O R I G I N A L A R T I C L E Social Support and its Correlation with Loneliness and Subjective...
Transcript of O R I G I N A L A R T I C L E Social Support and its Correlation with Loneliness and Subjective...
ORIGINAL ARTICLE
Social Support and its Correlation with
Loneliness and Subjective Well-being:
A Cross-cultural Study of Older Nepalese Adults
Hom Nath Chalise
Geriatric Center Nepal, Kathmandu; and Department of Public Health, Asian College for Advanced Studies
(Purbanchal University), Satdobato, Lalitpur, Nepal
Population aging in Nepal is a recent phenomenon, due more to demographic changes than to
socio-economic development. The study had three goals: to analyze the social support exchange
among elderly men and women; to discover the main sources of support in loneliness and subjective
well-being in the elderly; and to study the cross-cultural differences in support among elderly
Chhetri (N = 137, mean age = 69.1 [7.2] years) and Newar people (N = 195, mean age = 68.8
[7.7] years) in one ward in Kathmandu. The data were collected using face-to-face interviews. The
dependent variables were loneliness and subjective well-being (SWB). The results for both ethnic
Chhetri and Newar respondents show that their major support comes from their children living in
the same household and their spouses. I conclude that the sources of social support and social sup-
port exchange are similar between the two castes ⁄ ethnicities and that there are no cross-cultural dif-
ferences between them in terms of support for loneliness and SWB-life stability, although there are
cross-cultural differences in their SWB-life satisfaction. Providing social support to friends and
neighbors appears to be related to less loneliness and increased SWB in both castes ⁄ ethnicities.
Keywords elderly; loneliness; Nepal; social support; subjective well-being
doi:10.1111/j.1753-1411.2009.00034.x
Research background
Measures of social support, subjective well-being (SWB), and loneliness are of central
importance in research on elderly people (Chalise, Saito, Takahashi, & Kai, 2007).
Although numerous investigators have suggested that social support has a major impact
on the health and well-being of the elderly, it is less clear how this effect might operate
(George, 1989). There is also a lack of research on the different sources of social support
and how they affect the social support received and provided with regards to the loneli-
ness and SWB of older adults (Chalise et al., 2007).
Correspondence concerning this article should be addressed to Hom Nath Chalise, PhD, Founder Director, Geriatric
Center Nepal, G P O Box No. 23200 UPC – 119, Kathmandu-9, Battisputali, Nepal. Email: [email protected]
Acknowledgments: First, I gratefully acknowledge all the elderly participants, interviewers and social workers
without whom this study would not have been possible. I would also like to acknowledge Professor Ichiro Kai,
University of Tokyo for his valuable suggestions at every step of the data analysis in this research.
Asian Social Work and Policy Review 4 (2010) 1–25
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Social support is often assessed under three categories: perceived support, sup-
port behavior (received support), and support resources (Barrera, 1986; Vaux, 1985).
Perception of support refers to one’s subjective assessment of the availability and ade-
quacy of support. Research suggests that this perception affects one’s well-being as much
as support received (Thoits, 1995; Wethington & Kessler, 1986). Support behavior
describes the actual emotional and ⁄or instrumental assistance received. Support
resources are simply the social support networks i.e., the sources of one’s social capital or
the advantage gained through social interaction (Wu & Hart, 2002).
As people age they often need increased social support. The most common sources of
social support are their spouse (or partner), children and siblings, followed by close
friends (Lynch, 1998). The convoy model of social support (Kahn & Antonucci, 1980)
postulates that each individual is surrounded by a convoy; a set of people with whom the
individual maintains reciprocal emotional and instrumental support. The prevalence of
each type of support, however, varies according to union, parental and socioeconomic
statuses, as well as gender, age, and ethnicity (Barrett, 1999; Campbell, Connidis, &
Davies, 1999; Wu & Pollard, 1998). For example, research has found that the perception
of available support is higher among married people and increases with socioeconomic
and employment status, but decreases with age (Turner & Marino, 1994). Women gener-
ally report more perceived support than men (Ross & Mirowsky, 1989).
Loneliness in old age is a significant challenge for gerontological researchers and prac-
tices with the increasing growth of life expectancy worldwide. The experience of loneli-
ness impacts on individuals across the life spectrum and has physical, psychological and
social repercussions (Lauder, Sharkey, & Mummery, 2004). Loneliness lowers the quality
of life and is associated with poor medical prognosis in old age (Victor et al., 2000). There
is a strong relationship between depressive symptoms and loneliness (Holmen, Ericsson,
& Winblad, 1999; Prince, Harwood, Blizzard, Thomas, & Mann, 1997), and loneliness
predicts the increased use of health services (Geller, Janson, McGovern, & Valdini, 1999)
and early institutionalization (Tilvis, Pitkala, Jolkkonen, & Strandberg, 2000). Loneliness
has been shown to predict cognitive decline and increases the risk of mortality (Tilvis
et al., 2000).
SWB is a broad term that refers to a diverse group of indicators commonly used to
measure various aspects of life quality (George & Bearon, 1980). SWB measures reflect
underlying psychological states encompassing affective (e.g., happiness) and cognitive
(e.g., satisfaction, values, aspirations) dimensions (Diener, 1984; Schimmack, Radha-
krishnan, Oishi, Dzokoto, & Ahadi, 2002). Measures of SWB represent an individual’s
general evaluation of circumstances or perceptions within specific life domains (Chatters,
1988). Two commonly used global measures of SWB are happiness and overall life satis-
faction (Taylor, Chatters, Hardison, & Riley, 2001). Happiness is generally regarded as
an affective measure that involves emotional states, whereas life satisfaction is a cognitive
measure that involves a summation of intellectual evaluations of satisfaction from several
life domains.
Past research indicates that cognitive and affective components of SWB are influenced
by personality (Diener & Lucas, 1999) and by culture (Diener & Suh, 1999). According to
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Diener andDiener (1995), little attention has been paid to whether the predictor of psycho-
logical well-being differs in various cultures. They further add that variables that influence
peoples’ evaluations of their psychological well-being do vary across culture.
Research on social support (and related concepts) carried out in different contexts
and cultures have demonstrated that there is a strong relationship between health and
well-being throughout the lifespan, but particularly in old age (see Antonucci, Sherman,
& Akiyama, 1996; Chalise et al., 2007). Research studies have repeatedly found that peo-
ple who receive a high level of social support enjoy enhanced health and well-being,
improved physical health, less depression, improved life satisfaction and less loneliness.
So far,most such studies have been conducted in developed countries and cultures and it
is largely unknownwhether the findings can be generalized to other societies and how socio-
cultural factors can be implicated there (Chen et al., 2004). Nevertheless, a major problem
in social support research is the lack of an adequate theoretical framework for understand-
ing the impact of social support on health (see Fernandez-Ballesteros, 2002; Schreurs & de
Ridder, 2000, p. 90). At the same time, a major problem with SWB research in gerontol-
ogy is the lack of consistency in defining, measuring, and using terms like psychological
well-being, happiness, life satisfaction, and morale (see Mannell & Dupuis, 1996).
Study of social support, loneliness and SWB of the elderly in a developing country like
Nepal is quite new. Further, an elucidation of the relationship between the sources of social
support (such as husbands, children and friends) and loneliness and SWB will help to
elaborate our knowledge on this topic, which has had inadequate treatment in the litera-
ture. Nations tend to respond to the challenge of population aging in diverse ways because
they differ significantly in demographic composition, economic development, social and
political institutions and core cultural values (Liang, 2003). These differences are likely to
have a profound impact on the course of individual aging, health and well-being in old age.
Formal and informal support for the elderly in Nepal
The Nepal government provides pensions for government employees. They are provided
to civil servants, military personnel, police officers, and teachers. In 1995, the government
of Nepal introduced a new scheme for people over 75 years of age in five districts. The
scheme was extended to cover the whole country in the fiscal year 1995 ⁄1996 and the
amount provided to each beneficiary was Rs. 100 a month. The amount was increased
to Rs. 150 (nearly US$ 2.00) in 1999. The amount was increased to Rs. 500 (nearly
US$ 6.00) in fiscal year 2008 ⁄2009 and the minimum age for eligibility for such allow-
ances was also lowered to the age of 70 years. The program also provides similar allow-
ances to widows over 60 years of age and disabled individuals over 16 years of age
(Chalise, 2006). Although the amount paid to the elderly and to the widows over 60 is
nominal and does not cover most aged people (those aged between 60 and 69 years), it
has become popular among elderly Nepalese.
Like many other countries in Asia, most elderly people work in the informal sector
and children are regarded as security for old age. Culturally speaking, taking care of
parents is the responsibility of children, especially sons and daughters-in-law. Although
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most forms of support flow to the elderly, support also flows from the elderly to their
children in the form of goods, labor, and services. The elderly help their sons and daugh-
ters-in-law in different forms of household work. They may also participate in family
decision-making and assume leadership roles in the family and community.
Most elderly Nepalese elderly tend to work in the informal sectors and lack a regular
income after retirement. According to Chalise and Brightman (2006), < 7 percent of the
elderly receive a pension and most pension recipients are former security personnel
(military and police). The bulk of the elderly population of Nepal receives no pension
and most of them depend on family support and personal savings or continue working as
before. According to Subedi (2003), despite their old age, a large proportion (54%) of the
elderly contributes in non-economic activities related to the household.
Research objectives
The present study examines the importance of sources of specific social support (that is, the
spouse, children living with the elderly, children living apart from them and friends and
neighbors) in the mental health (namely, loneliness and SWB) of elderly people using cross-
sectional data fromKatmandu City. The specific objectives of this study are as follows:
1 To analyze the situation of social support exchange among elderly men and women
from different sources.
2 To find which are the main sources of social support for loneliness and SWB in the
elderly.
3 To study the cross-cultural validity of significant sources of loneliness and SWB
among elderly Chhetri and Newar people.
Research methodology
A face-to-face interview research method using a structured questionnaire was adopted
for the study. Data for this study were taken from a cross-sectional survey of elderly
Nepalese people in July–August 2005. The study site was Katmandu Metropolitan City,
the capital and largest city of Nepal, with a population of 671,846 (Central Bureau of
Statistics, 2003). For the purpose of this study an administratively and geographically
well-defined ward was selected. The ward was chosen for reasons of convenience, such as
its accessibility and cooperation from the inhabitants. It has a total population of 34,488
people living in 7848 households. According to an unpublished source in the Central
Bureau of Statistics, 1287 of these households have at least one older adult aged 60 years
or more. The sample was derived from a larger study and the sampling process has been
reported elsewhere (Chalise et al., 2007). We chose a convenience sample of 137 older
adults from the 1287 households based on the following criteria: (i) one older adult from
each household; (ii) belonging to Chhetri caste ⁄ ethnicity; (iii) consenting to participate
in the study; (iv) able to communicate in Nepali; and (v) without apparent cognitive
impairment, as judged by their family members. Further, due to considerable differences
between them, other castes ⁄ ethnicities were not included in this study.
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This study analyses the results of elderly Chhetri and Newar residents, representing
two different castes ⁄ ethnic groups in Nepal that have their own distinct language and cul-
ture. The Chhetri comprise the highest proportion of all caste ⁄ ethnic groups in Nepal
and the Newar comprise the indigenous population of the Kathmandu valley, where the
proportion of Newar is still the highest in this area.
Ethical consideration
The study protocol was approved by the Institutional Review Board of the Graduate
School of Medicine of the University of Tokyo on 2005 June. The purpose of the study
was explained and verbal informed consent was obtained from all participants before the
interviews. The interviews were conducted in the respondents’ homes and averaged an
hour. No other family members were present at the time of the interview.
Variables measurements and reliability
The validity and reliability of research instruments used in this study were carefully pre-
served throughout the procedures involving data collection; namely, the selection of the
items in the questionnaire, the translation of the questionnaire, the methods used by the
interviewers and statistical analysis.
Independent variables
Details of the social support and controlled variables are explained below.
Social support variables
A multitude of measures for this variable is available and a gold standard assessment tool
does not exist (Hogan, Linden, & Najarian, 2002). For the present study, the social sup-
port questionnaire was developed on the basis of a review of the literature in the area and
incorporated factors relating to the social context and living arrangements of older Nepa-
lese adults. The researcher developed 13 structured questions about the various types of
support received and provided during the previous year (including three types of avail-
able support) with six different sources of support, which are listed in Appendix A and B.
The researcher measured support availability as well as support received and provided,
using a dichotomous response (yes ⁄no) during the previous year with reference to each
source of support.
Due to the very low frequencies of a few social support items, the author included
only seven items of social support received (SSR) and social support provided (SSP) of
the 13 items included in the questionnaire. The social support items include: (i) someone
to listen to you when you need to talk; (ii) someone with whom to share most of your
worries and fears with; (iii) someone who gives you good advice; (iv) someone who gives
you love and affection; (v) someone who gives you a good time; (vi) someone who will
help you if you are confined to bed; and (vii) someone to take you to the doctor if needed
with four sources of social support (a spouse, children living with you, children living
apart from you and friends or neighbors) for this study. Although, the purpose of this
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study was not to develop an SSR and SSP scale, the internal consistency and reliability of
each source’s specific SSR and SSP measured using Cronbach’s alpha varied from 0.68 to
0.94 in the two castes ⁄ ethnicities sample. This showed that the internal consistency of the
sources of SSR and SSP items included was satisfactory.
Controlled variables
On the basis of the literature review, the author selected some confounding factors that
affect social support. They are age, sex, marital status, education, functional ability, liv-
ing arrangements and self-perception of economic satisfaction. The literature shows that
these variables also affect loneliness and SWB of the elderly.
The functional capability of the older adults was measured using five items (using
public transport, shopping for groceries, preparing meals, doing light housework and
taking medicine) from the seven-item instrumental activities of daily living (IADL) scale
(Lawton & Brody, 1969). For the present study, responses were dichotomized as ‘‘unable
to do it at all’’ and ‘‘can do it with some difficulty ⁄need some help’’ (coded 0) and ‘‘with-
out help’’ (coded 1).
Living arrangements were classified ‘‘living with children’’ or ‘‘living with others’’.
Marital status was classified ‘‘married’’ or ‘‘widow or widower’’. Widow or widower
includes unmarried, divorced, and separated respondents. The proportion of unmarried
divorced and separated respondents was very low. Financial satisfaction, as a widely used
measure of self-perceived financial condition, was assessed by the respondents’ estimate
of their present financial condition on a five-point Likert scale, with ‘‘not satisfied’’ coded
as 1 and ‘‘very satisfied’’ coded as 5. The respondents’ educational level was categorized
as illiterate, informally literate, below school leaving certificate: formally completion of
10 years of schooling (SLC) and above SLC. Sex was measured as ‘‘male’’ or ‘‘female’’.
Age was measured as a continuous variable.
Dependent variables
In this study loneliness and SWB (SWB-life satisfaction and SWB-life stability) are the
dependent variables.
Loneliness
A three-item loneliness scale (Hughes, Waite, Hawkley, & Cacioppo, 2004) developed
from the Revised UCLA Loneliness Scale (R-UCLA; Russell, 1996) is used. Hughes
et al. (2004) tested its psychometric properties in two studies and found Cronbach’s
alpha 0.72 in both. They also found very high correlation (0.82) between the three-item
loneliness scale and the R-UCLA loneliness scale. The internal consistency of this scale
was 0.81 and 0.84 in the elderly Chhetri and Newar participants, respectively.
SWB
For the present study SWB is measured using the life satisfaction index K (LSIK)
(Koyano & Shibata, 1994). The LSIK is a multidimensional construct with three
components: cognitive ⁄ short term, cognitive ⁄ long term and emotional ⁄ short term
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well-being. This scale also had very high reliability and validity when tested on a
national representative sample of elderly people in Japan (Koyano & Shibata, 1994).
This scale has nine items.
Confirmatory factor analysis of LSIK in the present study showed that the original
second-order model did not fit well with the Nepalese culture (not shown here). When the
author modified the LSIK by deleting two items that had a very low correlation the
model fit well. This study, then, assesses SWB using two factors separately, the SWB-life
satisfaction (cognitive ⁄ long term) and SWB-life stability (emotional ⁄ short term). The
internal consistency and reliability of SWB-life satisfaction and SWB-life stability was
satisfactory in the samples of both castes ⁄ ethnicities of the elderly participants.
Data analysis
First, distribution, in the form of frequencies and percentages, and mean and range for
all independent and dependent variables were reviewed. Difference in the characteristics
between elderly men and women were compared by bivariate analysis using the Student’s
t-test for continuous variables and Fisher’s exact test for dichotomous variables. A paired
sample t-test was used to compare differences on mean scores of social support between
SSR and SSP with sources of social support. The correlation between dependent vari-
ables (loneliness, SWB-life satisfaction and SWB-life stability) was tested using Spear-
man’s correlation coefficient. The author conducted a separate multiple regression
analysis on the Chhetri and Newar samples. In the multiple regression an analysis each of
the sources of social support received or provided was entered separately with all the con-
founding factors included together. Finally, in order to test for interaction between
sources of social support and caste ⁄ ethnicity, the author followed a method also used by
Sugisawa, Okabayashi, Naktani, Fukaya, and Shibata (2002), to test for difference of
slopes. The test statistic (t) was calculated according to the formula, t ¼ b1�b2ffiffiffiffiffiffiffiffiffiffiffiffiffiffi
SE21þSE2
2
p , where
b refers to the unstandardized regression coefficients and SE refers to the standard errors
of b. The analysis was conducted using SPSS 14.0 (SPSS Inc, Chicago, IL, USA) for
Windows.
General characteristics of elderly Chhetri
The socio-demographic characteristics of the 137 elderly Chhetri participants is shown in
Table 1. The participants ranged in age from 60 years to 93 years with a mean age of
69.1 (± 7.2) years. Of these, 63 (46.0%) were men, 70 (51.1%) were married, and 74
(54.0%) were illiterate (could not read or write). The proportion of married men was
considerably higher than that of elderly women (68.3% vs 36.5%, P < 0.001). In the
same way, the proportion of illiterate elderly women was considerably higher than that
of elderly men (65.1% vs 44.6%, P < 0.05). Regarding self-perception of economic satis-
faction, nearly half of the elderly reported this to be fair. A total of 86.1% of the older
adults were living with their children. The IADL score of the elderly Chhetri was 4.04
(± 1.6). Their SWB-life satisfaction and SWB-life stability scores were 2.4 (± 1.6) and
1.5 (± 1.3), respectively. Their mean loneliness scale score was 4.7 (± 1.7).
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Table 1 General characteristics of the Chhetri sample (N = 137)
Variables Total
(N = 137)
Male
(N = 63)
Female
(N=74)
P�
N % N % N %
Age (years) mean 69.1 68.7 69.5 0.470
SD� 7.2 6.7 7.6
Range 60–93 60–86 60–93
Marital status
Married 70 51.1 43 68.3 27 36.5 0.000
Educational level
Illiterate 74 54.0 41 65.1 33 44.6 0.007
Literate (Informally) 19 13.9 8 12.7 11 14.9
Below SLC§ 19 13.9 8 12.7 11 14.9
SLC and above 25 18.2 6 9.5 19 25.7
Self perceived economic satisfaction
Not satisfied 35 25.5 10 15.9 25 33.8 0.001
Fair 69 50.4 30 47.6 39 52.7
Satisfied 33 24.1 23 36.5 10 13.5
Living Arrangement
With children 118 86.1 54 85.7 64 86.5 0.137
IADL (Five items)–
Mean 4.0 4.3 3.9 0.137
SD� 1.6 1.5 1.6
Range 0–5 0–5 0–5
Loneliness scale (Three items)��Mean 4.7 4.3 5.1 0.002
SD� 1.7 1.4 1.8
Range 3–9 3–9 3–9
SWB-life satisfaction (Four items)��Mean 2.4 2.7 2.2 0.030
SD� 1.6 1.5 1.6
Range 0–4 0–4 0–4
SWB-life stability (Three items)§§
Mean 1.5 1.8 1.3 0.036
SD� 1.3 1.3 1.3
Range 0–3 0–3 0–3
Notes: �Dependent variable was sex (men = 1, women = 0). �Standard deviation. §SLC: School
Leaving Certificate (formally completion of 10 years of schooling). –Possible range 0–5, higher
score indicates better functional ability. ��Possible range 3–9, higher score indicates higher loneli-
ness. ��Possible range 0–4, higher score indicates higher life satisfaction. §§Possible range 0–3,
higher score indicates higher life stability.
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General characteristics of the Newar elderly
The distribution of socio-demographic characteristics of the 195 Newar elderly samples is
shown in Table 2. Respondents ranged in age from 60 to 97 years with a mean age of
68.8 (± 7.7) years. A total of 101 (52.0%) were men, 105 (53.8%) were married, and 106
(54.5%) were illiterate (could not read and write). The proportion of elderly married men
was considerably higher than that of elderly married women (67.3% vs 39.4%,
P < 0.001). In the same way, the proportion of illiterate elderly women was higher than
that of elderly men (59.6 vs 49.5, P < 0.1). Regarding self-perception of economic satis-
faction, 43.1%, of the elderly reported it to be fair. Most older adults (87.7%) were living
with their children. The IADL score of the elderly was 4.2 (± 1.5), the loneliness score
was 4.8 (± 1.7), SWB-life satisfaction score was 2.3 (± 1.6) and SWB-life stability score
was 1.2 (± 1.3).
Social support exchange situation with sources of social support among elderly Chhetri
The distribution of the mean SSR and SSP score for the elderly Chhetri is shown in
Table 3. The mean SSR score was highest for those who received support from children
living with them (4.0) followed by a spouse living with them (2.2), children living apart
from them (1.4), and from friends ⁄neighbors (1.3). There was a gender difference in the
mean SSR and SSP hierarchy. The mean SSR score of elderly men was highest for those
who received support from children living with them (3.8), followed by a spouse living
with them (3.6) friends ⁄neighbors (1.4), and children living apart from them (1.3). In the
same way, the mean SSR score of elderly women was highest for those who received sup-
port from children living with them (4.2), followed by support from children living apart
from them (1.3), from friends ⁄neighbors (1.2), and from the spouse living with them
(1.0). The result of the t-test showed there was a difference between elderly men and
women in the SSR from spouse (P < 0.001).
In the same way the mean SSP score was highest towards children living with them,
then towards their friends ⁄neighbors, spouse and children living apart from them. But
the trend is different between elderly men and women. In elderly men, the mean SSP
score is highest to their spouse (3.2) then to the children living with them (3.0),
friends ⁄neighbors (2.4), and children living apart from them (1.2). But, in the elderly
women, the mean SSP score is highest towards children living with them (2.9), then to
friends ⁄neighbors (2.1), children living apart from them (1.2), and their spouse (0.7). The
result of the t-test shows there is difference between elderly men and women in the SSP to
spouse (P < 0.001).
When the source specific mean score of SSR and SSP are compared (Table 3), the
mean score of SSR of respondents from their spouse, children living together and children
living apart from them was higher than their mean SSP score. In the case of friends ⁄neigh-bors mean SSP score was higher than the mean SSR from friends ⁄neighbors. The result ofthe paired samples t-test (Table 4) shows the difference between SSR and SSP in terms of
sources of social support in the elderly Chhetri sample. The author found a difference
(P < 0.05) between SSR and SSP in terms of the sources of support: the spouse, children
living with them, and friends ⁄neighbors in both elderly men and women.
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Table 2 General characteristics of the Newar sample (N = 195)
Variables Total
(N = 195)
Male
(N = 101)
Female
(N = 94)
P�
N % N % N %
Age (years) Mean 68.8 68.7 68.9 0.819
SD� 7.7 6.9 8.5
Range 60–97 60–87 60–97
Marital status
Married 105 53.8 68 67.3 37 39.4 0.000
Educational level
Illiterate 106 54.5 50 49.5 56 59.6 0.121
Literate (Informally) 35 17.9 18 17.8 17 18.1
Below SLC§ 22 11.3 14 13.9 8 8.5
SLC and above 32 16.4 19 18.8 13 13.8
Self perceived economic satisfaction
Not satisfied 55 28.2 27 26.7 28 29.8 0.922
Fair 84 43.1 47 46.5 37 39.4
Satisfied 56 28.7 27 26.7 29 30.9
Living Arrangement
With children 171 87.7 87 86.1 84 89.4 0.499
IADL (Five items)–
Mean 4.2 4.4 4.0 0.069
SD� 1.5 1.4 1.6
Range 0–5 0–5 0–5
Loneliness scale (Three items)��Mean 4.8 4.6 5.0 0.060
SD� 1.7 1.7 1.8
Range 3–9 3–9 3–9
SWB-life satisfaction (Four items)��Mean 2.3 2.4 2.3 0.671
SD� 1.6 1.6 1.6
Range 0–4 0–4 0–4
SWB-life stability (Three items)§§
Mean 1.2 1.3 1.2 0.812
SD� 1.3 1.3 1.3
Range 0–3 0–3 0–3
Notes: �Dependent variable was sex (men = 1, women = 0). �Standard deviation. §SLC: School
Leaving Certificate (formally completion of 10 years of schooling). –Possible range 0–5, higher
score indicates better functional ability. ��Possible range 3–9, higher score indicates higher loneli-
ness. ��Possible range 0–4, higher score indicates higher life satisfaction. §§Possible range 0–3,
higher score indicates higher life stability.
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Social support exchange situation with sources of social support among elderly Newar
The distribution of mean SSR and SSP scores for the elderly Newar is shown in Table 3.
The mean SSR score was highest from participants’ children living with them (4.2)
followed by their spouse (2.3), children living apart from them (1.2), and friends ⁄neighbors (1.1). As in the older Chhetri adults, the author found a gender difference in
the hierarchy of mean SSR and SSP in older Newar adults as well. The mean SSR score
by elderly men was highest from children living together with them (4.0), followed by
their spouse (3.4), friends ⁄neighbors (1.3), and children living apart from them (1.0). In
the same way, the mean SSR score for elderly women was highest from children living
with them (4.5), followed by their spouse (1.3), children living apart from them (1.3), and
friends ⁄neighbors (1.0). The result of the t-test showed there was a difference between
elderly men and women in the SSR from their spouse (P < 0.001).
Table 3 Descriptive statistics of the mean SSR� and SSP� of the Chhetri and the Newar sample
Chhetri elderly Total (N = 137) Men (N = 63) Women (N = 74) P§
Mean SD– Range Mean SD– Range Mean SD– Range
SSR variables
Spouse 2.2 2.8 0–07 3.6 2.8 0–07 1.0 2.1 0–07 0.000
Children living together 4.0 2.3 0–07 3.8 2.4 0–07 4.2 2.3 0–07 0.323
Children living apart 1.4 1.8 0–06 1.3 1.6 0–06 1.6 1.9 0–06 0.428
Friends ⁄neighbors 1.3 1.6 0–06 1.4 1.7 0–06 1.2 1.4 0–05 0.411
SSP variables
Spouse 1.9 2.5 0–07 3.2 2.7 0–07 0.7 1.6 0–06 0.000
Children living together 3.0 2.2 0–07 3.0 2.3 0–07 2.9 2.1 0–07 0.789
Children living apart 1.2 1.6 0–06 1.2 1.6 0–06 1.2 1.7 0–05 0.837
Friends ⁄neighbors 2.2 2.0 0–07 2.4 2.1 0–07 2.1 1.9 0–06 0.289
Newar elderly Total (N = 195) Men (N = 101) Women (N = 94) P§
Mean SD– Range Mean SD– Range Mean SD– Range
SSR variables
Spouse 2.3 2.6 0–07 3.4 2.5 0–07 1.3 2.3 0–07 0.000
Children living together 4.2 2.3 0–07 4.0 2.3 0–07 4.5 2.2 0–07 0.080
Children living apart 1.2 1.8 0–07 1.0 1.7 0–06 1.3 1.8 0–07 0.286
Friends ⁄neighbors 1.1 1.5 0–07 1.3 1.6 0–07 1.0 1.3 0–05 0.290
SSP variables
Spouse 2.2 2.7 0–07 3.0 2.8 0–07 1.4 2.4 0–07 0.000
Children living together 3.2 2.5 0–07 3.1 2.5 0–07 3.3 2.4 0–07 0.677
Children living apart 1.2 1.9 0–06 1.0 1.4 0–06 1.4 2.0 0–06 0.188
Friends ⁄neighbors 1.9 1.9 0–07 2.2 2.0 0–07 1.5 1.7 0–07 0.004
Notes: Figure in bold shows the significant values P < 0.05. �Social support received. �Socialsupport provided. §Bivariate analysis t-test of social support between elderly men and women.
–Standard deviation.
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The mean SSP score was highest for children living with them (3.2), followed by
their spouse (2.2), friends ⁄neighbors (1.9), and children living apart from them (1.2).
As in the SSR, the hierarchy of the mean SSP score was different between elderly
men and women. In elderly men the mean SSP score was highest for children living
together with them (3.1), followed by their spouse (3.0), friends ⁄neighbors (2.2), and
children living apart from them (1.0). In the same way, for elderly women, the
mean SSP score was highest for children living together with them (3.3), followed
by friends ⁄neighbors (1.5), and their spouse as well as children living apart from
them (1.4). The result of the t-test showed there was a difference between elderly
men and women in the SSP to spouse (P < 0.001) and friends ⁄neighbors(P = 0.004).
Further, when the sources specific mean SSR and SSP scores are compared (Table 3),
the mean SSR score from the spouse (2.3) and from children living with them (4.2) were
higher than mean SSP score to their spouse (2.2) and children living with them (3.2) by
elderly. But the mean SSP score for friends ⁄neighbors (1.9) was higher than what they
received from their friends ⁄neighbors (1.1). The result of the paired sample t-test
(Table 4) shows that there was difference a between SSR and SSP in terms of the elderly
participants’ sources of social support. The difference between SSR and SSP was found
for the children living together (P < 0.05) and friends ⁄neighbors (P < 0.05) in both
elderly men and women in the Newar sample.
Relation between loneliness and SWB
Table 5 shows correlation among loneliness, SWB-life satisfaction and SWB-life stability
of both the Chhetri and the Newar samples. The correlation between SWB-life satisfac-
tion and SWB-life stability was 0.597 (P < 0.001), and 0.395 (P < 0.001) in the Chhetri
and the Newar samples, respectively. In the same way the correlation between loneliness
and SWB-life satisfaction was )0.558 (P < 0.001) and )0.365 (P < 0.001) in the Chhetri
Table 4 Paired sample statistics of the mean SSR and SSP of the Chhetri and the Newar elderly
Variables SSR-SSP Total Men Women
Mean P Mean P Mean P
Chhetri elderly
Spouse 0.33 0.000 0.38 0.023 0.28 0.005
Children living together 1.01 0.000 0.75 0.000 1.24 0.000
Children living apart 0.26 0.051 0.16 0.377 0.34 0.070
Friends ⁄neighbors )0.91 0.000 )0.98 0.000 )0.85 0.000
Newar elderly
Spouse 0.17 0.076 0.38 0.020 )0.04 0.691
Children living together 1.05 0.000 0.84 0.000 1.27 0.000
Children living apart )0.05 0.592 )0.01 0.941 )0.10 0.486
Friends ⁄neighbors )0.70 0.000 )0.96 0.000 )0.43 0.001
Note: Figure in bold shows the significant values P < 0.05.
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and the Newar elderly, respectively. A further correlation between loneliness and SWB-
life stability was )0.507 (P < 0.001) and )0.257 (P < 0.001) in the Chhetri and the
Newar elderly, respectively. This shows that loneliness and SWB are inversely correlated.
Social support exchange, loneliness and SWB
Table 6 shows the coefficient estimates of regressing loneliness, SWB-life satisfaction and
SWB-life stability score with sources of SSR and SSP for the Chhetri and the Newar sam-
ple elderly separately. The author analyzed the interaction between gender and social
support by including the interaction terms in the multiple regression analysis and found
no significant interaction. The author also compared the regression coefficients between
men and women using statistical tests for differences of slope, but no significant differ-
ence was found. Both elderly men and women samples were then combined in the multi-
ple regression analysis. The result of multiple regression analysis and comparison of
regression coefficients (Table 6) is explained below separately for loneliness, SWB-life
satisfaction and SWB-life stability.
Social support exchange and loneliness
SSR from spouse was associated with lower loneliness in both the Chhetri (b = )0.217,P < 0.001) and Newar (b = )0.253, P < 0.001) elderly participants. The author did
not find any evidence that there was any difference between the Chhetri and the Newar
elderly (t = 0.478, P > 0.10). SSR from children living together was also associated
with lower loneliness in both the Chhetri (b = )0.233, P = 0.001) and the Newar
(b = )0.290, P < 0.001) elderly sample, and no difference was found in both samples
(t = 0.551, P > 0.10). The author further found that SSR from friends ⁄neighbors hada marked impact in reducing loneliness in the Newar samples (b = )0.161, P = 0.041)
relative to the Chhetri samples (b = )0.116, P > 0.10).
In the same way, SSP to spouse was associated with lower loneliness in both the
elderly Chhetri (b = )0.238, P < 0.001) and the Newar (b = )0.235, P < 0.001) par-
ticipants. SSP to children living together was also associated with lower loneliness in both
the elderly Chhetri (b = )0.172, P = 0.021) and Newar (b = )0.284, P < 0.001)
Table 5 Correlation between loneliness and SWB
Caste ⁄ ethnicity SWB-life SWB-life
satisfaction
stability
Loneliness
Chhetri
SWB-life satisfaction 1
SWB-life stability 0.597** 1
Loneliness 0.558** 0.507** 1
Newar
SWB-life satisfaction 1
SWB-life stability 0.395** 1
Loneliness 0.365** 0.257** 1
Note: **Correlation is significant at the 0.01 level (2-tailed).
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sample. SSP to friends ⁄neighbors was also associated with lower loneliness in both
elderly Chhetri (b = )0.152, P = 0.026) and Newar (b = )0.147, P = 0.027) groups.
The author further did not find any evidence of any difference between the elderly
Chhetri and Newar participants in all the above cases.
Table 6 Contribution of sources of social support to loneliness and SWB-life satisfaction and
SWB-life stability in Multiple Regression Analysis in the Chhetri and Newar elderly
Variables Chhetri Subjects Newar Subjects t�
b Beta (SE) b Beta (SE)
Loneliness
SSR
Spouse )0.217** )0.359 0.058 )0.253** )0.376 0.048 0.478
Children living together )0.233** )0.324 0.078 )0.290** )0.381 0.068 0.551
Children living apart 0.023 0.025 0.077 )0.256** )0.260 0.064 2.787**
Friends ⁄neighbors )0.116 )0.109 0.084 )0.161* )0.138 0.078 0.392
SSP
Spouse )0.238** )0.354 0.063 )0.235** )0.366 0.045 )0.039Children living together )0.172* )0.226 0.074 )0.284** )0.405 0.051 1.246
Children living apart )0.014 )0.013 0.084 )0.259** )0.281 0.059 2.387*
Friends ⁄neighbors )0.152* )0.178 0.067 )0.147* )0.160 0.066 )0.053SWB-life satisfaction
SSR
Spouse 0.216** 0.381 0.055 0.053 0.084 0.049 2.213*
Children living together 0.111 0.164 0.076 0.343** 0.483 0.062 )2.365*Children living apart )0.021 )0.024 0.073 0.159* 0.172 0.062 )1.879Friends ⁄neighbors 0.045 0.045 0.080 0.086 0.079 0.074 )0.376
SSP
Spouse 0.260** 0.413 0.059 0.019 0.032 0.045 3.248**
Children living together 0.053 0.075 0.071 0.151** 0.230 0.050 )1.129Children living apart 0.011 0.011 0.080 0.184** 0.213 0.057 )1.761Friends ⁄neighbors 0.153* 0.191 0.064 0.127* 0.147 0.063 0.325
SWB-life stability
SSR
Spouse 0.099* 0.217 0.047 0.132* 0.256 0.041 )0.529Children living together 0.068 0.125 0.064 0.127* 0.218 0.057 )0.688Children living apart 0.088 0.123 0.060 0.131* 0.174 0.054 )0.533Friends & neighbors 0.088 0.110 0.066 0.191* 0.213 0.063 )1.129
SSP
Spouse 0.117* 0.229 0.052 0.132* 0.268 0.038 )0.233Children living together 0.068 0.119 0.059 0.048 0.090 0.045 0.270
Children living apart 0.041 0.052 0.066 0.126* 0.178 0.050 )1.027Friends & neighbors 0.141** 0.219 0.053 0.146** 0.208 0.053 )0.067
Notes: �This t statistics is the difference of bs between two sub samples calculated as t ¼ b1�b2ffiffiffiffiffiffiffiffiffiffiffiffiffiffi
SE21þSE
22
p ;
Newar was used as the reference group; *P < 0.05; **P < 0.01.
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The result of loneliness further showed that SSR from children living apart was asso-
ciated with significant reduction in loneliness in the elderly Newar (b = )0.256,P < 0.001), while no such effect was present in the elderly Chhetri (b = 0.023,
P > 0.10). In the same way, SSP to children living apart was also associated with a sig-
nificant reduction in loneliness in the elderly Newar (b = )0.259, P < 0.001), while no
such effect was present in the elderly Chhetri (b = )0.014, P > 0.10), although the
direction of the coefficients was the same. The difference between the elderly Chhetri and
the Newar was significant for both SSR from children living apart (t = 2.787, P < 0.01)
and SSP to children living apart (t = 2.387, P < 0.05).
Social support exchange and SWB-life satisfaction
SSR from a spouse and SSP to a spouse were related with higher SWB-life satisfaction in
the Chhetri samples but not in the Newar ones. SSR from a spouse (b = 0.216, P < 0.1)
and SSP to a spouse (b = 0.260, P < 0.1) had a marked impact on the higher SWB-life
satisfaction in the Chhetri samples but no such effect was found on the Newar samples
(bSSR spouse = 0.053, P > 0.1; bSSP spouse = 0.019, P > 0.1), although the direction of
the coefficients was the same. The difference between the elderly Chhetri and Newar par-
ticipants was significant for both SSR from a spouse (t = 2.213, P < 0.05) and SSP to a
spouse (t = 3.248, P < 0.01).
SSR from children and SSP to children, regardless of where they lived, were
related to higher SWB-life satisfaction in the elderly Newar, but not in the
elderly Chhetri group. SSR from children (bSSR children living together = 0.343,
P < 0.01; bSSR children living apart = 0.159, P < 0.05) and SSP to children
(bSSP children living together = 0.151, P < 0.01; bSSP children living apart = 0.184, P < 0.01)
were associated with higher SWB-life satisfaction in the Newar samples, while no
such effect was present in the Chhetri elderly (bSSR children living together = 0.111,
P > 0.1; bSSR children living apart = )0.021, P > 0.10; bSSP children living together = 0.053,
P > 0.1; bSSP children living apart = 0.011, P > 0.1).
The author found SSP provided to friends ⁄neighbors was related with higher SWB-
life satisfaction in both the Chhetri (b = 0.153, P < 0.05) and Newar (b = 0.127,
P < 0.05) elderly. The author did not find evidence that there was any difference
between the Chhetri and Newar elderly group (t = 0.325, P > 0.10).
Social support exchange and SWB-life stability
SSR from a spouse was associated with higher SWB-life stability in both the Chhetri
(b = 0.099, P = 0.038) and Newar (b = 0.132, P = 0.008) elderly group. In the
same way, SSP to a spouse was associated with higher SWB-life stability in both the
Chhetri (b = 0.117, P = 0.026) and Newar (b = 0.132, P = 0.001) group. Further,
SSP to friends ⁄neighbors was also associated with higher SWB-life stability in both
the Chhetri (b = 0.141, P = 0.008) and the Newar (b = 0.146, P = 0.006) elderly.
The author did not find evidence that there was any difference between the elderly
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Chhetri and Newar group (tSSR spouse = )0.529, P > 0.10; tSSP spouse = )0.233,P > 0.10; tSSP friends ⁄ neighbors = )0.067, P > 0.10).
Further, among the Newar elderly participants, SSR from children living together
with them (b = 0.127, P = 0.008), from children living apart from them (b = 0.131,
P = 0.008), and from friends ⁄neighbors (b = 0.191, P = 0.008) and SSP to children liv-
ing apart from them (b = 0.126, P = 0.008) were also related to higher SWB-life stabil-
ity but did not increase SWB-life stability among the elderly Chhetri participants,
although the direction of the coefficients was the same. When comparing the regression
coefficients using statistical methods, the author found no difference between the Chhetri
and the Newar samples on SWB-life stability.
Discussion
This research is among the first to examine the relative importance of source-specific
social support (received and provided) on mental health (SWB and loneliness) among
older Nepalese adults. This research attempts to extend our limited understanding on
effects of the sources of social support (received and provided) on the loneliness and
SWB of older adults. On the basis of a comprehensive model that controls some common
confounding factors, the sources of social support (received and provided) identified are
significant predictors of loneliness and SWB (life satisfaction and life stability) among
older adults. Further, this study looks at the cross-cultural differences of the significant
variables in two castes ⁄ ethnicities of Kathmandu, Nepal.
A previous study by Chalise et al. (2007) on elderly Brahmin respondents from the
same survey data cannot be directly compared with the result of this study due to differ-
ent social support items included in the SSR and SSP, and differences in the data analysis
technique. But some findings of that study are included in this section.
Situation of social support exchange
In this study, the results from the elderly Chhetri and Newar participants showed that
the major support exchange of older adults was with children living together with them
and their spouse. The mean SSR score showed that elderly women received more support
from their children than the elderly men, as in the previous study of the Brahmin elderly
(Chalise et al., 2007). This finding is also consistent with other findings that women
received more emotional support from family members than their husbands (Taylor,
1985). Other studies (Akiyama et al., 1996; Antonucci, Akiyama, & Takahashi, 2004)
have shown that adults feel closer to their older mothers than to their older fathers and
are expected to interact with their parents accordingly (e.g., provide more assistance to
their mother when needed).
The results of this study showed that the mean SSR and SSP score to a spouse by the
elderly men was higher compared with elderly women in both castes ⁄ ethnicities, whichwas similar to the study of elderly people in the Brahmin caste (Chalise et al., 2007). This
may be due to the higher proportion of married men compared with women, and other
reasons may be due to traditional Hindu ideals held by high-caste Hindu women (Chalise
et al., 2007). Traditional Hindu ideals dictate that women should be shy, patient, good,
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sequestered, devoted, faithful, and restrained (Benett, 1983) and, as the oft quoted book
of Manu (Buhler, 1984) states, women must always be protected by a man, be it her
father, husband or son. Furthermore Gray (1991) writes that dharma (duty) defines the
nature of the whole household and it is through domestic practices that men directly
uphold dharma. Men are associated with the goal of moral action in the world to sustain
the cosmos: women are the means of doing this and accordingly they are subordinated to
their husbands. As the personification of dharma in the household, the husband is worthy
of respect (mannu parne) from his wife and from those to whom she gives birth (Benett,
1983). There is also culturally a common saying, ‘‘a wife should treat her husband like a
god’’. Even nowadays many conservative elderly women do not like to pronounce the
name of their husband in light of the cultural taboos of dharma.
This study further identified the differences between the SSR and SSP with reference
to sources of social support. The results showed differences in the social support
exchange between elderly participants with children living with them and friends ⁄neigh-bors in both Chhetri and Newar older adults. This was also true for both the elderly men
and women in both castes ⁄ ethnicities. The author also found a difference in the social
support exchange with a spouse in the elderly men in both the castes ⁄ ethnicities. In addi-
tion, the findings of this study show that the elderly received more support from a spouse
and children living together with them, but provided more support to friends ⁄neighbors.A finding from Korea showed that women provide more support to their husbands,
yet they are not reciprocally rewarded with support from their husbands (Kim, Hisata,
Kai, & Lee, 2000). Adult children in Taiwan provide net financial support to their parents
(Lee, 1994). Rossi and Rossi (1990), in particular, found that widowed parents tend to
receive more assistance than they give to their children, while married parents tend to give
more assistance than they receive. According to Dowd (1984) exchange is based on power
and resources and as individuals grow older they have less power and fewer resources.
They are therefore at a disadvantage in the exchange market because of their increased
age, as they are frequently in the position of receiving valued goods from people who are
in more powerful or prestigious positions. Culturally, elderly Nepalese people expect more
social support from their children (especially from their sons and daughters-in-law) and in
turn the elderly also provide support to them in the form of goods, labor and services.
Relation between loneliness and SWB
This study found that loneliness and SWB (SWB-life satisfaction and SWB-life stability)
were negatively correlated. Other studies support this finding. Borge et al. (1999) found
that SWB was strongly negatively correlated with the degree of loneliness (r = )0.64,P < 0.001). Steverink et al. (2001), in one study of elderly, also found that loneliness
and life satisfaction were negatively correlated (P = )0.39, P <0.01). And Cohen et al.
(1997) found that the absence of loneliness was a significant predictor of SWB in elderly
people dwelling in the community.
Significant variables of loneliness
Results of multiple regression analysis showed that when the effects of age, sex, marital
status, education, IADL, living arrangements, and economic satisfaction were controlled,
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SSR from a spouse, children living together with them as well as SSP to a spouse, chil-
dren living together with them and friends ⁄neighbors related to lower loneliness in both
the Chhetri and Newar elderly groups. No difference was found between the elderly
Chhetri and Newar participants on the above results when the regression coefficients
were compared statistically using the test for difference of slope. A previous study of the
Brahmin caste (Chalise et al., 2007) showed that SSR from children living together with
them and SSP to a spouse, children living together with them and friends ⁄neighbors wererelated to lower loneliness in older adults.
This study further found that SSR and SSP to children living apart from them were
related with lower loneliness in the elderly Newar, but not in the elderly Chhetri partici-
pants. The different in the result may be due to the difference in the living arrangements
of the children of two caste ⁄ ethnicities. Most of the elderly Newar in this sample tradi-
tionally live in Kathmandu and any children they have who do not live with them live
near them, so they have frequent opportunities for interaction with them. But the Chhetri
sample of this study included a large number of elderly migrants, whose children living
apart from them are not living nearby in many cases. Opportunities for interaction with
them may not therefore be possible.
Studies from other countries showed that frequent contacts with friends, especially
close ones, greatly reduce the risk of loneliness among elderly (Bitzan & Kruzich, 1990).
However, contacts with sons and or daughters (Bondevik & Skogstad, 1998; Felton &
Berry, 1992) and neighbors (Bondevik & Skogstad, 1998) were also related to lower levels
of loneliness. According to Seeman and Berkman (1988), a spouse can be an important
source of emotional and tangible support. Further, Page and Cole (1991) found that
marital status was the strongest demographic predictor of self-reported loneliness in
adults. Holmen, Ericsson, Andersson, and Winblad (1992) found that the lowest fre-
quency of loneliness was among those who lived with a partner, and the highest loneliness
was among older adults who were widowed.
Significant variables of SWB
This study showed that SSR from a spouse and SSP to a spouse and friends ⁄neighborswere related to higher SWB-life satisfaction in the elderly Chhetri participants. On the
other hand, SSR from children and SSP to children, both living together with the
participants and apart from them, as well as SSP to friends ⁄neighbors were related to
higher SWB-life satisfaction in the elderly Newar participants. But SSP to friends ⁄neigh-bors was related to higher SWB-life satisfaction in both castes ⁄ ethnicities and no evidence
was found that there was any difference between the two castes ⁄ ethnicities when the
regression coefficients were compared.
Further, SSR from a spouse and SSP to a spouse and friends ⁄neighbors were related to
increasing SWB-life stability (happiness) in the elderly Chhetri. SSR from a spouse, chil-
dren living together with them, children living apart from them, friends ⁄neighbors as wellas SSP to a spouse, children living apart from them and friends ⁄neighbors were related to
increasing SWB-life stability in the elderly Newar group. Interestingly, SSR from a spouse
and SSP to a spouse, as well as SSP to friends ⁄neighbors were related with increasing
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SWB-life stability in both the elderly Chhetri and Newar participants. In addition, there
was no evidence of any difference on predictor sources of SWB-life stability between the
elderly Chhetri and the Newar groups when the regression coefficients were compared.
Findings based on this study, SWB-life satisfaction and SWB-life stability cannot be
directly compared with other studies, as, to the knowledge of the author, no such a study
that differentiates life satisfaction and life stability in relation to sources of social support
measuring SWB exists.
According to Diener and Diener (1995), little attention has been paid to whether the
predictors of psychological well-being differ in various cultures. They further add that
variables that influence peoples’ evaluations of their life satisfaction vary across cultures.
A study from Japan shows that among older Japanese who were married with children,
social support from their spouse had a greater association with positive well-being than
social support from their children and others. In contrast, among those without a spouse,
only greater support from children was significantly correlated with higher positive well-
being, less distress, and less cognitive impairment (Okabayashi, Liang, Krause, Akiyama,
& Sugisawa, 2004). Some earlier studies from developed countries have shown that inter-
generational aid had no association with the well-being of older parents (Arling, 1976;
Lee, 1979; McCulloch, 1990).
According to Taylor et al. (2001), social support from family and friends all contribute
to an individual’s SWB. The frequency of contacts with friends and the availability of close
friends were positively related with happiness (Ellission, 1990) and well-being (Adams,
1989; Lennartsson, 1999). Studies of older adults showed that the quality of social contacts
had a stronger association with SWB than the quantity of social contacts (Pinquart &
Sorensen, 2000). Studies from the USA have shown that relationships with friends were
more strongly related to SWB than those with children (Antonucci, 1990; Blau, 1973;
Haring-Hidore, Stock, Okun, & Writer, 1985). A study by Venkatraman (1995) further
corroborates this finding with evidence that for both older Americans and Indians, social
support (emotional support) from a spouse was much more important than that from
adult children, friends and relatives in affecting their SWB (Venkatraman, 1995).
The finding of this study shows the social support exchange with friends ⁄neighbors isrelated to higher SWB in both the Chhetri and Newar elderly groups. This result is
consistent with many results in developed societies (Dean, Kolody, & Wood, 1990). Fur-
ther results showed that providing social support to friends ⁄neighbors was related to
higher SWB in elderly participants in both castes ⁄ ethnicities.
Limitations of the study
An interpretation of these studies should be considered within the context of the study’s
strengths and limitations. There are a number of limitations to this study. First, the data
were cross-sectional, so it is difficult to establish the casual directions of correlations
between dependent variables and independent variables (Bowling, 1997). Therefore,
future research needs to test the causality between sources of social support and loneli-
ness and the SWB of the elderly using a longitudinal design. Second, data come from only
one ward of Katmandu metropolis and includes only one respondent from each family of
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the selected two caste ⁄ ethnic groups, so the results may not be generalized to other castes,
ethnicities, and populations. For the future research a more representative sample from
the larger geographical area should be included.
Third, several aspects of social support have not been addressed in this study. Analysis
of social support of this study is based on a dichotomous (yes or no) design of social sup-
port responses, and does not take into account the frequency or intensity of social support.
Further, measures of social support did not include the perceived satisfaction with social
support (received and provided). Many studies show that perceived support has a direct
effect on the health and well-being of older adults (Thoits, 1995; Wethington & Kessler,
1986). Several important covariates, such as undesirable life events (acute stressors), and a
sense of personal control or mastery and self-esteem (psychological and coping resources),
known to be important determinants of social support (Thoits, 1995), are not included in
this study. There may be some bias in the reporting of women due to the cultural norms of
dharma, and this study also does not address the intergenerational relations.
Fourth, a three-point scale for loneliness may not be sufficiently discriminatory to
measure loneliness. For future study, the revised UCLA loneliness scale may be a better
choice. Thus, the validation of the suitability of applying the revised UCLA loneliness
scale in the Nepalese elderly population is a subject worthy of future research.
Implications
Because of the paucity of aging-related data from developing countries and different cul-
tures, studies describing different types of aging research will make a contribution to our
understanding about aging. This study is the first attempt at measuring the SWB and
loneliness among Nepalese elderly in the capital city of Nepal. Further research is
required with other caste ⁄ ethnicity in rural and urban areas.
One implication of this study is that a positive interaction between family members is
necessary to decrease loneliness among the elderly. As providing social support by the
elderly is found to benefit their mental health, there should be opportunities for the
elderly to participate formally or informally in social programs. Further, to increase
the sense of filial responsibility in children, formal and informal programs (i.e., through
the school curriculum, radio and TV programs) should be given priority.
A national policy for the elderly population should be formulated that focuses on the
health care and social security of the elderly. Measures should be taken by the govern-
ment as well as by non-governmental organizations to provide health care and social
security, especially for elderly widows and widowers who do not receive support or
proper care from their sons, daughters, and other relatives. An ideal living arrangement
for the elderly is living with their children, so the government should provide incentives
for families to take care of their frail elderly relatives. There should also be a provision of
community care for the elderly.
Conclusions
Despite these limitations, several conclusions can be drawn from this study. Elderly
Nepalese people were found to be actively engaged in the exchange of social support with
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their families and friends. The main social support exchange for the elderly was with chil-
dren living with them and a spouse, but providing social support to friends ⁄neighborswas also important to reduce their loneliness and enhance their SWB among both elderly
Chhetri and Newar participants. The results show there is a gender difference in SSR and
SSP and that social support exchange was similar in the elderly Chhetri and Newar
groups. Based on the results of this study, similarities were found on the significant
sources of social support on loneliness and SWB-life stability, but differences exist on
SWB-life stability. Cross-cultural similarities were found regarding social support pro-
vided to friends ⁄neighbors: reduced loneliness and increased SWB. A more in-depth
study should continue along this line of investigation to improve and extend the findings
of this study by including other castes and ethnicities.
References
Adams, R. G. (1989). Conceptual and methodological issues in studying friendships of older adults.
In R. G. Adams & R. Bliezner (Eds.), Older adult friendship: structure and process (pp. 17–41).
Newbury Park, CA: Sage.
Akiyama, H., Elliott, K., & Antonucci, T. C. (1996). Same-sex and cross-sex relationships. Journal
of Gerontology: Psychological Sciences, 51B, 374–82.
Antonucci, T. C. (1990). Social support and relationships. In R. H. Binstock & L. K. George (Eds.),
Handbook of aging and social science (3rd edn) (pp. 203–26). San Diego, CA: Academic Press.
Antonucci, T. C., Sherman, A. M., & Akiyama, H. (1996). Social network, support and
integration. In J. E. Birren (Eds.), Encyclopedia of gerontology (pp. 505–15). New York:
Accademic Press.
Antonucci, T. C., Akiyama, H., & Takahashi, K. (2004). Attachment and close relationships across
the life span. Attachment and Human Development, 6, 353–70.
Arling, G. (1976). The elderly widow and her family, neighbors and friends. Journal of Marriage
and the Family, 38, 757–68.
Barrera, M. (1986). Distinctions between social support concepts, measures, and models. American
Journal of Community Psychology, 14, 413–45.
Barrett, A. E. (1999). Social support and life satisfaction among the never married: Examining the
effects of age. Research on Aging, 21, 46–72.
Benett, L. (1983). Dangerous wives and sacred sisters: Social and symbolic roles of high-caste
women in Nepal. Columbia: Columbia University Press.
Bitzan, E. J., & Kruzich, J. M. (1990). Interpersonal relationships of nursing home residents.
The Gerontologist, 30, 385–9.
Blau, Z. (1973). Old age in changing society. New york: Franklin Watts.
Bondevik, M., & Skogstad, A. (1998). The oldest old, ADL, Social contact and loneliness. Western
Journal of Nursing Research, 20, 325–43.
Borge, L., Martinsen, E. W., Rudd, T., Watne, Ø., & Fris, S. (1999). Quality of life, loneliness, and
social contact among long-term psychiatric patients. Psychiatric Services, 50, 81–4.
Bowling, A. (1997). Research methods in health: investigating health and health services. Bucking-
ham, Philadelphia: Open University Press.
Buhler, G. tr. (1984). The Laws of Manu. Delhi: Banarsidass (Reprint from Oxford University’s
1886-edition).
Hom Nath Chalise Social Support and its Correlation with Loneliness and Subjective Well-being
� 2010 The Author
Journal compilation � 2010 Blackwell Publishing Asia Pty Ltd 21
Campbell, L. D., Connidis, I. A., & Davies, L. (1999). Sibling ties in laterlife: A social network
analysis. Journal of Family Issues, 20, 114–48.
Central Bureau of Statistics (CBS). (2003). Population Monograph of Nepal 2003. Volume 1,
Kathmandu: CBS.
Chalise, H. N. (2006). Demographic situation of population ageing in Nepal. Kathmandu University
Medical Journal, 4(3), 356–64.
Chalise, H. N., & Brightman, J. D. (2006). Aging trend: Population aging in Nepal. Geriatrics and
Gerontology International, 6(3), 199–204.
Chalise, H. N., Saito, T., Takahashi, T., & Kai, I. (2007). Relationship specialization amongst
sources and receivers of social support and its correlations with loneliness and subjective
well-being: A cross cultural study of Nepalese older adults. Archives of Gerontology and
Geriatrics, 44(3), 299–314.
Chatters, L. M. (1988). Subjective well-being evaluations of among older Black Americans.
Psychology and Aging, 3, 184–90.
Chen, X., He, Y., Oliveria, A. M. D., Coco, A. L., Zappulla, C., Kaspar, V. et al. (2004).
Loneliness and social adaptation in Brazilian, Canadian, Chinese and Italian children: a
multi-national comparative study. Journal of Child Psychology and Psychiatry, 45(8),
1373–84.
Cohen, C. I., Talavera, N., & Hartung, R. (1997). Depression among aging persons with schizo-
phrenia who live in the community. American Journal of Geriatric Psychiatry, 5(2), 145–55.
Dean, A., Kolody, B., & Wood, P. (1990). Effect of social support from various sources of
depression in elderly persons. Journal of Health and Social Behavior, 31, 148–61.
Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95, 542–75.
Diener, E., & Diener, M. (1995). Cross-cultural correlates of life satisfaction and self-esteem.
Journal of Personality and Social Psychology, 68, 653–63.
Diener, E., & Lucas, R. E. (1999). Personality and subjective well-being. In D. Kahneman, E.
Diener & N. Scwarz (Eds.), Well-being: The foundations of hedonic psychology (pp. 213–29).
New York: Russell Sage Publication.
Diener, E., & Suh, E. M. (1999). National difference in the subjective well-being. In D. Kahneman,
E. Diener & N. Schwarz (Eds.), Well-being: The foundations of hedenic psychology
(pp. 434–52). New York: Russell Sage Foundation.
Dowd, J. J. (1984). Beneficence and the aged. Journal of Gerontology, 39, 102–8.
Ellission, C. G. (1990). Family ties, friendships, and subjective well-being among Black Americans.
Journal of Marriage and the Family, 52(2), 298–310.
Felton, B. J., & Berry, C. A. (1992). Do the sources of urban elderly’s social support determine its
psychological consequences? Psychology and Aging, 7, 89–97.
Fernandez-Ballesteros, R. (2002). Social support and quality of life among older people in Spain.
The Journal of Social Issues, 58(4), 645–59.
Geller, J., Janson, P., McGovern, E., & Valdini, A. (1999). Loneliness as a predictor of hospital
emergency department use. Journal of Family Practice, 48, 801–4.
George, L. (1989). Stress, social support, and depression over the life course. In K. Markides &
C. Cooper (Eds.), Aging, stress, social support, and health (pp. 241–67). New York: Wiley.
George, L. K., & Bearon, L. B. (1980). Quality of life in older persons: Meaning and measurement.
New York: Human Science Press.
Gray, J. N. (1991). Marriage and the constitution of hierarchy and gender in Bahun-Chhetri
households. Contributions to Nepalese Studies, 18(1), 53–82.
Hom Nath Chalise Social Support and its Correlation with Loneliness and Subjective Well-being
� 2010 The Author
22 Journal compilation � 2010 Blackwell Publishing Asia Pty Ltd
Haring-Hidore, M., Stock, W. A., Okun, M. A., & Writer, R. A. (1985). Marital status and
Subjective well-being: A research synthesis. Journal of Marriage and the Family, 47(4), 947–53.
Hogan, B. E., Linden, W., & Najarian, B. (2002). Social support interventions Do they work?
Clinical Psychology Review, 22, 381–440.
Holmen, K., Ericsson, K., Andersson, L., & Winblad, B. (1992). Loneliness among elderly people
living in Stockholm: a population study. Journal of Advanced Nursing, 17(1), 43–51.
Holmen, K., Ericsson, K., & Winblad, B. (1999). Quality of life among the elderly. State of mood
and loneliness in two selected groups. Scandinavian Journal of Caring Sciences, 13, 91–5.
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring
loneliness in large surveys. Research on Aging, 26(6), 655–72.
Kahn, R. L., & Antonucci, T. C. (1980). Convoys over the life course: Attachment, roles, and
social support. In P. B. Baltes & O. G. Brim (Eds.), Life Span Development and Behaviour
(pp. 253–86). New York: Academic Press.
Kim, H. K., Hisata, M., Kai, I., & Lee, S.-K. (2000). Social support exchange and quality of life
among the Korean elderly. Journal of Cross-Cultural Gerontology, 15(4), 331–47.
Koyano, W., & Shibata, H. (1994). Development of a measure of subjective well-being in Japan:
Construct validity and reliability of the life satisfaction index K. Facts and Research in
Gerontology. pp. 181–7.
Lauder, W., Sharkey, S., & Mummery, K. (2004). A community survey of loneliness. Journal of
advanced Nursing, 46(1), 88–94.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and
instrumental activities of daily living. The Gerontologist, 9(3), 179–86.
Lee, G. R. (1979). Children and the elderly: Interaction and morale. Research on Aging, 1, 335–60.
Lee, Y. J. (1994). Sons, daughters, and intergenerational support in Taiwan. American Journal of
Sociology, 99(4), 1010–41.
Lennartsson, C. (1999). Social ties and health among the very old in Sweden. Research on Aging,
21, 657–81.
Liang, J. (2003). Changes in health and well-being among older Japanese. Social Science Japan, 27,
6–8.
Lynch, S. A. (1998). Who supports whom? How age and gender affect the perceived quality of
support from family and friends. The Gerontologist, 38, 231–8.
Mannell, R. C., & Dupuis, S. (1996). Life satisfaction. In J. E. Birren (Eds.), Encyclopedia of
gerontology volume 2 (pp. 59–71). New York: Accademic Press.
McCulloch, B. J. (1990). The relationship of intergenerational reciprocity of aid to the morale of
older parents: Equity and exchange theory comparisons. Journal of Gerontology: Social
Sciences, 45(4), S150–5.
Okabayashi, H., Liang, J., Krause, N., Akiyama, H., & Sugisawa, H. (2004). Mental health among
older adults in Japan: Do sources of social support and negative interaction make a difference?
Social Science and Medicine, 59(11), 2259–70.
Page, R. M., & Cole, G. E. (1991). Demographic predictors of self-reported loneliness in adults.
Psychological Reports, 68, 939–45.
Pinquart, M., & Sorensen, S. (2000). Influences of socioeconomic status, social network, and compe-
tence on subjective well-being in later life: Ameta analysis.Psychology and aging, 15(2), 187–224.
Prince, M., Harwood, R., Blizzard, R., Thomas, A., & Mann, A. (1997). Social support deficits,
loneliness and life events as risk factors for depression in old age: the Gospel Oak Project VI.
Psychological Medicine, 27, 323–32.
Hom Nath Chalise Social Support and its Correlation with Loneliness and Subjective Well-being
� 2010 The Author
Journal compilation � 2010 Blackwell Publishing Asia Pty Ltd 23
Ross, C. E., & Mirowsky, J. (1989). Explaining the social patterns of depression: Control and
problem solving—or support and talking. Journal of Health and Social Behavior, 30, 206–19.
Rossi, A. S., & Rossi, P. H. (1990). Of Human Bonding: Parent-Child Relations Across the Life
Course. New York, NY: Aldine de Gruyter.
Russell, D. W. (1996). UCLA Loneliness Scale (Verson 3): reliability, validity, and factor structure.
Journal of Personality Assessment, 66, 20–40.
Schimmack, U., Radhakrishnan, P., Oishi, S., Dzokoto, V., & Ahadi, S. (2002). Culture,
personality, and subjective well-being: Integrating process models of life-satisfaction. Journal of
Personality and Social Psychology, 82, 582–93.
Schreurs, K. M. G., & de Ridder, D. T. D. (2000). Integration of coping and social support
perspectives: Implication for the study of adaptation to chronic diseases. Clinical Psychology
Review, 17, 89–112.
Seeman, T. E., & Berkman, L. F. (1988). Structural characteristics of social networks and their
relationship with social support in the elderly: who provides support. Social Science and
Medicine, 26(7), 737–49.
Steverink, N., Westerhof, G. J., Bode, C., & Dittmann-Kohli, F. (2001). The personal experience
of aging, individual resources and subjective well-being. Journal of Gerontology: Psychological
Sciences, 56B, 364–73.
Subedi, B. P. (2003). Customary images and contemporary realities: the activities of older people in
Nepal. Working Paper No WP 403. UK: Oxford Institute of Aging.
Sugisawa, H., Okabayashi, H., Naktani, Y., Fukaya, T., & Shibata, H. (2002). The impact of social
ties on depressive symptoms in US and Japanese elderly. The Journal of Social Issues, 58(4),
785–804.
Taylor, R. J. (1985). The extended family as a source of support to elderly Blacks. The Gerontolo-
gist, 25, 488–95.
Taylor, R. J., Chatters, L. M., Hardison, C. B., & Riley, A. (2001). Informal social support
networks and subjective well-being among African Americans. Journal of Black Psychology,
27(4), 439–63.
Thoits, P. (1995). Stress, coping, and social support processes: Where are we? What next? Journal
of Health and Social Behavior, (extra issue), 53–79.
Tilvis, R., Pitkala, K., Jolkkonen, J., & Strandberg, T. (2000). Feelings of loneliness and 10-year
cognitive decline in the aged population. Lancet, 356, 77–8.
Turner, R. J., & Marino, F. (1994). Social support and social structure: A descriptive epidemiology.
Journal of Health and Social Behavior, 35, 193–212.
Vaux, A. (1985). Variations in social support associated with gender, ethnicity, and age. The
Journal of Social Issues, 41, 89–110.
Venkatraman, M. M. (1995). A cross-cultural study of the subjective well-being of married elderly
persons in the United States and India. Journal of Gerontology: Social Sciences, 50B, S35–44.
Victor, C., Scambler, S., Bond, J., & Bowling, A. (2000). Being alone in later life: loneliness, social
isolation and living alone. Reviews in Clinical Gerontology, 10, 407–17.
Wethington, E., & Kessler, R. C. (1986). Perceived support, received support, and adjustment to
stressful life events. Journal of Health and Social Behavior, 27, 79–89.
Wu, Z., & Hart, R. (2002). Social and Health Factors Associated with Support among Elderly
Immigrants in Canada. Research on Aging, 24, 391–412.
Wu, Z., & Pollard, M. S. (1998). Social support among unmarried childless elderly persons. Journal
of Gerontology: Social Sciences, 53, S324–35.
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Appendix A: Questionnaire about social support received
1. Did someone listen to you when you needed to talk during the last year?
1. Yes 2. No 3. Don’t know 4. Not applicable
If yes, ask the source of support (multiple choice questions)
1. Spouse 2. Children and in-laws living together 3. Other members of the family living
together 4. Children and in-laws living apart 5. Relatives 6. Friends ⁄neighbors2. Did you share your most private worries and fears with someone during the last year?
3. Did someone give you good advice at a time of crisis during the last year?
4. Did someone help you with transportation during the last year?
5. Did someone help you with small repairs during the last year?
6. Did someone help you with household work during the last year?
7. Did someone help you by giving you money during the last year?
8. Did someone help you by giving clothes (or presents) during the last year?
9. Did someone show you love and affection during last year?
10. Did you have a good time with someone during the last year?
11. Does someone help you if you are confined to bed?
12. Does someone take you to a doctor if you need one?
13. Does someone prepare a meal if you are unable to do it yourself?
Appendix B: Questionnaire about social support provided
1. Did you listen to someone when he ⁄ she needed to talk during the last year?
1. Yes 2. No 3. Don’t know 4. Not applicable
If yes, ask the source of support (multiple choice questions)
1. Spouse 2. Children and in-laws living together 3. Other members of the family living
together 4. Children and in-laws living apart 5. Relatives 6. Friends ⁄neighbors2. Did someone share his ⁄her most private worries and fears with you during the last year?
3. Did you give good advice to someone at a time of crisis during the last year?
4. Did you help someone with transportation during the last year?
5. Did you help someone with small repairs during the last year?
6. Did you help someone with household work during the last year?
7. Did you help someone by giving them money during the last year?
8. Did you help someone by giving them clothes (or presents) during the last year?
9. Did you show someone love and affection during the last year?
10. Did you accompany someone to have a good time during the last year?
11. Do you help someone who is confined to bed?
12. Do you take someone to a doctor if s ⁄he needs it?13. Do you prepare a meal for someone if s ⁄he is unable to do it him ⁄herself?
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