Walter-Ginzburg Adrian, Blumstein T, Chetrit A, Modan B
Herczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel 69978.
J Gerontol B Psychol Sci Soc Sci. 2002 Sep;57(5):S308-18. doi: 10.1093/geronb/57.5.s308.
Using a theoretical framework that divided social factors measures into structure, function, and social engagement, this study determined those aspects of social networks most significantly associated with 8-year, all-cause mortality among the old-old in Israel.
Jews (n = 1,340) aged 75-94 living in Israel on January 1, 1989, were randomly selected from the National Population Register; stratified by age, sex, and place of birth; and interviewed in person. Mortality was determined according to the National Death Registry (December 1997).
After controlling for sociodemographics and measures of health, cognitive status, depressive symptoms, and physical function, the measures of social engagement that explicitly involved others were associated with a lower risk of mortality. No measure of the function of the social network was associated with risk of mortality. Living in the community without a spouse and with a child and living in an institution were significantly associated with a higher risk of mortality.
The finding that participating in activities with people outside of the immediate family is associated with a lower risk of death has practical implications for helping the aging population and their families in their decision-making process. Lack of support for the hypothesis that those with more social support would show reduced risk of mortality may indicate that the positive effect of perceiving support and the negative effect of needing support may cancel each other out and result in no perceived effect. In this population, the association between socioeconomic status (SES) and the risk of mortality seems to be expressed through the living arrangements, with the sick and frail, both in institutions (higher SES) and in the community with a child or other (lower SES), having a higher risk of mortality. These findings are consistent with the use of children as a substitute for institutionalization, and imply that at least some cohabitation was the caretaking solution for the noninstitutionalized old-old who were of low SES, frail, and close to death.
本研究采用一个将社会因素测量分为结构、功能和社会参与的理论框架，确定了以色列高龄老人社交网络中与8年全因死亡率最显著相关的那些方面。
1989年1月1日居住在以色列的75 - 94岁犹太人（n = 1340）从国家人口登记册中随机选取；按年龄、性别和出生地分层；并进行了面对面访谈。死亡率根据国家死亡登记处（1997年12月）确定。
在控制了社会人口统计学因素以及健康、认知状态、抑郁症状和身体功能的测量指标后，明确涉及他人的社会参与测量指标与较低的死亡风险相关。社交网络功能的任何测量指标均与死亡风险无关。无配偶且有子女居住在社区以及居住在机构中与较高的死亡风险显著相关。
与直系家庭以外的人参与活动与较低的死亡风险相关这一发现，对帮助老年人群体及其家庭进行决策过程具有实际意义。缺乏对社会支持较多者死亡风险会降低这一假设的支持，可能表明感知到支持的积极作用和需要支持的消极作用可能相互抵消，从而没有观察到明显效果。在这一人群中，社会经济地位（SES）与死亡风险之间的关联似乎通过生活安排来体现，机构中的患病和体弱老人（SES较高）以及与子女或其他人一起居住在社区中的老人（SES较低）死亡风险较高。这些发现与利用子女替代机构照料一致，意味着至少部分同居是低SES、体弱且接近死亡的非机构化高龄老人的照料解决方案。
