The influence of Chronic Comorbidity on Confidant Network Efficiency for Older Adults: Evidence from NSHAP

Tianyao Qu


This paper investigates how chronic comorbidity (e.g., Osteoporosis) of older people influence the composition of their confidant networks. This analysis unfolds the links between having chronic comorbidities and the characteristics of network efficiency, which associate with the capability of bridging networks for older people in the context of later life. Older people with chronic diseases usually result in ongoing medical attention and limited mobility. Although existing literature concludes that chronic health affects older people’s social support in older adults’ later life, few studies explicitly elucidate how having chronic diseases is associated with the characteristics of network structures (such as network turnover, efficiency, network embeddedness, etc.). Available care resources for older people tend to embed in more stable and diverse network structures. As an essential step towards identifying the relationship between chronic health and network structures in later life, this analysis investigates how having chronic health conditions influence the efficiency and redundancy of older people’s networks. This study uses wave 2 (2010-2011) data from the National Social Life, Health, and Aging Project (NSHAP). NSHAP comorbidity index provides a comprehensive range of chronic conditions and a framework based on the Charlson comorbidity index (Charlson et al., 1987) for combining these chronic conditions into informative comorbidity indices. NSHAP index assigns weighted scores to chronic diseases based on their relationship to mortality. The initial results indicate that having severe and complex chronic conditions can significantly increase the redundancy of one’s confidant networks. In contrast to healthy older adults, respondents with more than five chronic conditions possess more redundant ties in their confidant networks. Meanwhile, the results also imply that gender seems to play a critical role in explaining the effect of chronic illness on network efficiency. However, the gender compensation effect occurs only when old adults are extremely ill and have multiple comorbidity issues. Compared to extremely ill older women, older men with similar medical situations have more redundant ties in their confidant networks. These results conclude that older adults’ networks tend to largely overlap when they are extremely ill, and this process differs by gender. These results suggest that the specific function of network structure and confidant ties are different for men and women in their later life. Although their network composition can be considered similar, the network structures for chronically ill men and women may be different. The sets of confidants of husbands and wives can be almost entirely disjunctive. There are two future directions I would like to explore, first, since married status in all models is strongly significant, the couple-level network structure might play an indispensable role in mediating chronic illness and network efficiency. Second, in future analysis, more attention will be placed on the different network positions of the caregivers of older men and women. Longitudinal data are useful to analyze the changes of overlapping ties since comorbidities are especially taxing for old adults. Furthermore, it is also crucial to examine how the dyadic level of network structure shaped by chronic conditions can determine network efficiency and closure.

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