A Literature Review: Technology of Social Support for Aging in Place Situation
Introduction
Numbers of studies show that social support benefit not only to reduce mortality (Lyyra & Heikkinen, 2006), but also to enhance health outcomes, such as cancer, heart diseases, immune system, and endocrine system (Uchino, Cacioppo, & Kiecolt-Glaser, 1996).
Studies of social support have different points. Some of studies emphasis the relationship of Social Integration and health outcomes, while some of studies focus on the beneficial effects of Social Relationship and some of studies explores the functions Social Network provided. This literature review accepts the Cohen’s classifications of social support (Cohen, 1988). Cohen and his colleagues described that social support has two measures: structural support measure and functional support measures. “Structural refers to measures describing the interconnections between social ties that is often termed social integration (SI).” SI cares the relationships between perceived availability of support and health outcomes. Functional imply to studying that interpersonal relationships serve particular function (for example, network satisfaction, or psychological support).
Psychosocial Models of Social Support
Two psychosocial models explain the mechanism of that social support effects health. Main-effect model unveils that social support encourages health behaviors to enhance
physical health. Stress-buffering model explains that social support reduces the negative responses of a stress situation that relatives to psychological states, health behaviors, and physical health.
Each model has four perspectives, Information-based models, Identity and Self-esteem models, Social Influence models, and Tangible Resource models, to deduct mechanism to details. Cohen’s review (Cohen, 1988) show the process of that how social support effects health outcome (Table 3&4 in Cohen, 1988).
In main-effect model, information provides resources of health information to engage health behaviors and to make people to avoid stressful situation. Social support also
enhances identity and self-esteem that help people has positive psychological states that contribute to increase motivation to care themselves healthily. When people are under social influence condition, they are forced to have healthful behavior by social
controls and peer pressure. Tangible resource, for example, provided aids, and economic services, prevents slight illness from aggravation to serious disease.
In stress-buffering model, when people face to a threat or harm, they may have overreactions that deleterious to health. Information resource make people to know the threat well and help them to decrease the evaluation of threat or harm, which cause intensive stress appraisal to harm health. Identity and self-esteem solids personal control that lead to health behaviors under a stress environment. Social influence helps people to normative their behaviors and to cope with stressors. Tangible resource could also reduce stress appraisal.
In the other hand, however, providing social support brings negative effects for people. For example, people relay on information resource so much that they may lack of willingness to use medical services, especially when they live a long distance away from hospital or clinical, or when the expense of using medical services is too high
to afford it. Social influence has negative influence to health through peer pressure that doing non-healthy behavior around people. For example, adolescent prefer to become a smoker when their group members are smoking (Tyas & Pederson, 1998).
Uchino (Uchino, 2006) explicated a broad model based on different theoretical perspectives, Fig. 1. The broad model indicates that behavioral processes and psychological processes are linked to and influenced each other. And they effect biological processes separately or combined.
Social Support and Aging in Place
The U.S. Center for Disease Control and Prevention (CDC) defined aging in place: The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. Aging in place provides a familiar environment and an emotional bond to older people. Aging in place has less financial cost and more positive psychosocial benefits (Tang & Lee, 2011). In the other hand, living in their own home or community could trigger social isolation because their size of social network will be change and be instable when they getting older (Tilburg, 1998). The mobility and cognitive capacity of elders declined, meanwhile the chronic illness aggravated as aging, elders may feel depression because they lost controlling environment (Kawachi, 2001).
The benefits that are brought by social support is important for older people aging healthily. For example, social support links to health outcomes of chronic illness mental health, and self-management/self-care (Gallant, 2003). Social support also influent Cardiovascular Function, Neuroendocrine Function and Immune Function (Uchino, Cacioppo, & Kiecolt-Glaser, 1996). Researches demonstrated that heart disease, asthma, diabetes, and chronic illness self-management take advantages from having enough social support (Gallant, 2003). Self-management programs for elders reduces
the progress of diabetes mellitus and hypertension but not weight loss ( Chodosh, et
al., 2005). The self-management program should encourage elders to participate in
self-monitoring or decision making.
Besides facing physical challenge, older people suffer psychological changes. Morbidity,
disability in activities of daily living (ADLs), and chronic illness contribute to depression symptoms (Adamson, Price, Breeze, Bulpitt, & Fletcher, 2005). Social support does release depression and anxiety of older people (Cattan, White, Bond, & Learmouth, 2005).
Technology of Social Support
New technologies, such as online services, home health devices, smart phone, and communication through network, let older people live independently and qualifiedly. Technology of social support, especially Information Communication Technology (ICT) (Magnusson, Hanson, & Borg, 2004), Computer, and Sensor were applied in social support, has been providing benefits for aging people, their family members, and care providers. Social support technology makes older people not only age in their own houses, but also own a life with independence, safety, and quality at home because using social support technology has three major benefits: supporting awareness for extended family members, aiding recall of past actions, compensating for physical decline (Mynatt, melenhorst, Fisk, & Rogers, 2004).
Digital Family Portrait (DFP) base on sensing technology. Sensors which are layered in a private house for monitoring older people’s Activity of Daily Life (ADL) and visualize data for older people’s caregivers, for example, offspring, friends, or nurses of institution, who lives far away from (Rowan & Mynatt, 2005). Caregivers know older people’s general activities in their home and make a contact with older people when caregivers find that data shows an unusual condition.
Personal emergency response system (PERS) and Radio-Frequency Identification Devices (RFIDs) also provide data of ADL (Mihailidis, Carmichael, & Boger, 2004), however, devices of the two system must be worn on the person. These devices may obtrusive and difficult for older adult to operate them.
Cognitive decline companies with aging progress. Technology of Object-and-Action Recognition helps older people who has cognitive issues. Cook’s Collage (Mynatt, melenhorst, Fisk, & Rogers, 2004) is an execution of older people who has memory deficits, for example, Dementia. The assistant system could visually capture a series of motions and compare motions’ sequence with programed correct events. Then system provides older adults a cue of next correct action or alerts older people they missed. Same technology also is used in monitoring handwashing or boiling water.
Gesture pendent (Mynatt, melenhorst, Fisk, & Rogers, 2004) is a wireless device and is a part of smart home. Different gestures represent vary physical tasks, such as close/open front door, control air conditioning, or turn on/off lights. The pendent helps people who cannot accomplish ADL tasks. However, the device may cause a heavy workload that is hard for older people who has cognitive issues.
Recent years, people devote focus to build intelligent environment, smart home, for people aging in place. Technology mentioned above combines Artificial Intelligence (AI) (Pollack, 2005) not only help older people accomplish physical ADL tasks, but also assess older people’s cognitive status to alert caregivers to contact with older people.
Discussion
1 Inconsistent of Evidence
Although in majority study cases social support links to healthy outcomes, the relationship between social support and health is still obscured in some cases (Cohen, 1988). Some cases found irrelative links, others found conflictive evidence. The reason of such phenomena is undetermined: maybe it is caused by different conditions of experiments, or it is aroused by non-standard measurement of social support.
2 Confounding Factors
Biological factors and psychological factors effect health outcomes too, Fig.2. It is hard to separate social factors from other two factors. The confounding conditions may weaken links between social support and health or may gain results difficultly by applying inappropriate methods to process data.
Fig.2 Biopsychosocial Model of Health
3 Temporal Stability
Demonstration of health relative researches is a long-term progress. In a large life span, there are many uncontrolled conditions: experiments’ condition may change, the objectives may die, and unperceptive conditions may happen. Maintaining temporal stability is a critical issue of health relative researches.
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