Social vulnerability from a social ecology perspective: a cohort study of older adults from the National Population Health Survey of Canada

BMC Geriatrics

Janice M Keefe²  Melissa K Andrew¹ 

[1] Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada;Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada

关键词: Canada;    National Population Health Survey;    Survival;    Frail elderly;    Frailty;    Social isolation;    Social ecology;    Social vulnerability;   

Others  :  1090086
DOI  :  10.1186/1471-2318-14-90

 received in 2013-07-16, accepted in 2014-08-14,  发布年份 2014

【 摘 要 】

Background

Numerous social factors, generally studied in isolation, have been associated with older adults’ health. Even so, older people’s social circumstances are complex and an approach which embraces this complexity is desirable. Here we investigate many social factors in relation to one another and to survival among older adults using a social ecology perspective to measure social vulnerability among older adults.

Methods

2740 adults aged 65 and older were followed for ten years in the Canadian National Population Health Survey (NPHS). Twenty-three individual-level social variables were drawn from the 1994 NPHS and five Enumeration Area (EA)-level variables were abstracted from the 1996 Canadian Census using postal code linkage. Principal Component Analysis (PCA) was used to identify dimensions of social vulnerability. All social variables were summed to create a social vulnerability index which was studied in relation to ten-year mortality.

Results

The PCA was limited by low variance (47%) explained by emergent factors. Seven dimensions of social vulnerability emerged in the most robust, yet limited, model: social support, engagement, living situation, self-esteem, sense of control, relations with others and contextual socio-economic status. These dimensions showed complex inter-relationships and were situated within a social ecology framework, considering spheres of influence from the individual through to group, neighbourhood and broader societal levels. Adjusting for age, sex, and frailty, increasing social vulnerability measured using the cumulative social vulnerability index was associated with increased risk of mortality over ten years in a Cox regression model (HR 1.04, 95% CI:1.01-1.07, p = 0.01).

Conclusions

Social vulnerability has important independent influence on older adults’ health though relationships between contributing variables are complex and do not lend themselves well to fragmentation into a small number of discrete factors. A social ecology perspective provides a candidate framework for further study of social vulnerability among older adults.

【 授权许可】

   
2014 Andrew and Keefe; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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