Spousal social support and strain: impacts on health in older couples

Association between behavioral patterns and depression symptoms: dyadic interaction between couples

Background

Behavioral patterns are sometimes associated with depression symptoms; however, few studies have considered the intra-couple effects. This study examined the effect of a spouses' behavioral patterns on depression symptoms within themself and in their spouse.

Methods

A total of 61,118 childbearing age participants (30,559 husband-wife dyads) were surveyed. The depression symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9). The behavioral patterns were identified by the latent class analysis. The effects of behavioral patterns on the couple's own depression symptoms (actor effect) and their partner's depression symptoms (partner effect) were analyzed using the Actor-Partner Interdependence Model (APIM).

Results

Three behavioral patterns were identified: low-risk group, moderate-risk group, and high-risk group. The high risk of these behavior patterns would be associated with a higher score on the PHQ-9; for both husbands and wives, their behavioral patterns were positively associated with PHQ-9 scores (βhusband = 0.53, P < 0.01; βwife = 0.58, P < 0.01). Wives' behavioral patterns were also positively associated with their husbands' PHQ-9 scores (β = 0.14, P < 0.01), but husbands' behavioral patterns were not associated with their wives' PHQ-9 scores.

Conclusions

Wives' depression symptoms were affected only by their own behavioral patterns, whereas husbands' depression symptoms were influenced by both their own and their spouses' behavioral patterns.

Pregnancy, spousal connectedness, and young married women's mental health: an analysis of the Bangladesh adolescent health and wellbeing survey

Mental health disorders are responsible for 125.3 million disability-adjusted life years (DALYs) lost globally, with depression in adolescents rising faster than in adults. In total, more than 90% of the 1.2 billion adolescents in the world live in low- and middle-income countries (LMICs). Despite the rise in teenage marriage and pregnancy in LMICs, there is a paucity of research on the role of pregnancy as a risk factor for adolescent mental health, and the role of spousal connectedness as a potential protective factor. This study aims to address this gap. A total of 2408 currently married adolescent (aged 15-19 years) women from the Bangladesh Adolescent Health and Wellbeing Survey 2019-2020 were analysed. Multivariable models were used to assess the factors associated with depression symptoms and major depressive disorder (MDD). The prevalence of moderate/severe depressive symptoms or MDD among adolescents was 14.6%, well ahead of south Asian levels. The odds of having moderate/severe depressive symptoms (adjusted odds ratio [AOR]=1.94, 95% confidence interval [CI] 1.37-2.76) or MDD (AOR=1.63, 95%CI 1.18-2.25) were higher in pregnant adolescent women than in non-pregnant adolescent women. A closer relationship with one's husband reduced the risk of developing moderate/severe depressive symptoms (AOR=0.90, 95% CI 0.84-0.96) or MDD (AOR=0.91, 95% CI 0.86-0.97). Pregnancy and connectedness had no statistically significant interaction effect on depression. There is an urgent need for affordable and scalable interventions to reduce the risk of mental health morbidity in pregnant adolescent women especially in low- and middle-income countries.

Life-course social connectedness: Comparing data-driven and theoretical classifications as predictors of functional limitations in adulthood

A life course perspective on social relationships highlights the importance of specific relationships at specific times in life, but analyses that account for life course trajectories in social relationships are rare. This study compares theoretical and data-driven approaches to classifying life course relationships, including multiple dimensions of social connectedness at different time points across the life course. We examine each approach's ability to predict later-life functional limitations, given that functional impairment is prevalent among middle-aged and older adults. Data were from three waves of the Midlife in the United States (MIDUS) study (n = 6909). Relationship variables (parental affection, parental discipline, social support, social strain, and positive relations with others) were from wave 1 or wave 2. Functional limitations were measured at wave 3. Results showed that the data-driven approach had more predictive power than the theoretical approach. Additionally, results suggested that including only positive relationship features was nearly as robust as including both positive and negative relationship features. Overall, the data-driven approach outperformed the theoretical approach and revealed relationship trajectories consistent with life course cumulative processes.

Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective

OBJECTIVES

This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory.

METHODS

Longitudinal data from the Health and Retirement Study (2004-2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory.

RESULTS

Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p > .05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890).

DISCUSSION

Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory.

Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study

Introduction

Stroke is a significant health problem and is considered one of the leading causes of mortality and permanent disability worldwide. Hypertension is a primary risk factor for stroke. Thus, hypertensive patients' knowledge, attitudes, and practices (KAP) are essential in preventing stroke.

Objective

To examine hypertensive patients' KAP towards stroke prevention among rural population in Saudi Arabia.

Methods

The study utilized a cross-sectional design. The data were collected using a convenience sampling technique from hypertensive patients in the northwestern rural areas of Riyadh Province. A self-administered questionnaire was adapted from the Stroke Recognition Questionnaire (SRQ) and utilized to assess KAP towards stroke prevention among rural hypertensive patients. The STrengthening of the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to report the study.

Results

A total of 196 hypertensive patients participated in the study. The total mean scores categorization into three quartiles showed that most respondents had poor levels of KAP towards stroke prevention. Weak positive correlations were found between KAP of patients. There were statistically significant differences between respondents' attitudes and practices with their age, education, marital status, and occupational status.

Discussion

This study denoted poor levels of KAP towards stroke prevention among hypertensive patients living in rural areas. This study showed the importance of further considering rural population by which improving their health and quality of life. Extending health educational programs and behavior-changing strategies to rural areas is essential to increase hypertensive patients and general public awareness about their stroke prevention and other health-related concerns.

Understanding Suicide over the Life Course Using Data Science Tools within a Triangulation Framework

Suicide and suicidal behaviors are important global health concerns. Preventing suicide requires a nuanced understanding of the nature of suicide risk, both acutely during periods of crisis and broader variation over the lifespan. However, current knowledge of the sources of variation in suicide risk is limited due to methodological and conceptual challenges. New methodological approaches are needed to close the gap between research and clinical practice. This review describes the life course framework as a conceptual model for organizing the scientific study of suicide risk across in four major domains: social relationships, health, housing, and employment. In addition, this review discusses the utility of data science tools as a means of identifying novel, modifiable risk factors for suicide, and triangulation as an overarching approach to ensuring rigor in suicide research as means of addressing existing knowledge gaps and strengthening future research.

Effects of supportive and conflicting interactions with partners and friends on emotions: Do the source and quality of relationships matter?

This study investigated the independent and interactive effects of supportive and conflicting interactions and overall relationship quality with partners and friends on positive and negative emotions. Data on social interactions and overall relationship quality with partners and friends, and emotions were collected from 717 South Korean adults (M _age = 47.23; 50.6% male). The results showed that supportive interactions with friends and high relationship quality with partners and friends were associated with enhanced positive emotions, whereas conflicting interactions with partners and friends and low relationship quality with partners were associated with increased negative emotions. In addition, interactive effects of social interactions and overall relationship quality suggested the evidence of reverse buffering. The beneficial effect of friend support on positive emotions was present only when friend conflict was high, and the adverse effect of partner conflict on positive emotions was magnified when individuals perceived high overall relationship quality with their partners.

Marriage and health: exploring the role of stress overload

BACKGROUND AND OBJECTIVES

The association between marital status and health is well-established, but its causes remain unclear. This study was the first to examine stress overload, the pathogenic form of stress, as a possible explanation.

DESIGN

The study employed a cross-sectional design and convenience sample to explore relationships among stress overload, marital status, social support, and illness.

METHODS

A diverse sample (n = 455), recruited from community and social media sites, completed an anonymous online survey. Included were standardized measures of stress overload (SOS-S), perceived social support (MSPSS), and somatic symptoms (PHQ-15).

RESULTS

Married participants reported lower stress overload levels than those in any other type of relationship (single, in-a-relationship, or cohabiting). They did not differ from the unmarried in overall level of social support, nor did statistically controlling social support or income levels erase the stress overload differential. They also reported lower levels of symptomology than the unmarried. SEM analyses yielded a best-fitting model showing stress overload to partially mediate the link between marital status and symptoms.

CONCLUSIONS

Stress overload is one mechanism that explains the marital health disparity, albeit not the only one. This holds implications for future research and practice focused on personal relationships and well-being.

Support Received and Provided by Older Adults who Lost a Child: A Qualitative Content Analysis

BACKGROUND

Despite the vulnerability of older adults and the importance of social support following the death of a child, little research has been conducted on the Iranian older population. This study aimed to explore perceived support among older adults after the death of a child.

MATERIALS AND METHODS

This study was carried out in Iran in 2020-2021 using a qualitative content analysis method. Semi-structured interviews with older adults who had experienced child death were used to collect data. To ensure the data's trustworthiness, Guba and Lincoln's criteria were applied. The Graneheim and Lundman method was used to analyze the data.

RESULTS

The participants' mean age was 70.41 years. The findings were organized into one theme, two main categories, and five subcategories based on 352 initial codes. Two main categories emerged from the participants' experiences: "supporting networks" and "giving support to others" with the theme of "healing emotional pain." Following the death of a child, the older parents perceived support as recuperation from their hurt feelings.

CONCLUSIONS

Receiving support from family, entourages, and society, as well as providing support to the family and parents with the same experience were protective factors against the effects of child death among older parents. To reduce the consequences of child death, older parents' health should be monitored through home care provided by nurses.

Aging and Family Relationships among Aymara, Mapuche and Non-Indigenous People: Exploring How Social Support, Family Functioning, and Self-Perceived Health Are Related to Quality of Life

Family relationships play a central role in wellbeing among older adults in Chile. Based on the theory of social production functions, this study examined the relationship between perceived social support from children, partners and relatives, family functioning, self-perceived health and quality of life (QoL) among Chilean older adults. The study used a multi-ethnic sample of Chilean older adults living in rural areas in the regions of Arica and Parinacota (north) and Araucanía (south). A model was analyzed that emphasizes relationships differentiated by the source of support, family functioning and self-perceived health in the explanation of QoL. The results obtained from the structural equation modelling (SEM) analysis showed the existence of indirect relationships of social support from children, partners and other family members via family functioning, while self-perceived health was directly associated with QoL. The findings indicate that family functioning is a main variable in the contrasted model, in addition to confirming the importance of distinguishing the role of the various sources of support. Research is needed to examine in detail intergenerational relationships and other relationships with family members who are significant in the wellbeing of older adults. This research corroborates that family relationships have a specificity that needs to be addressed in gerontological social intervention, as well as continuing along the lines of strengthening or improving existing family ties (more quality) over the quantity of social relationships.

Partner's Perceived Social Support Influences Their Spouse's Inflammation: An Actor-Partner Analysis

Social support has been linked to lower cardiovascular morbidity and mortality. However, most studies have examined perceived support as an intrapersonal construct. A dyadic approach to social support highlights how interdependence between individuals within relationships, including partner perceptions and interactions, can influence one's health. This study's overall purpose was to test actor-partner models linking perceived social support to inflammation. Ninety-four cisgender married couples completed perceived support measures and had their blood drawn for CRP and IL-6 to produce an overall inflammatory index. The primary results indicate that only a partner's level of perceived support was related to lower inflammation in their spouse. Our sample size, although moderate for inflammatory studies, was probably not large enough to detect actor influences. These data highlight the importance of taking a dyadic perspective on modeling perceived support and its potential mechanism.

Impact of Upper and Lower Body Functional Ability on Affect in Older Couples

Objective: We explore how upper and lower body functional ability of older adults and their partners relate to affect in later life. Methods: Data regarding own and partner's upper and lower body functional abilities were reported by 1767 married/partnered persons aged 57-83. Using multilevel modeling to account for nesting within couples, we examined the impact of a respondent's own functional abilities, their perception of their partner's abilities, and the interaction of respondent's and perceived partner's abilities on respondent's positive and negative affect. Results: Higher upper and lower body ability of both respondents and partners were associated with higher positive and lower negative affect. Moderating effects demonstrated a protective role of respondents' ability on affect when their partners experienced lower ability. Discussion: There is a potential compensatory relationship between older couples adapting to functional changes; it is important to support the functional abilities of both partners in couples to maximize psychological well-being.

Within-Couple Personality Concordance Over Time: The Importance of Personality Synchrony for Perceived Spousal Support

OBJECTIVES

Within-couple similarities in personality traits tend to be positively associated with relationship well-being. However, research in this area is typically based on cross-sectional designs, thereby limiting examination of longitudinal personality concordance. Given that life experiences shape within-person change in personality, and that partners within a couple often experience similar life events, investigation of within-couple personality synchrony and associations with marital outcomes is warranted.

METHODS

Using data from 3,988 couples (mean age at baseline = 67.0 years, SD = 9.6), multilevel dyadic growth models estimated within-couple similarity in baseline levels, change, and occasion-to-occasion variability for each of the Big Five personality traits over an 8-year follow-up. Bivariate growth models examined the effect of within-couple similarity on perceived spousal support, accounting for dependency within couples.

RESULTS

Adjusting for baseline age, education, functional ability, and relationship length, analyses revealed within-couple concordance between baseline levels of all 5 personality traits, as well as correlated within-couple fluctuations in neuroticism, extraversion, and openness over time. Similarity in openness, agreeableness, and neuroticism trajectories predicted spousal support. Couples were most similar in openness, showing correlated intercepts, change, and variability, and this longitudinal synchrony was particularly important for perceived spousal support in women.

DISCUSSION

These findings provide evidence for longitudinal personality synchrony over time within older adult couples. Further, concordance in neuroticism, extraversion, and openness predicted perceived spousal support, though there may be some gender differences in personality dynamics and relationship well-being. Effects of similarity were relatively small compared to actor and partner effects of these traits.

So Close and Yet So Irritating: Negative Relations and Implications for Well-being by Age and Closeness

OBJECTIVES

Negative social relationships are associated with poor health, chronic illness, and mortality. Yet, we know little about the dynamics of negative aspects of relationships within individual's closest relationships over time, how those experiences vary by age, and the implications of those relationships for well-being.

METHOD

A total of 592 participants (ages 25-97; M = 57.5; 63.3% women) from the Social Relations Study completed monthly web surveys for up to 12 months. Each month they reported negative relationship quality with their three closest network members and multiple dimensions of well-being (positive affect, negative affect, self-rated health, and sleep quality).

RESULTS

Multilevel models revealed older individuals reported less negativity in their relationships than younger people, but fewer age differences in the closest tie. Greater negative relationship quality predicted poor well-being (i.e., greater negative affect, sleep problems). Links between negative relations and well-being were less strong among older individuals; especially in the closest ties.

DISCUSSION

Results were partially consistent with the strength and vulnerability integration (SAVI) model, which proposes fewer age-related improvements in emotion regulation when individuals are unable to avoid tensions. Despite feeling just as negative as younger individuals, older individuals may be more resilient to tensions in their closest relationships.

Factors Associated with Increased Risk of Patient No-Show in Telehealth and Traditional Surgery Clinics

Background

With the growing use of telehealth, understanding factors affecting patient follow-up in traditional and telehealth settings is important. Few data exist examining the use of telehealth compared with traditional settings. Bridging this gap is critical to optimizing telehealth use and reducing barriers.

Study Design

This is a retrospective cohort study of return and postoperative (electronic video [eClinic] and traditional) visits from January 2018 to March 2020 at single tertiary care center. There were 12,359 unique first-encounter patients with 903 eClinic and 11,456 traditional visits; 11,547 patients completed visits, while 812 patients did not show up. Multivariable logistic regression modeling was performed to identify factors associated with no-show. County-level mapping was used to identify patterns in no-show rates.

Results

Patients from the eClinic had twice the odds of no-show compared with those from a traditional clinic (p < 0.001). Age was inversely proportional to odds of no-show, with each additional decade associated with a 16% decrease in these odds (p < 0.001). African-American patients had greater odds of no-show compared to Caucasian patients (odds ratio [OR] 2.47; 95% CI 1.95–3.13, p < 0.001). Marital statuses of single and legal separation were associated with higher odds of no-show compared with married marital status (p < 0.001 and p = 0.04, respectively). Minimally invasive and endocrine surgery clinics had lower odds of no-show compared with acute care surgery clinic (p < 0.001 for both). County-level no-show rates demonstrate similar patterns between clinic settings.

Conclusions

Several factors are associated with increased odds of no-show, including the visit being in eClinic. County-level analysis suggests no-show variation is not dependent on geographic location. Understanding these patterns allows for prospective identification of barriers and development of interventions to optimize access and patient care.

Relationship quality and 5-year mortality risk

OBJECTIVE

The present study examined positive and negative aspects of relationship quality with one's spouse or partner as predictors of mortality and the role of gender in moderating this link.

METHOD

Data were drawn from 2 waves, 5 years apart, of the National Social Life, Health, and Aging Project (N = 1,734). Positive aspects of relationship quality (frequency of opening up to the partner to talk about worries and relying on the partner) and negative aspects (frequency of the partner making too many demands and criticism by the partner) were assessed. Survival/mortality status was recorded at the time of Wave 2 data collection 5 years later (1,567 alive; 167 deceased). Covariates included sociodemographic variables, relationship type, health status, and the network size of close family relationships and friendships.

RESULTS

Logistic regression analyses showed that negative relationship quality with one's spouse or partner was associated with significantly higher odds for mortality after 5 years (odds ratio [OR] = 1.20, 95% CI [1.03, 1.38], p < .001), after including the statistical covariates. Also, age, gender, education, self-rated health, and medication use were significantly related to mortality. Propensity score matching replicated these findings. Follow-up analyses revealed that criticism from one's spouse or partner, in particular, was linked to a higher mortality risk (OR = 1.44, 95% CI [1.10, 1.88]). Gender did not moderate the relationship-quality-mortality link.

CONCLUSIONS

Negative relationship quality, notably, criticism received from one's spouse or partner, heightens older adults' risk of mortality. These results suggest the value of developing interventions that target reducing expressed criticism in couple relationships. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Community Social Characteristics and Health at Older Ages: Evidence From 156 Religious Communities

Objectives

Previous studies have found that individuals' health is associated with the social characteristics of their communities. However, interpreting the causality of the relationships is difficult due to a number of potential confounders on both the individual- and community-levels as well as potential selection effects. In the current article, we analyze data on health and community characteristics from Catholic order members aged 50+ living together in religious communities. We argue that the potential for confounders and selection effects is reduced in our sample.

Method

We use multilevel group actor-partner interdependence models and cross-sectional questionnaire data (N = 1,041, k = 156 communities) to test whether individuals' self-rated health was associated with the level of social conflict and connectedness of their community separate from their own involvement in conflict and feelings of connectedness.

Results

We find that living in communities with higher levels of conflict is associated with worse health, especially at older ages. We also find that (a) the relationship between health and own feelings of connectedness is stronger for men and (b) women report better health than men in more connected communities.

Discussion

Our results offer further evidence that at least some social characteristics of the community have a causal impact on health.

The Good, the Bad, and the Indifferent: Physical Disability, Social Role Configurations, and Changes in Loneliness Among Married and Unmarried Older Adults

Objectives: To examine how social role configurations (SRCs)-combinations of the quality of spousal, family, and friend relationships-moderate the association between functional limitations (FLs) and loneliness among married and unmarried older adults and whether this differs by gender. Method: Longitudinal data from the National Social Life, Health, and Aging Project on married (n = 945) and unmarried (n = 443) older adults (aged 57-85 years). Latent class analysis was used to identify SRCs. Tobit regression models examined the associations between FLs, SRCs, and loneliness. Results: Nine SRCs were identified. The effectiveness of SRCs for coping with FLs did not differ by marital status despite higher loneliness among the unmarried. Only for women with FLs did SRCs characterized by negativity/strain exacerbate loneliness. For men with FLs, SRCs characterized by excess positivity/support were problematic. Discussion: These findings underscore the importance of considering how SRCs provide resources for coping with FLs that have gendered implications.

Husbands' and Wives' Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study

BACKGROUND

When examining older adults' health behaviors and psychological health, it is important to consider the social context.

PURPOSE

The purpose of this study was to examine in older adult marriages whether each spouse's physical activity predicted changes in their own (actor effects) and their partner's (partner effects) depressive symptoms. Gender differences were also examined.

METHOD

Each spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989-1990), wave 3 (1992-1993), and wave 7 (1996-1997). Dyadic path analyses were performed.

RESULTS

Husbands' physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse's depressive symptoms (partner effects). However, husbands' physical activity and depressive symptoms predicted wives' physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.

CONCLUSION

Findings suggest that husbands' physical activity is particularly influential for older married couples' psychological health.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure

OBJECTIVES

The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives.

METHOD

Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time.

RESULTS

The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations.

DISCUSSION

Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health.

Social interactions at the onset of rheumatoid arthritis and their influence on help-seeking behaviour: A qualitative exploration

OBJECTIVES

To explore how social interactions at the onset of rheumatoid arthritis (RA) influence help-seeking behaviour from the perspectives of those with RA and their significant others (family and friends).

METHODS

Nineteen semi-structured qualitative interviews were undertaken with people recently diagnosed with RA and their significant others. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Significant others' initial appraisals of symptoms led them to provide practical support with daily activities rather than advice to seek help. People with RA described difficulties in communicating the severity of their symptoms and often attempted to hide their symptoms from others. Significant others also reacted negatively, expressing disbelief and dismissing symptoms. On occasion, early symptoms were even described as the catalyst for the breakdown of relationships. On reflection, significant others expressed guilt about their initial reactions and wished that they had recognized the need for intervention earlier. When symptoms had advanced and were more obvious, significant others often strongly advised that help should be sought and, in some cases, physically escorted the patient to their medical appointment. In many instances, people with RA described significant others as the catalyst for eventually seeking help.

CONCLUSIONS

Significant others play an important role in influencing help-seeking behaviour; this has implications for theoretical models of help-seeking and the development of help-seeking interventions. A negative consequence of social interactions resulted from a lack of understanding and knowledge about RA among significant others, highlighting the need for greater public awareness about the early symptoms of RA.

Social Networks in Later Life: Weighing Positive and Negative Effects on Health and Well-Being

Social networks provide a mix of positive and negative experiences. Network members can provide help in times of need and day-to-day companionship, but they can also behave in ways that are inconsiderate, hurtful, or intrusive. Researchers must grapple with these dualities in order to develop a comprehensive understanding of how social network ties affect health and well-being. This article provides an overview of research that has examined the health-related effects of positive and negative aspects of social network involvement. If focuses on later life, a time when risks for declining health and for the loss or disruption of social relationships increase.