Social Capital and Health: Maximizing the Benefits

Social Capital and Healthy Aging

Joanne Veninga, Division of Aging and Seniors, Centre for Health Promotion, Public Health Agency of Canada

The author acknowledges the assistance of Norah Keating, Jennifer Swindle and Deborah Foster from the University of Alberta.

As a population group, seniors face a number of major life-course transitions that can put them at risk of social isolation and exclusion. A social capital perspective focusing on seniors' networks is, therefore, especially relevant when developing policies and programs that support healthy aging. Highlighting recent research on social capital and "aging well," this article examines the different types of seniors' networks and the role they can play in reducing social isolation, providing quality care and creating supportive community and voluntary sector opportunities and services.

Canada's Aging Population

Seniors are the fastest growing population group in Canada. This population group will continue to grow as the "baby boomers" begin turning 65.¹ By the year 2015, seniors will outnumber children.¹

In 2005, seniors represented 13%² of the total population, and by 2031 it is expected that they will account for approximately 23% (see Figure 1).³ "Oldest" seniors are the fastest growing segment; by 2056, one out of ten Canadians will be 80 years or older, compared to one in thirty in 2005.¹ More and more seniors are also "aging in place," with over 90% aged 65 and older living in the community.⁴ Women in Canada tend to live longer than men and make up 57% of the aging population.^2,5 At age 65, a woman can expect to live another 20.8 years, whereas a man can expect to live another 17.4 years.⁵

Figure 1: Canadian Seniors by Age Subgroups, 1921-2051³

Source: Statistics Canada, 1999-2005.

A Time of Transitions

Many seniors undergo major life transitions in their later lives--such as retirement, declining health, forced relocation and the death of loved ones--that can strain their social networks.^6,7,8 Social isolation also tends to increase as people age, and as family and friend networks become smaller.⁹ Research shows that those who remain actively engaged in life and socially connected are happier, physically and mentally healthier, and better able to cope with transitions.

Supportive social relations (e.g., family, friends, participation in local groups) have positive and protective effects on health,^10,11 and people with increased social contacts and stronger support networks have lower premature death rates, less heart disease and fewer health risk factors.¹² A focus on social capital is, therefore, particularly relevant for policy and program initiatives aimed at healthy aging. As described in the article on page 6, social capital refers to "the networks of social relations that may provide access to needed resources and supports."

Social Networks and Aging Well

In "The Role of Social Capital in Aging Well," Keating et al.¹³ use social capital theory to understand the different types of seniors' networks and how they relate to aging well. The authors offer three main views of healthy aging and explore the role that networks play:

• Maintenance of physical and cognitive health: Do networks provide the needed resources and access to services necessary to maintain and enhance physical and cognitive status?
• Engagement in work and community activities: Do networks constrain or enhance these opportunities?
• Person-environment fit: How do networks assist in ensuring a good person-environment fit?¹³

Seniors' networks differ considerably in their composition and the resources they provide. They are categorized by Keating et al. as: social networks (groups of twelve to thirteen people with whom seniors have close links); support networks (helpful connections that include day-to-day social interactions and/or instrumental activities, such as help with chores, transportation--five to ten people); and care networks (networks of three to five people who provide support to seniors with long-term health problems or limited functional capacity).

Highlights of existing research offer some useful and interesting information about seniors' networks (see sidebar on page 23).

Some Facts about Seniors Networks . . . Age is an important determinant of social and support networks--older seniors have smaller, more kin-focused social networks. Gender influences network composition--older women have larger support networks than older men. Much of the research on care suggests it is female-dominated, though recent findings from a national survey suggest that proportions of women and men who provide care are similar (54% are women, 46% are men).17 Unmarried people tend to have smaller networks. Higher education is associated with a greater number of ties to younger friends and neighbours, while low education is associated with support from family. People with a higher income and better health have more ties to the wider community. Having higher proportions of women in their networks, higher proportions of kin and larger network size are important factors in whether seniors receive personal care. Highly supportive communities are relatively small in size, have higher proportions of seniors and individuals who have lived in the community for a long time, and are typified by relatively higher hours of unpaid work done by community members.13 Consequently, residing in a cohesive community may provide individuals with access to resources even when personal networks are lacking.

Balancing Formal and Informal Care

Whether seniors receive formal care from professionals, rely on informal care provided by family and friends, or receive no care at all depends mainly on the size (number of friends and family members), quality (of the relationship) and proximity (living close by) of their social networks.¹⁴ Although the nature of the Canadian family has changed, estimates suggest that approximately 80% of all care is still provided by close friends and family.¹⁵

An analysis of the 2002 General Social Survey (GSS), Cycle 16 on Aging and Social Support,¹⁶ examined the relationships between social networks of non-institutionalized seniors and whether they received formal, informal or no care.¹⁴ The findings confirmed the importance of care networks:

• Of seniors receiving care, 45% relied exclusively on informal networks.
• Decayed social networks owing to advanced age (even for those in stable health) and death of a spouse were related to the need for more formal care.
• Those with a large support network pool (e.g., a large family, and those who were part of a faith community) relied more on informal care.
• Those with higher levels of education and more connections within their communities relied on more formal care networks, possibly because they are better able to negotiate the institutional channels that sometimes present barriers for seniors with lower literacy. Education is also correlated with lifetime earnings and wealth, suggesting that people with more education have the means to pay for formal assistance.¹⁴

Reducing Social Isolation: Social Networks Play a Role

Social networks can benefit seniors by enhancing their sense of well-being and control and by decreasing the risk of social isolation. While social isolation tends to increase as people age, other factors play a role, including: poor health, disabilities, gender (more women are socially isolated than men¹⁸--taking into account that they live longer), loss of a spouse, living alone, reduced social networks, transportation barriers, place of residence, distrust of others, poverty and low self-esteem.^18,19,20 It is important to recognize, however, that factors affecting one senior may not affect another in the same way. For instance, living alone does not necessarily mean someone is lonely or unsupported.⁸ Moreover, seniors who have fewer social contacts as they age may not necessarily feel dissatisfied or lonely. Research suggests that the quality of social contacts is more strongly associated with well-being than the quantity.²¹

With more seniors "aging in place," addressing social isolation takes on a greater importance. Although research has consistently demonstrated a strong association between social isolation and health, the direction of causality between social support and health is unknown--while the lack of support networks may lead to ill health, ill health itself may lead to a reduction in social support.¹⁹ Nonetheless, programs and services can play a role in reducing isolation by promoting seniors' participation and inclusion in their communities. Evidence suggests that communities with "high stocks"²² of social capital are better equipped to protect the health of their citizens, including the socially isolated.

More evidence on the characteristics, risk factors and potential consequences of social isolation and its impact on the quality of life of seniors is needed. A greater understanding of policies that may influence social isolation and social integration of seniors should also be examined.¹⁹ To address these information needs, the Federal/Provincial/Territorial Ministers Responsible for Seniors acknowledged social isolation as an emerging issue and directed officials to study it, to share information across jurisdictions, to identify potential program and policy implications, and to develop options for collaborative work.²³

Volunteering and Healthy Aging

Volunteer activity has been shown to increase the well-being of those who volunteer, as well for those receiving services.²¹ Volunteering is also an effective means to deal with losses as one ages.²⁴

Social capital can be generated through volunteering--high levels of social capital support and maintain the health of older persons, provide informal support in times of need, reduce or delay the onset of illness and death, and enhance overall quality of life.^25,26 Volunteer activity throughout one's adult years also promotes healthy aging by providing people with the potential for multiple roles in older ages. It is suggested that having multiple roles in life (e.g., friend, worker, spouse, volunteer) increases social integration and aids in coping with stress.²⁷

While the proportion of seniors who are formal volunteers is lower than the national average, Canadian seniors donate the highest number of volunteer hours.^28,29 Contributions made by seniors are vital to Canada's volunteer sector, notably to various community organizations including those created by and for seniors. It is important to recognize the value of volunteering and expand opportunities as people age to participate in meaningful volunteer activities, especially for those with health, income or transportation restrictions.³⁰

Building Social Capital

While not intentionally developed using a social capital lens, many current federal seniors' programs (e.g., Compassionate Care Leave Program, New Horizons for Seniors Program) have the potential to build social capital in order to enhance aging well. These programs contribute to the development of the three types of social capital: bonding--relations that help people "get by" with day-to-day activities; bridging--connecting people to "external assets" that may help them "get ahead"; and linking--fostering connections among networks.⁶

Bonding: Being part of an informal care network of family and friends can be stressful due to possible financial, health and emotional costs. However, formal supports to seniors (e.g., home care and community services) can alleviate some pressures on members of the informal care network. Formal supports enhance bonding social capital since they allow seniors to "age in place" while staying positively connected to their social network.¹³

Bridging: Programs that provide access to resources can help seniors maintain their social networks and reduce the risk of social isolation. An example is Social Development Canada's New Horizons for Seniors Program (http://www.sdc.gc.ca/en/isp/horizons/toc.shtml), which supports local projects that encourage seniors to contribute to their communities through social participation and active living.¹³

Linking: Programs that foster linkages among voluntary organizations and/or various levels of governmental programs can improve the access to resources for seniors and families. The Canadian Caregiver Coalition is a national organization that supports care networks and links caregiver organizations, researchers and governments on issues of public policy on caregiving (http://www.ccc-ccan.ca/).¹³

Looking Forward

A social capital perspective focusing on seniors' networks is especially relevant when developing policies that promote healthy aging. Some potential public policy challenges include the need to better understand the weak ties of older adults and the purposes they serve; to further examine how linkages in "physical" and "virtual" communities can be useful to older adults; to determine the place of families and care networks in aging well; and to emphasize the importance of program evaluation.¹³

The Public Health Agency of Canada "plans to use a social capital lens to better understand how social relations affect seniors' health and to examine the effectiveness (and appropriateness) of policy interventions in supporting these relations."³¹ More research is needed to identify those approaches that are most effective in fostering various types of health-promoting networks.