There are two potential determinates that might influence quality of life and psychological well-being of elderly people. Firstly there are the objective factors that are income, health, status and age and intuitively, usually having more of these things means greater quality of life. However, in various research based on happiness of the elderly people, objective factors are less powerful than one might expect as Lyubomirsky et al; cited in the research article titled ‘Psychological Acceptance and quality Of Life in the Elderly,'(2007). The research suggested that objective factors account for about 8 to 15 % of the difference in happiness. So, ”Do people get less happy as they get older?” and their well- being while ageing has been discussed by various researchers in order to define the concept of successful ageing but there is still a lack of consensus on what defines a successful ageing. The various researches on the relationship between old age and well-being have been at many times assessed through life satisfaction, happiness and morale.
2.2 Theories of ageing
In attempting to explain the ageing process and moreover the elderly experience with family support in this particular study, the theories of ageing, which describes the ageing process and what it implies will be taken into account.
2.2.1 Activity theory, developed by Havighurst and associates in 1953, asserts that remaining active and engaged with society is primordial to satisfaction in old age. The theory asserts that positive relationships in the aged individual’s level of participation in social activity leads to life satisfaction as active aging equals successful aging. Activity can be physical or intellectual in nature so as to replace those interests and relationships that have been diminished or lost over time. This theory proposes that elderly people need to remain active in a variety of social spheres as for instance with family or friends because activity is preferable to inactivity as it facilitates well-being on multiple levels that is assuming that activity is vital to well-being. Activity theory proposes that social activity and involvement with others results in an increased ability to cope with aging, improved self-concept, and enhanced emotional adjustment to the aging process (Lee, 1985).
2.2.2 Disengagement theory was proposed by Cumming and Henry (1961). This theory states that ‘aging is an inevitable, mutual withdrawal or disengagement; resulting in decreased interaction between the ageing person and others in the social system he belongs to’ (Cumming and Henry, 1961, p.2). Disengagement theory thus assumes that social involvement decreases with aging and that successful ageing is best achieved through abandoning social roles and relationships and by the individual reducing both activities and involvement. Proponents of this theory maintain that this separation is desired by society and older adults, and serves as such to maintain social equilibrium. While high morale is evident at the completion of the process, the transition is characterized by low morale. However, this theory has been strongly criticized by researchers who found a lack of evidence from older people disengaging from their surroundings. Whereas older people social relationships change and that they possibly have fewer ties, it was found that these relationships were often deeper and more significant.
2.2.3 The Continuity theory states that as elderly adults adapt to changes associated with the normal ageing process, they will attempt to rely on existing resources and comfortable coping strategies. This theory of aging states that older adults will actually maintain the same activities, behaviours, and relationships as they usually did in their earlier years of life. As older adults try to maintain this continuity of lifestyle by adapting strategies that are linked to their past experiences, decisions and behaviours will form the foundation for their present behaviour. Continuity of self which occurs in two domains: internal and external is thus important. Whereas internal continuity occurs when one wants to preserve some aspects of oneself from the past so that the past is sustaining and supporting one’s new self, external continuity involves maintaining social relationships, roles and environments such that internal and external continuity are maintained, life satisfaction is high.
2.2.4 R.Weiss (1974) put forward a theory about provision of support from close relatives and relationships. According to Weiss, these provisions reflect what we receive from relationships with other people. He maintains that the elderly require six main social provisions to maintain well-being and avoid loneliness. They are the assistance-related that is reliable person and guidance as well as non- assistance related one namely social integration, reassurance or worth, nurturance and attachment. These components provided by close relationships mainly provide and guarantee support to people as those people who lack the social support experience negative effects. He argues that individuals must maintain a number of relationships in order to maintain psychological well-being. Weiss holds that multiple needs must be satisfied by an individual’s support network. In that respect, social provisions may be provided by friends but more often are provided by family members who are usually the primary source of support in old age.
2.2.5 One of the first theoretical frameworks to focus on interpersonal relationships was proposed by Kahn and Antonucci (1980): the convoys of social relationships. They stated that social support is primordial to the individual in describing it to include attachment, roles and social support. Social support is viewed as interpersonal relationships that include these following components: affect affirmation and aid. Their basic idea is to view social connections and social support as a lifetime and ongoing set of relationships which generally serves to enrich, fortify and reassure people. The convoy model assumes that all people need social relations and that it is important because they have favourable effects on health and well-being. Despite being dynamic and lifelong in nature, Kahn and Antonucci suggest that losses and gains in convoys could have a variety of causes. It was hypothesized that social relations were more psychological than physical, and therefore, would affect psychological or mental health, that is, depression, life satisfaction or happiness rather than physical health. (Antonucci, Fuhrer & Dartigues, 1997; Fratiglioni, Wang, Ericsson, MAytan, , 2000)
2.3 Social Support
‘My family has always been an essential part of my life, but the older you get; the more you feel… how much you need each other. As long as you are together, it is like a growing tree… the longer the tree is there, the stronger the branches become and the more you are knit into one. So, the more you are together, the more you realize how important it is to be together and stay together.’ -66 year old married father of two. (Cited in Family ties and ageing, Connidis, 2007, p3)
Worldwide the family is the primary caregiver to the elderly. This reality transcends culture, politics and economic circumstances in spite of a wide variation in the way care is provided in different societies. However, almost everywhere round the world, support often flows in only one direction. Many older people receive financial help from their adult children but what about their help in terms of the social support in order to ensure healthy psychological ageing?
Social support is defined as ‘the individual belief that one is cared for and loved, esteemed and valued, and belongs to a network of communication and mutual obligations.’ (Cobb, 1976). Some experts suggest that social support provides a sense of connectedness to one’s social group, which results in feelings of well being (Ryan. 1995). As people become old, social relationships often change and that they sometimes have fewer social ties, it was found that these relationships are often deeper and more meaningful to them, (Helmuth 2003). Maintaining relationships with their families and their friends is important to the vast majority of elderly persons. Rosenmayr (1968) found that, though they may not want to live with them, they do maintain contact with their children. Shanas (1967) found, in a study of elderly persons in three societies, that they generally live near at least one of their children. These relations seem to be at a large extent important, if not vital, to the elderly as the experience of ageing often requires them relationships and families support to evolve and adapt or cope with the challenges of the transition. Observers and various researches have showed that the loss of important relationships leads to feelings of emptiness and depression (Freud, 1917/1957; Bowlby, 1980).
The interplay between relationships and various domains of life is complex as older adults reporting a greater number of social ties have been shown to have lower mortality risks, and both social integration and social support have been associated with mental and physical health outcomes (reviewed in Berkman 1995; Cohen & Herbert 1996; Seeman 1996). Social support provided to the elderly parents by family members is thus proven to have positive consequences on the elderly in many ways. Moreover, a considerable number of researches show that social support is the key determinant of successful ageing (Rowe & Kahn1998; Leviatan 1999; Unger et al, 1999; Seeman et al, 2001b). Persons involved with positive relationships are often less affected by everyday problems, are said to be more effective, and to act with greater sense of control or independence. Those without relationships often become isolated, cynical, mistrusting and depressed whereas those caught in poor relationships tend to develop and maintain negative perceptions of self, find life less satisfying. The usefulness of social support for dealing with illness has also been repeatedly shown, suggesting that a positive social environment encourages health and well- being whether or not stress is present. Social support is thus an important factor that may buffer the ill effects of stress on mental and physical health.
2.4 Lack of social support
According to many researchers, the absence of social support is linked to various illness and poor quality of life in old age. Depression and loneliness are the most common in the elderly. Findings of depression and lack of social support are often interrelated due to the often inseparable nature of the two variables. There is also a clear link between chronic disease and depression, with those in nursing homes showing higher rates than those living in their own house. Depression as well as loneliness has been discussed by researchers and it was found that elderly people mostly suffer from these two major problems besides physical problems. The most firmly establishes link between of elderly parents and their psychological well-being in old age is that they basically suffer from loneliness and depression. Some research has shown that elderly individuals who have not maintained contact with family members are at a higher risk of developing depression, personality disorders and other cognitive or behavioural issues. The physical as well as psychological state of the elderly parent is put at risk when he or she is not in contact with other individuals and especially the family. It is observed that if communication is done on a daily basis with family members, there is a better maintenance of the elderly psychological well-being as friends and family become often the sole support system for the elderly. According to American Geriatrics Society, depression can affect 40% of nursing homes residents in a given year which is often undiagnosed and untreated or treated as a normal component of ageing.
A growing number of studies and articles have been published in that respect and shows how social support is beneficial to the elderly. For instance, there is a published thesis submitted in 2010 in Canada, titled “Social support, loneliness and depression in the elderly”. In this study, the association between loneliness and depressive symptoms was explored in 54 elderly residents living in both nursing and retirement homes out of 62 interviewed. The findings demonstrate that loneliness remained a significant risk factor for depressive symptoms, even after controlling other demographic variables such as age, gender, length of stay, time of interview and institution. This finding is consistent with a qualitative study by Barg et al. (2006), which suggests that loneliness in older adults is closely tied to depression. In this particular study, the author found that loneliness is easily mapped onto standard assessments of depression and hopelessness in the population, thus showing strong correlation between loneliness and depression.
The “Evaluation of depression in elderly people living in nursing homes,” involving 35 people by Aribi L et al; publishes in October 2010 in Tunisia had for main aim to determine the prevalence of depression in old people living in a nursing home and to evaluate the degree of their autonomy. A descriptive and analytical survey was carried out on 35 old people at a nursing home in Sfax, Tunisia. The study was evaluated by using two scales specific to the geriatric practice: The scale of depression: GDS (geriatric depression Scale) applied to 30 items and the scale of autonomy: IADL (Instrumental Activities of Daily Living). Results were as such the examined population was composed of 35 people aged from 65 to 9, 51.4% of the residents were in a state of depression. Depression was more frequent in female subjects however (58.8% of women compared to 44.4% of men and it was concluded that depression in the elderly is related to several depressive factors particularly for patients living in institution.
Anxiety and depression are thus very common in elderly living in nursing homes. Studies have shown a relatively low prevalence of anxiety disorders in older individuals but that among elderly, anxiety disorders occur two to seven times more often than depression problems. The rate of anxiety disorders may be even higher among elderly living at institutional settings. Another study which support that view is that of study Anxiety and Loneliness in Lone Elderly done by T.T.A Rahman which evaluated the prevalence of anxiety and depression in lone elderly living at their own homes and those going to geriatric clubs regularly or living at geriatric home. There was 164 lone elderly participants from geriatric clubs named group I and 168 lone elderly participants from geriatric homes, group II were included in this study. Hamilton Anxiety Scale and Hamilton Depression Rating Scale were used for detection of anxiety & depression respectively. Results were as follow: The co-occurrence of anxiety and depression is 34.1% & 57.1% in group I and group II respectively, while depression is actually 22.0% & 23.8% and anxiety is 2.4% & 1.2% in group I & group II respectively. Living at geriatric homes and age group 60 to 70 are independent risk factors for anxiety, depression or mixed anxiety and depression. It was concluded that lone elderly, living at institutional settings such as geriatric homes is an independent risk factor for anxiety, depression or mixed anxiety and depression. Mixed anxiety and depression is more prevalent than anxiety or depression per se.
Another survey conducted by Agewell Research & Advocacy Centre released by the Canadian Institute for Health Information recently, found that about one in four (26 per cent) seniors living in a residential care facility, such as a nursing home or long-term care home, had been diagnosed with depression. A further 18 per cent had symptoms of depression but had not been diagnosed. Many of these residents dealt with persistent anger, tearfulness and repetitive anxiety, yet had not received a diagnosis. The problem is a serious one because, as the researchers note, depression can have serious effects on a senior’s medical condition, their emotional state and general quality of life as seniors with symptoms of depression are more likely to display aggressive behaviour and may be three times more likely to have sleep disturbances while having difficulty to communicate. Different factors can contribute to the development of a depressive disorder that may include feelings of hopelessness, self-blame and loneliness, possibly accompanied by physical symptoms such as poor sleep, decreased appetite and lack of energy, often leading to social withdrawal. The researchers note that there is a perception that depression is a natural part of aging. That’s because a number of factors associated with late-life, depression is common among older people, such as: illness, loss of family, friends, social support or independence. But they note that depression can shorten lives. In studies of the effects of depression on seniors, the odds of dying were 1.5 to 2 times greater in elderly people with depression compared to those without.
According to Himanshu Rath, Founder Chairman of Agewell Foundation, “Depression is quite common among many of the people, particularly in old age. It is a major social challenge that cannot and should not be ignored. However, to fight Depression in Old Age, both the suffering older persons and the family members need to join hands and work together to bring back the golden happy times,” from a Survey on Depression in old age published in September 18, 2010.
2.4 Rationale of the study
There are many researches as such that have examined the importance of single, close, personal relationship related to elderly people which put forward that family support acts as a buffer against psychological illness. Family support promotes higher morale and lower levels of loneliness and social isolation in old age. Older people who lack confidants report more psychological distress and higher rates of depression (Hays et al. 1998). It is thus true on one hand that relationship and especially with family is important for older adults as social isolation may be devastating especially in old age but on the other hand can social relationships have negative impacts on people? Although a great deal of research have focussed on the positive effects that social support can have on adults, recently researchers have urged greater attention to the negative side of informal relationships. Since Rook (1984) demonstrated that social relationships can adversely influence the psychological well-being of older adults, several investigators have examined the effects of both positive and negative social ties in later life. (Ingersoll-Dayton, Morgan & Antonucci, 1997; Okun & Keith, 1998). Furthermore, in considering that the closeness and mutually supportive relationships that many adult children and elderly parents share may make the latter happier than those who do not have children, research on this issue has consistently demonstrated that individuals who are childless are as happy and well-adjusted as are parents, even in the later years. As people who are sixty-five or older and do not have children are more likely to report advantages than disadvantages of childlessness. Individuals who have remained childless have been found to develop social networks that compensate for the absence of support from adult children in terms of friends as some studies suggest that friends are more important than family to morale and well-being of the elderly (O’Conner, 1995). A realatively popular research topic has been the well-being and resources of childless elderly. It seems safe to conclude that these people are at least as happy as older parents, andthat they are able to find alternate sources of emotional and instrumental support for their need (Beckman & Houser, 1882; Johnson & Catalano, 1981; Keit, 1983; Kivett & Learner, 1980). The research put forward that instead of presence or absence of children, factors such as marital status, health and economic well-being are more strongly linked to the morale and life satisfaction of the older people.
As Hoff and Tesch- Romer ( 2007: 77) has described: ‘the relative importance of family relations and family support in contemporary societies may have diminished, but as empirical findings of many studies into the subject have shown, family relations have remained a reliable and stable source of support.” For the majority of elderly people, ties with their children represent the most important component of their family network and social support. Since ageing is becoming an important aspect in the Mauritian context and that many studies relating to old age and relationships have not been conducted at the local level, it deems to be important to infer about the contributions of family support to the older person’s psychological well-being.