Social Network Types, Intimacy and Healthy Longevity Among the Chinese Elderly

The significant association between an individual's social network and his or her health and mortality at old ages is well-documented in western societies. However, similar research from developing countries, especially among long-lived persons, is rare due to lack of data. The value of social support embedded in the social network for healthy longevity is generally more significant in developing countries given the lack of advanced and institutionalized social security systems. This chapter provides us with a good opportunity to address how social network types and intimacy are related to healthy longevity among Chinese elders. Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a unique specially designed nationwide survey with a sample of 15,232 community-residing Chinese elders, this chapter examines the associations between social network types and intimacy and subsequent healthy longevity from 2002 to 2005 within a multi-level context. The outcome variables include instrumental activities of daily living, activities of daily living, cognitive functioning, self-rated health, chronic diseases, frailty index, and mortality. We classified social networks into eight types based on living arrangement, number of frequently visiting children, and social connection (playing cards/mah-jong and involvement in religious and social activities): (1) isolated, (2) children-visiting-only, (3) family coresidence only, (4) family coresidence plus children-visiting only, (5) social connection only, (6) social connection plus children visiting, (7) social connection plus family coresidence, and (8) social connection plus family coresidence & children visiting. Source of intimacy was measured by the most frequent daily talking-person and grouped into (1) nobody/social service provider/matron, (2) spouse, (3) child, and (4) friend/neighbor. Other individual variables and community socioeconomic variables served as controls. We used multilevel logistic regression to examine the effects of social network types and source of intimacy on subsequent 3-year mortality and health status. Our analyses show that compared to the isolated elders, elders in socially integrated networks had up to a 35% reduction in odds of mortality over a 3-year period, although such protection was diminished after controlling for baseline health. Elders in family-oriented networks, on the other hand, had up to a 51% increase in odds of mortality over the 3-year period independent of baseline health. Compared to those who did not have an intimate network alter, those whose source of intimacy was a friend/neighbor or spouse had 15-50% decreased odds of death in the presence of various confounders including baseline health. Socially integrated networks reduce the likelihood of poor health by up to 60% in terms of cognitive impairment, ADL/IADL disability, poor self-rated health, chronic diseases, and frailty. Similar results were found for having a friend/neighbor as the source of intimacy. These results suggest that the protective effects of network types and source of intimacy on healthy longevity still exist at advanced ages. We further examined the patterns of social network types and source of intimacy by age, gender, childhood and adulthood SES, and community SES. We demonstrate there are substantial differences in network type and source of intimacy across ages, gender and SES. These findings are useful for the promotion of successful aging among the Chinese elderly in the context of largely reduced family size and greatly changing household structure due to population aging.