Older Adults in Nursing Homes: Assessing Relationships Between Multiple Constructs of Social Integration, Facility Characteristics, and Health

Abstract

An extensive body of research has examined connections between older adults' social worlds and health and well-being, particularly for community-dwelling older adults. Yet, little is known about the social worlds of older adults living in nursing homes because of this population's exclusion from many studies and national databases. Further, the influence of social workers and culture change practices on the social lives of nursing home residents is not well-documented. This research assessed the relationships between multiple social integration (i.e., social networks, social capital, social support, and social engagement) and health (i.e., depression, functional health and well-being) constructs, and examined the influence of facility characteristics (i.e., culture change, role of social workers) on these variables. This study drew on a model based on social network theory developed by Berkman, Glass, Brissette, and Seeman (2000). Data were collected at 30 nursing homes in Northeast Kansas using a cross-sectional, quantitative, planned missing data design with random sampling techniques. Data collection occurred at the individual-level through in-person structured interviews with older adult nursing home residents (N = 140) and at the facility-level (N = 30) with social service directors and nursing home administrators. Data were imputed using multiple imputation, and multilevel confirmatory factor analysis was used to verify measurement properties. Multilevel structural equation modeling (MSEM) was used to answer the research questions and test hypotheses. Findings revealed that the data did fit the proposed model supporting social network theory, showing that social networks and social group participation indirectly influence depression and functional health and well-being primarily via social engagement. Social capital had a direct influence on both health constructs. Further, the relationships sub-scale of culture change involvement significantly influenced between-level differences in residents' social networks, and the number of social workers in a nursing home was positively associated with between-level differences in residents' social support. These findings inform social integration strategies for reducing social isolation and related declines in physical and mental health for older adults in nursing homes as well as nursing home and health care policies for improving quality of life of those utilizing long term care services.