, dependenT and requlre frequenT hospITeIIzaTIons.
Thls bellef can lead To lnTervenTIons ThaT promoTe
dependenT behavlors. Sellgman (I975) colned The Term
"learned Helplessness". Brlefly, Thls concepT means ThaT
learned helplessness develops Through repeaTed exposure To
unpredIcTable and unconTrollable evenTs, so ThaT paTIenTs
learn To be helpless. A cycle occurs In whlch The
professlonal and paTIenT belleve Thlngs cannoT be changed
and boTh glve up (Hochhauser, 1981). HospITal rules and
regulaTIons by Thelr naTure, asserT and reTaln conTrol over
The major and mlnor daIly acTIvITIes of paTIenTs. Dress,
mealTlmes, menus, physlcal acTIvITy, envlronmenT, space,
bed Tlme, vIsITIng hours are all prescrlbed for The
paTIenT. Elderly persons who learn and dlsplay helpless
behavlors serve To furTher conflrm The sTereoTypes of aglng
persons and jusTIfy The behavlor of The nurse.

IT wlll llkely be some Tlme before hospITal rules are
changed so ThaT rouTInes can be adapTed To lndlvldual

paTIenT needs, however The area mosT susceplele To change

153

Is ThaT of dlspelllng wldespreed myThs and sTereoTypes of
aglng persons. Increased awareness Through educaTIon
programs, publlcaTIons, especlally The lnhouse hosplTaI
journals, and Through cllnlcal conferences. The
sTereoTyplcal pIcTure of The decrepIT, IrrITable older
person who Is seT In Thelr ways and unable To change Is
rejecTed by emplrlcal sTudles and specIaIIsTs In aglng.

In relaTIon To Thls sTudy IT becomes clearer ThaT
older women are noT a homogeneous group and Thelr
percepTIons of soclal supporT are dlfferenT as They grow
older and needs change. Besldes sharlng These resulTs wlTh
sTaff nurses The nurse In advanced pracTIce musT erTIculaTe
These dlfferences and role model The use of such fIndIng,
Taklng opporTunITIes To dlscuss her reTlonale wlTh oThers.

AddITIonally, IT Is The role of Nurslng AdmInIsTraTors
To assIsT In brIngng The gap beTween varlous educaTIonal
levels of nurses. DIssemInaTIon of research flndlngs
should be made avallable To Thls group wlTh pracTIcal
recommendaTlons for InTegraTIng new knowledge lnTo pracTIce
sITuaTIons. Ideas such as Brown Bag lunches wlTh sTaff
nurses In Thelr seTTIngs could benefIT boTh The sTaff nurse
and nurse researcher. Cllnlcal research needs To be
sclenTlc buT prachcal, and sTaff nurses can ofTen see
paTTerns of evenTs from a dlfferenT poInT of vlew. In

effecT boTh learn from The oTher.

154

MW

The nurse cllnlclan has The besT of boTh worlds. She
Is educaTed To be cllnlcally "sound" and To be a beglnnlng
level researcher. The cllnlcal sITuaTlon provIdes a
consTanT IaboraTory. for observlng human InTeracTIon wlTh
The. envlronmenT. The nurse cllnlclan has knowledge and
skIlls for comprehenslve assessmenTs and The GeronToIogIcal
Cllnlcal Nurse SpecIaIIsT (GCNS) has addITIonal speclallzed
knowledge In worklng wlTh The elderly.

Evldence Is provIded In The llTeraTure ThaT soclal
neTwork characTerIsTIcs are relaTed To healTh sTaTus. Thls
has ImplIcaTlons for lndlvldual assessmenT as well as,
commuany level assessmenT of needs and program plannlng.
The neTwork analysls approach ldenTIfled In ChapTer ll,
concepTually dellneaTed varlous sTrucTural and InTeracTIve
componenTs of an lndlvldual's neTwork and The funcTIons
ThaT neTwork provIdes In Terms of emoTlonal and Tanglble
supporT.

Thls framework can provIde The GeronTologlcal Cllnlcal
Nurse SpeclallsT dIrecTIon for assessmenT, clearer
IdenTIfIcaTIon of problem areas, and more accuraTe
sTaTemenTs of ouTcomes. For example, a cllenT wlTh
hyperTensIon may have a large neTwork of supporT persons
who provIde only low lnTenslTy supporT. The GeronTologIcal
Cllnlcal Nurse SpeclalIsT mlghT dIrecT InTervenTIons aT

assIsTIng The cllenT To sTrengThenIng InTeracTIons wlTh

155

neTwork members, herself Included, by encouraglng
InTeracTIons ThaT Include muTual sharlng and emoTlonal
supporT.

In a commuany assessmenT a neTwork analysls mlghT
reveal a parTIcular nelghborhood has large numbers of
wldows. SupporT whlle presenT from famlly and frlends may
be enhanced by developmenT of a self-help group To
encourage lndlvldual women To InTeracT and reach ouT To one
anoTher for emoTlonal and Tanglble supporT.

AddITIonally, evldence has been found In emplrlcal
research ThaT There Is an assocIeTlon beTween reclprocITy
and well-belng (WenTowskI, 1981). FIrsT, lnTervenTIons
should aTTempT To facIlITaTe InTeracTIons ThaT are
InTerdependenT and muTual. Thls mlghT be accompllshed by
Teachlng a cllenT To be more reclprocol In hls or her
relaTlonshlps by role modellng. Programs developed for
communITy use mlghT Involve peer educaTIon, self-help
groups In whlch muTuaI sharlng and problem-solvlng are
encouraged.

Israel (1982) has suggesTed ThaT perhaps home care
programs should be evaluaTed more closely In Terms of The
way servlces are dellvered. Such programs ofTen provIde
Tanglble ald To aglng persons In Terms of medlcaTIon,
dresslng changes, exerclses and assIsTance wlTh acTIvITIes
of daIly lIvIng. There may be IITTIe conslderaTlon or

analysls made To evaluaTe wheTher an lndlvldual cllenT

 

156

already has a neTwork member who does or could provIde some
of These resources. AddITIonally, Thls neTwork person
mlghT brlng emoTlonal supporT, closeness and muTual
sharlng. WhaT occurs as The nurse beglns To provIde
servlces Is The neTwork member feels he or she no longer
needs To sTop by as ofTen. Thls may also lead To
dependency on The professlonal as The paTIenT has IITTle
opporTunITy or resources To reclprocaTe. The
GeronTologIceI Cllnlcal Nurse SpeclalIsT uslng research as
basls of pracTIce should recognlze The poTenTIel for Thls
problem and provIde opporTunITIes Thru consulTeTIon,
educaTIon and publlcaTlon To share The flndlngs and
ImplIcaTlons for Improved cIIenT healTh.

Up To Thls poInT, concenTraTIon has been on The
posITIve effecTs of soclal supporT on cllenT's well-belng
and as a facTor To promoTe healTh. LITTle ls found In The
llTeraTure, parTIcularIly In emplrlcal research ThaT Is
relaTed To The poTenTlal negaTlve effecTs of soclal
supporT. NegaTlve effecTs however, may have a poTenTIalIy
deTrImenTal effecT on healTh. NegaTlve effecTs on famlly
equlllbrlum mlghT resulT durlng an acuTe Illness In whlch
famlly funcTIonlng Is dlsruped. WITh elderly persons acuTe
eplsodes of chronlc Illness may place demands on spouse,
chlldren and oTher relaTIves and lead To decreased muTual

sharlng and a dependency cycle.

157

Soclal supporT may undermlne The cllenT's self esTeem,
To The exTenT ThaT supporTIve oThers reflecT a pIcTure of
an 'lmpalred person". Two aspecTs of Thls problem has been
noTed In The llTeraTure. FIrsT, There Is evldence ThaT
cllenTs are ofTen dIsTressed by The "burdon" (emoTlonal,
physlcal, flnanclal) ThaT They place on famlly as a resulT
of Thelr Illnesses (Harker, I972; SchwarTz, 1977). Second,
recelvlng supporT from oThers requlres The cllenT To
recognlze hls or her sTaTus as "needlng assIsTence". In
order To conceal Thelr IdenTITy some cllenTs may ethbIT
soclal deTachmenT and noT dlsclose InformaTIon abouT Thelr
feellngs or Themselves (Goffman, I963; Gussow and Tracy,
I968). UnforTunaTely, soclal deTachmenT may lead To
allenaTIon of supporT persons.

Lasle, compllance could be negeTIvely Influenced by
soclal supporT persons. If TreaTmenT Is unaccepTable To
slgnlflcanT members of a cllenT's supporT sysTem or The
TreaTmenT goes agaInsT Thelr bellefs and values, They may
dlscourage compllance wlTh The TreaTmenT program.

In summary, negaTlve supporT may be as deTrImenTal as
posITIve supporT Is ThoughT To be helpful. Thls

sTrengThens The need To vlew The cllenT holIsTlcally and

The envlronmenT In assessmenT. InvolvemenT of famlly and
oTher slgnlflcanT members In The plannIng and
ImplemenTaTIon of The care plan should always be

consldered.

158

In summary, The prlmary care seTTIng In whlch The
GeronTologIcal Cllnlcal Nurse SpeclalIsT works offers The
greaTesT advanTage of longITudInal assessmenT, follow-up,
and InTeracTIons wlTh mulTl-neTwork members. Elderly
cllenTs brlng llfe-long paTTerns and values ThaT can be
sTrengThs or may predlspose Them To IsolaTIon or
depresslon. The GeronTologlcal Cllnlcal Nurse SpeclalIsT's
maln goal Is To assIsT The cllenT In IdenTIfylng Thelr
exIsTlng supporTIve relaTlonshlps or To facIlITaTe The
esTabllshmenT of oTher relaTlonshlps for Those losT or
unavallable. The GeronTologlcal Cllnlcal Nurse SpeclalIsT
can suggesT many supporTIve avenues for esTabllshIng
effecTIve soclal neTworks. Old frlendshlps and slbllngs
offer a poTenTIally good resource for emoTlonal and
Tanglble supporT. CombInIng The fIndIngs from Thls sTudy
on The percelved Types of soclal supporT avallable wlTh
acTual supporT avallable allows The GeronTologlcal Cllnlcal
Nurse SpeclaIIsT To plan more accuraTe ouTcomes wlTh The

cllenT.

Wm

ImplIcaTlons for nurslng educaTIon may be drawn from
sTudy flndlngs as They relaTe To The concepTual framework
upon whlch Thls research was based. FundamenTal concest
of Thls framework wlll be presenTed along wlTh The research

flndlngs and ImplIcaTlons.

 

159

PaTTerns exIsT In The percepTIons of old-old females
concernlng Tanglble ald avallable and emoTlonal supporT
recelved. Based on Rogerlen Theory lndlvlduals InTeracTIon
wlTh The envlronmenT To produce paTTerns. Thls framework
provIdes a sclenTIflc basls for observlng human responses
In a hollsTlc way. STudenTs of nurslng need such
frameworks In whlch To base The nurslng process, oTherwIse
InTervenTlons become based on InTuITIon and lsolaTed
evenTs. Nurslng currlculum eT all levels musT also Include
InformaTIon regardlng percepTIons of aglng persons and The
effecTs ThaT soclodemographlc facTors end lndlvldual
dlfferences can play In percepTIons.

Wanna

STudenTs aT all levels of undergraduaTe educaTIon flnd
Themselves prachcIng wlTh aglng lndlvlduals. Emphasls In
mosT programs are based on dlsease In aglng persons and
lITTle knowledge Is Included In currlculums regardlng The
normal process of aglng. Cllnlcal decIsIon-maklng Is
Impalred when The sTudenT cannoT judge normal from
paThology or InTegraTe The concepT of dlfferenTlaTlon or
heTerogenITy among aglng lndlvlduals. Whlle The flndlngs
of Thls sTudy dld noT deal wlTh The Issue of normal or
abnormal changes, dlfferences were shown To be
sTaTIsTIcally slgnlflcanT among aglng women of Ilke ages

and beTween Two groups of aglng women. Cllnlcal

 

160

InsTrucTors need To be aware of such sTudles and assIsT
sTudenTs To learn and InTegraTe such flndlngs lnTo pracTIce.

In addITIon, Two oTher slgnlflcanT Issues have been
ldenTIfled In ChapTer II and ChapTer III, I) Only a small
porTIon of elderly persons are InsTITuTIonaIlzed or fall
lnTo The group called The frall elderly. Increased focus
should be placed on The healThy elderly wITh emphasls on
healTh promoTIon and healTh malnTalnence. 2) Older women
ouTnumber older men. There Is Increased need To develop
sTraTegles wlTh older women To proTecT, promoTe, and
malnTaln healTh.

Wm

GraduaTe sTudenTs In nurslng have The opporTunITy To
Increase The depTh and breaTh of Thelr undersTandlng of The
aglng process and In parTIcular women's healTh. The focus
of 'Thls sTudy has been on women and a facTor, soclal
supporT, whlch has been ldenTIfled as a mechanlsm To
promoTe healTh. The deslgn of Thls sTudy prevenTs
generallzaTIon To The ToTal aglng female populaTlon buT
should sTlmulaTe faculTy and oTher graduaTe sTudenTs To
repllcaTe or To deslgn oTher sTudles ThaT wlll add To The
sclenTIc base of facTors Influenclng healTh aglng.

Currlculums In graduaTe educaTIon should Include
objecTIves ThaT I) challenge myThs and sTereoTypes
assoclaTed wlTh aglng, 2) dIsTIngulsh The normal process of

aglng from dlsease, 3) emphaslze The growTh poTenTIal of

 

161

women aT all levels of healTh, 4) examlne soclal, physlcal,
and psychologlcal facTors Influencelng healTh aglng, 5)
develop sTraTegles wlTh older women To proTecT, promoTe and
malnTaln healTh and, 6) reflne a funcTIonaI concepT of
healTh whlch acknowledges personal as well as envlronmenTal
resources (Geleln, I982; Norbeck, 1981).

W

There are several ImplIcaTlons for developlng
ConTInuIng EducaTlon programs for nurses worklng wlTh aglng
persons. The alm should be To Increase Thelr
undersTandlng of soclal supporT as a healTh promoTIng
facTor and for dIsemInaTIon of sTudy flndlngs In
professlonal llTeraTure To accompllsh The same purpose.
Programs ThaT focus on normal aglng and age dIfferenTIaTe
can be buIlT around physlcal assessmenT courses, whlch seem
To be popular wlTh sTaff nurses. Flndlngs from sTudles
such as Thls one could be InTegraTed lnTo courses ThaT are
an ongolng parT of orlenTaTIon so ThaT They become a parT
of pracTIce. In parTIcular, flndlngs from Thls sTudy
suggesT ThaT IT Is crlTIcal To obTaIn a hIsTory ThaT
Includes cllenT's percepTIons and The lndlvldual's neTwork
characTerIsTIcs, epeclally need for emoTlonal and Tanglble
supporT.

In addITIon, Tools such as, Gordon's Manual 91 Mugging
Diagnosis (1982) could be uTIlIzed aT all levels of nurslng

 

162

educaTIon as IT provIdes means of collechng and organlzlng
daTa In funcTIonal healTh paTTerns. When problems or
defIcITs are ldenTIfled (poTenTlal or acTuaI) They can be
placed lnTo dlagnosTIc caTegorIes upon whlch sTraTegIes and
ouTcomes can be deTermIned. Thls Tool provIdes a pracTIcal
way To Teach undergraduaTe as well as, graduaTe level
nurslng sTudenTs. IT would be expecTed ThaT The depTh of

InformaTIon collecTed and sTraTegIes would be dlfferenT.

Wessex):
The resulTs of Thls sTudy and The lImITaTIons In

deslgn have many ImplIcaTlons for fuTure research. In The
sTaTemenT of Research PrlorITes for The 1980's, The
Amerlcan Nurses' AssocIaTIon Commlsslon on Nurslng Research
ldenTIfled soclal supporT and neTworks as human and
envlronmenTal deTermlnanTs of wellness and healTh
funcTIonlng ThaT needs furTher sTudy (Nunslngflnseancn_l980).
Soclal supporT Is a mulTI-complex varlable ThaT Is
InTuITlvely undersTood buT has proven dlfflculT To deflne.
MeThodologIcal problems In daTa collecTIon wITh an elderly
sample musT be addressed. Maddox and Douglas (1974)
ldenTIfled several problems ThaT Influence The
InTerpreTaTIon of fIndIng wlTh an aglng populaTlon. FIrsT,
mosT sTudles are cross-secTIonal and provlslon for
selecTIve survlval, sampllng blas such as, fraIl elderly
are less llkely To be parTIclpanTs In research of Thls

Type, and sex dlfferences are noT accounTed for In The

 

163

deslgn. Second, age changes can be confused wlTh age
dlfferences In cross-secTIonal deslgns.

AdequaTe sample slze, random sampllng, and The
Incluslon of conTrol groups (In experImenTal sTudles) are
crITIcaI To The achlevemenT of valld concluslons abouT The
role of soclal supporT and healTh. AddITIonally, mosT of
The research has felled To assess more Then one klnd of
supporT, provlder, or reclpIenT, and have been focused on
only on one or Two ouTcomes aT a Tlme. MulTIpIe sources,
klnds of supporT, Types of Illnesses, and recovery and
coplng ouTcomes need To be explored.

A meThodologIcal problem In Thls sTudy Is ThaT a
convenlence sample was used whlch llmlTs The
generallzabIlITy of The flndlngs To The sample populaTlon.
AddITIonally, slnce sTudles (GarrITy, I973; Hyman, 1971)
have IndlcaTed posslble negaTlve effecTs of soclal supporT
on well belng, InvesTIgaTors need To conslder boTh posITIve

and negaTlve consequences In fuTure research..

Wench
I) The sTudy needs To be repllcaTed wlTh a sTraTlerd
sample ThaT Is represenTaTIve of The elderly populaTlon.
2) STudIes based on Ionngudlnal deslgn need To be
developed and carrled ouT.
3) Sex dlfferences should be acknowledged and

comparaTIve deslgns carrled ouT To examlne The dlfferences

 

164

In percepTIon of soclal supporT and acTual supporT
avallable.

4) Examlne sampllng blas by aTTempTIng To deTermIne
characTerIsTIcs of The persons refuslng or unable To
parTIclpaTe.

5) Include a measure of adequacy of soclal supporT

percelved To be avallable.

6) Include a measure of exTernal valldaTIon of
percelved soclal supporT needs by surveylng slgnlflcanT
oThers as well.

7) STudIes should Include mInorITIes end The elderly.

Sum

In summary, The overall value of Thls sTudy emphaslzes
ThaT large numbers of women are lIvIng longer and wlll
requlre a greaTer share of The healTh care 'resources.
HealTh promoTIon and malnTenance of funcTIonlng.of aglng
women Is of crITlcal concern To The GeronToIoglcal Cllnlcal
Nurse SpecIaIIsT. FacTors such as soclal supporT have been
shown To promoTe healTh and as a concepT needs reflnemenT
of defInITIon and conTInued research To gaIn knowledge wlTh
The preclslon requlred To gulde cllnlcal appllcaTIon. In
ChapTer VI a summary and InTerpreTaTIon of The sTudy
flndlngs was presenTed. Flndlngs were relaTed To The
concepTual framework of Thls sTudy, and recommendaTlons for

nurslng pracTIce, educaTIon, and research were presenTed.

BIBLIOGRAPHY

 

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I77

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‘T

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I79

SefTon-Cojocel, L. (1984). A deeeniniixe 51nd; o1 nine:
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180

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APPENDICES

 

APPENDIX A
CONSENT FORM

 

CONSENT FORM

The study in which we are asking you to participate is designed to learn
more about how older individuals' life situations and support affect their
ability to actively participate in their health care. It will take about
45 minutes to complete. If you agree to participate, please sign the
following statement.

1. I have freely consented to take part in a study of patients being
conducted by the College of Nursing at Michigan State University.

2. The study has been described and explained to me and I understand
what my participation will involve.

3. I understand that if I withdraw from the study after originally agree-
ing to participate, the amount and quality of service provided me will
not change. I understand that I can withdraw from participating at
any time.

4. I understand that the results of the study will be treated in strict
confidence and that should they be published, my name will remain
anonymous. I understand that within these restrictions results can,
upon request, be made available to me.

I. , state that I understand what is
(Print Name)
required of me as a participant and agree to take part in this study.

 

Signed

 

(Signature of Patient)

Date

 

 

APPENDIX B

NORBECK'S SOCIAL SUPPORT
QUESTIONNAIRE

Pt. 1.0. __ ._._.. (1-4)

Form ______(S-6) Site _____(7-8)

Card 9-10)

_(

 

 

 

SOCIAL INTERACTION

Everyone has some type of Interaction with other people. It may be family,
friends. people at work, or someone providing a service for you. You may
talk, share an activity, or offer or receive assistance with a project.

On the right hand page please list each significant person in your life.
Consider all the people who provide personal support for you or who are
important to you now.

In the column on the LEFT, list each person by their first name or initials
only.

In the column on the RIGHT, list the relationship of each person to you.
Please use words from the following groups to describe the relationship.

Spouse or partner Family or relative Friend
work or school associate Neighbor Health care provider
Counselor or therapist Minister/priest/rabbi Other

Here is an example:

 

 

 

 

FIRST NAME OR INITIALS RELATIONSHIP
1. Mary 1. Spouse
2 . D. M. 2 . Minis ter
3. Ted 3. Friend

 

 

After completing the first page, please open the booklet on the left and follow
the directions for completing the rest of the questionnaire.

Please list each significant person in your life on the LEFT. List their
relationship to you on the RIGHT from the groups in the directions‘

#UN

00

11.
12.
13.
14.
1s.
16.
17.
13.
19.
20.

FIRST NAME OR INITIALS

 

 

 

 

 

 

 

 

 

O‘DCDNm

 

 

 

 

 

 

 

 

 

 

 

H
O

omwmmaum

N .——J ——l —O c... ——O ——6 —J —J ——l —J
O to so \1 O\ (11 4:- u N -‘ C
e e e e o e e 0 e e 0

RELATIONSHIP

 

(I?)

 

(T7)

 

(W)

 

(”I-9')

 

(20')

 

(2T)

 

(’27)

 

(33')

 

 

 

 

(27)
(7?)
(75)
('27)

 

('2'8')

 

(2?)

 

 

 

(

vvv

 

 

V

 

filtlifilfiflb‘l

Do not open until page
on the right 15 completed.

When the right page is completed, please open this booklet and match the lines
on the right and left pages that are numbered 1-20.

The questions you will answer on the left are about the peeple you listed on the
right.

Be very careful that the numbers of the lines match on both pages. Check
them occasionally as you are completing the questions.

Please turn the page and begin
by answering question 1.

 

 

For each person you listed. please answer the following questions by writing

in the number that applies.

Question 1:

l 8 Not at all

2 a A little

3 - Moderately
4 8 Quite a bit
5 e A great deal

How much does this person make

you feel liked or loved?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 (an
3' (37)
4' (33)
5' (357
6' (W
7' (In
8' (I21
9' (m
' (m

10.
n (IS)
' (It)

12.
(m

13.
(it)

14.
(p)

15.
(36)

16.
(an

17.
(32)

18.
(a?)

19.
(ET)

20.
(as)

Question 2:
How much does this person make you
feel respected or admired?

—l
O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(35)

2.
3 (37)
° (32)

4.
5 (‘5?)
a. (an)
' (ET)

7.
(37)

8.
9 (63')
' (321')

10.
(3‘5)

11.
(F?)

12.
(m

13. .2‘

' (T5)

14.
15 (357
' (7'0)

16.
(71)

17.
(772’)
18. .__
(73)
19. (7:3

20.
(71')

GO ON TO NEXT PAGE End Card #10

For each person you listed, please answer the following questions by writing
iin;the number that applies.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l a Not at all
2 e A little
3 - Moderately
4 - Quite a bit
5 - A great deal
Question 3: Question 4:
How much can you confide in this How much does this person agree with
person? or support your actions or thoughts?
Repeat
1-15
l. #1 l.
2 (T6) 2 (33‘)
3' (T7) 3' (37)
' (T8) ’ (1m
4. 4.
5 (T5) 5 (35)
6' (211) 6' (1m
7' (m 7' (In
' (22) ' (a)
8. 8.
9 (23') 9 (If)
' (m ' (m
10. 10.
(2'5) (351
ll. 11.
(23') (7131
12. 12.
(’47) (I71
l3. 13.
(2'8) (18)
l4. 14.
(23) (1‘5)
15. 15.
(3'0) (3‘0”)
16. 16.
(3'1) (3'0
l7. 17.
(E) (32')
18. 18.
('3'3') (3'3')
19. 19.
(321') (32')
20. '20.
(38’) (‘5?)

GO ON TO NEXT PAGE

 

 

.For each person you listed. please answer the following questions by writing

in the number that applies.

Ul-th—l
“III.

Question 5:

If you needed to borrow SlO, a
ride to the doctor, or some
other immediate help, how much
could this person usually help?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not at all
A little
Moderately
Quite a bit
A great deal

Question 6:

If you were confined to bed for
several weeks, how much could
this person help you?

Repeat l-lS

c—J
C

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

z (57:) 2 (TD
3 11:71 3 (T77
(3'8) (18)

4. 4.
5 (3'5) 5 (T5)
6 (EU) 6 (26‘)
7 (ET) 7 (51')
(3‘27 (2?)

8. a.
9 (33') 9 (2'3)
’ W (a?) (21')

1o. 10.
(357 (m

11. 11.
(33) (2'5’)

12. 12.
(37) (27)

13. 13.
(38) (28)

14. 14.
(35) (2'51

15. 15.
(75) (‘35)

l6. 16.
(7T) (3T)

17. 17.
(721 (El

l8. 18.
(7'51 (33)

19. 19.
(73') a (370
20. __ .zp. _
( ) (3 )

0

End Card ll G

5
ON TO NEXT PAGE

 

For each person you listed, please answer the following questions by writing

in the number that applies.

Question 7:
How long have you known this
person?

Less than 6 months

6 months-l8 years
Between lkyyears-3 years
Between 3-5 years

5 years or more

U‘IQNNA
III.“

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2 (3'5’)
3’ (7m
' (at)

4.
S (35)
' (EU)

6.
7 m)
0' (m
’9’ (m
' (m

10.
(m

ll.
(R)

12.
(T7)

l3.
(m

l4.
(15)

l5.
(3m

l6.
(m

l7.
(37>

l8.
1??)

l9.
(in

20.
135')

Question 8:
How frequently do you usually have con-

tact with this person?

visits, or letters)

(II-DUN

to (I) \J at
O C O .

10.
ll.
12.
13.
14.
15.
16.
l7.
l8.
l9.

. 20"

l 3 Once a year or less
2 - Every 3-6 months

3 - Once a month

4 - Once a week

5 8 Once a day

(phone calls.

 

('5?)

 

(37)

 

(33')

 

(357

 

(375')

 

 

 

 

 

 

 

 

 

 

 

 

 

GO ON TO NEXT PAGE

End Card 12

 

Question 9:

During the past year have you lost any important relationships due to moving,
a Job change, divorce or separation, death, or some other reason? (PLEASE
CHECK ONE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Repeat l-lS
Yes No
"— (T's’)
If yes. specify
9a. 9b.
If YES, indicate the category(s) If YES, indicate how much support
of persons no longer available this person (or persons) has pro-
to you. vided in the past six months.
l a Spouse or partner 1 8 Not at all
2 ' Family or relative 2 e A little
3 - Friend 3 I Moderately
4 - Work or school associate 4 a Quite a bit
5 I Neighbor 5 1 A great deal
6 =- Health care provider
7 - Counselor or therapist
8 - Minister/priest/rabbi
9 8 Other
l T l.
2 (T7) 2 (27)
3 (T8) 3 (2'8)
(m ' <2?)
4. 4. 4.
5 (2'5) 5 (35)
5 (ET) 6 (3T)
7 (I?) 7 (32')
a (73’) 8 ('3?)
g ('2?) 9 (37)
' (751 1331
lO . 10.
(i?) . (33)

lcs
2/l8/83