(October 2009) Social and intimate connections change with age. These changes affect and are affected by health.
Social connections come from a variety of sources—family and friends, shared living spaces, interaction with neighbors, and participation in community or religious organizations. For many people as they get older, their family structure changes as children leave home and spouses die. Also, as their friends die, the networks of older persons shrink. Many try to remain socially active through involvement with community organizations, church, and neighbors, but confronted with fewer and less intimate connections, older people may disengage from the social world.
Consequences of Decreased Social Connections
Social isolation results in higher morbidity and mortality. Married or cohabiting couples exchange information about health, monitor each other's health, and provide emotional support and a sense of solidarity. Loss of a spouse or partner is a loss of psychological and social support and often a loss of access to informal, if not formal, health care. But illness can also drive social isolation. As their health deteriorates, older individuals no longer tend to be at the center of a network of friends and acquaintances but more often are on the periphery of social activities.
One fear is that social isolation of older adults leaves them vulnerable to abuse—verbal, physical, or financial. However, one study finds that in a nationally representative sample, only a small proportion report being verbally, financially, or physically mistreated by an immediate family member. Indeed, someone outside the immediate family was more likely to be the perpetrator of abuse (see Tables 1 and 2).
Fewer Than 10 Percent of Elderly Experience Verbal Abuse by an Immediate Family Member
|Type of Mistreatment Reported
Source: Edward O. Laumann, Sara A. Leitsch, and Linda J. Waite, "Elder Mistreatment in the United States: Prevalence Estimates From a Nationally Representative Study," The Journals of Gerontology Series B: Social Sciences 63, no. 4 (2008): S248-54.
Nonfamily Members Are Responsible for More Than Half of Abuse Experienced by
Adults Ages 57-85
||Verbal Abuse (%)
||Financial Abuse (%)
||Physical Abuse (%)
Source: Edward O. Laumann, Sara A. Leitsch, and Linda J. Waite, "Elder Mistreatment in the United States: Prevalence
Estimates From a Nationally Representative Study," The Journals of Gerontology Series B: Social Sciences 63, no. 4 (2008): S248-54.
Effects of Health Changes on Sexuality
Sexuality is an important component of health, and good health is important to continued sexual function. In a study published in the New England Journal of Medicine, Stacey Lindau and her colleagues found that sexual activity with a partner declines from age 55 to 85, with fairly low levels of activity in the last year among the oldest adults. In general, regardless of health, men report less change than women do in their sexual activity and little change in the probability of having a partner. Women, however, have substantial declines in both the probability of having a partner and in sexual activity, with women in poor health experiencing greater declines than those in better health.
Sexual problems, such as lack of interest, pain, and anxiety about performance, are part of the reason for the decline in sexual activity among women. For women, sexual problems may be related not only to their own health but also to their male partner's health. Among those with partners, over 50 percent of men and less than 20 percent of women attribute lack of sexual activity to their own health limitations. Women are twice as likely to say that their partner's health limitations is one reason for sexual inactivity, with over 60 percent of women but less than 30 percent of men giving this reason. In another study in the Journal of Sexual Medicine, the researchers found that among sexually active women, those reporting problems were also more likely to say they had fair to poor health, depression, and less satisfaction with the relationship with their partner. Men with sexual problems similarly reported depression and less satisfaction with their relationship but did not report poor health as often as women did.
Despite a decline in sexual activity among older women, risks of sexually transmitted infections remain for the sexually active. Using data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative survey, researchers estimate that one in 16 women ages 57 to 85 have high-risk for the human papillomavirus (HPV) and prevalence does not decline with age. However, prevalence is higher for single, sexually active women than for married, sexually active women.
Intimate connections and social involvement continue to change over a lifetime, often in tandem with changes in family structure and the types of support received from family members. These changes may lead to a decrease in psychological and emotional support as well as to reduced access to health care, leaving the elderly vulnerable to depression, loneliness, and health complications resulting from inadequate care.
Marlene Lee is a senior research associate at the Population Reference Bureau. This article is based on Linda Waite's presentation for the symposium in honor of the 15th anniversary of the National Institute of Aging P-30 Centers on the Economics and Demography of Aging at the Rand Summer Institute, July 8-9, 2009, www.rand.org/labor/aging/rsi/2009/rsi_agenda.html. Linda Waite is a professor of sociology at the University of Chicago. Also see: Erin York Cornwell and Linda J. Waite, "Social Disconnectedness, Perceived Isolation, and Health Among Older Adults," Journal of Health and Social Behavior 50, no. 1 (2009): 31-48.
- Edward O. Laumann, Sara A. Leitsch, and Linda J. Waite, "Elder Mistreatment in the United States: Prevalence Estimates From a Nationally Representative Study," The Journals of Gerontology Series B: Social Sciences 63, no. 4 (2008): S248-54.
- Stacy Tessler Lindau et al., "A Study of Sexuality and Health Among Older Adults in the United States," New England Journal of Medicine 357, no. 8 (2007): 762-74.
- Edward O. Laumann, Aniruddha Das, and Linda J. Waite, "Sexual Dysfunction Among Older Adults: Prevalence and Risk Factors From a Nationally Representative U.S. Probability Sample of Men and Women 57-85 Years of Age," Journal of Sexual Medicine 5, no. 10 (2008): 2300-2311.
- Stacy Tessler Lindau et al., "Prevalence of High-Risk Human Papillomavirus Among Older Women," Obstetrics and Gynecology 112, no. 5 (2008): 979-89.