Commentary

The multiple mechanisms by which social support influences health status, health behaviour, and health services use continue to challenge researchers. This longitudinal study by Penninx et al contributes to the evidence of links between social support and mortality over time. Moreover, it bridges a gap by examining the effect of coping resources other than social support. The findings pertaining to age and sex reinforce earlier research.

The authors acknowledge that despite oversampling the “old-old”, non-response was higher for the older and less healthy subjects. Key sources of social support were elicited by the structural dimension of the support measure. Information and affirmation functions of support could have been assessed in addition to instrumental and emotional functions. Given that the emotional distress of loneliness is typically attributed to perceived deficiencies in social relationships and networks,¹ loneliness is an outcome of perceived support rather than a measure of perceived support itself. Indeed, social support can alleviate loneliness. Recent research indicating that the negative features of social relationships have a far greater effect on health outcomes than positive features is noteworthy.

The results of this research are relevant to nurses who work with seniors and their families in hospital, long term care, and community based settings. The research points to the importance of support, in particular emotional support which may diminish emotional loneliness. Nurses can provide emotional support and can mobilise this type of support from families and neighbours of older people. The interpretation that older people who receive more practical support may be more susceptible to physical morbidity, and hence mortality, is astute. Because reinforcement (ie, affirmational support) influences mastery, nurses can use supportive strategies that provide positive feedback and promote perception of mastery and can encourage the families of older people to use similar strategies.