Social Support for Seniors Living in the Home Environment

Social support is very important for a happy old age. It aff ects a person’s health and mental well-being and is also perceived as a protective factor of social exclusion in old age. The aim of the article is to present partial results of quantitative research done in the fi eld. In the research, data collection was performed with the use of the PAPI methodology. The research group was seniors aged 65 and older living in their own household. The research is a part of the project ‘Sociální vyloučení u seniorů 65+ žijících v domácím prostředí v ČR’ (Social exclusion in Seniors Aged 65+ Living in the Home Environment in the Czech Republic). The results of the research did not show that seniors were a socially excluded group. Most seniors living in their own households claimed to have enough social contacts and did not feel lonely. They perceived family, friends, neighbours, the community, and contacts with them as important social support. This was infl uenced by age and health factors, though. An interesting fi nding was also the role of the municipality in creating a supportive environment for the quality of life of seniors in the community and natural encounters of individuals during volunteering.


Introduction
Th e aim is to present partial quantitative fi ndings concerning the possibilities of social support as a tool for the prevention of social exclusion of seniors. Social support 2 appears to be very important for a happy life in old age. According to Šolcová and Kebza, 3

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infl uencing a person's health and mental well-being as well as an important preventive tool for the social exclusion of seniors. According to Cohen, 4 social support can be understood as social resources that a person perceives as available or that are actually provided to them by non-professionals within formal support groups or informal relationships. For the elderly, social support received from family members 5 is the most important. According to Vohralíková, 6 a well-functioning family provides mental and physical as well as material support. Th e family is oft en involved in the activity of the individual, thus becoming an important reference framework for the life of the elderly. It is important to draw attention to the individuation in family relationships -a harmonious relationship will certainly have a positive eff ect on seniors while a cold to hostile relationship can lead to the social exclusion of seniors. In harmonious family relationships, you can observe respect for older members on the one hand, but respect and support for younger members of the family on the other. 7 As a rule, a senior is a respected member of society 8 despite the fact that various pitfalls are stemming from the old age. Přibyl 9 explains the term senior as an emotionally neutral concept, acceptable for various scientifi c disciplines such as sociology, medicine, psychology, etc., and as a term that can be used to describe an individual throughout aging, disregarding their abilities and self-suffi ciency. Aging is perceived as a natural course of life. Langmeier, 10 similar to Vašutová, 11 understands old age as a set of changes in the structures and functions of the organism resulting in higher vulnerability and reducing the performance and abilities of the individual, although Haškovcová 12 points out that each person ages diff erently -faster in some stages while slower in others. It is a phase of human life determined by two points in time -the upper age limit is sharply defi ned by death while the lower age limit is blurred by the fact that the phenomena and processes that old age entails enter life gradually and only the aggregate constitutes old age. 13 Čevela 14 clearly summarises that old age is an objective reality with manifestations and consequences of physical, functional, and social changes that are very individual and happen at a specifi c speed and lead to the phenotype of old age which is infl uenced by the environment, health, lifestyle, and psychological or socioeconomic consequences. Říčan 15 states that the World Health Organisation divides later life periods into early old age (higher age, 60-74), old age (advanced age, 75-89), and longevity (90 and over). Foreign authors such as Aldwin 16 point out that in some cases, old age is defi ned in the literature as the age of 65, while in other cases the turning point is 60 years of age, and in some cases it may already be 50 years 11 2021 of age. In the Czech Republic, Haškovcová 17 moves the range of old age by 5 years compared to WHO and defi nes early old age (young seniors, 65-74), old age (old seniors, 75-85) and longevity (very old seniors, 85 and over). Some authors 18 even move the old age limit to 70 and over. Hegyi 19 divides age according to various aspects into chronological, biological, functional, psychological, and social age while the individual age may vary. Biological age, also subjective age, can change in response to personal experience that mingles with changes in emotional age, age appearance, and age-appropriate interests. 20 Kebza 21 divides social support into individual and institutional. Individual (or personal) social support is the eff ort of an individual to help another specifi c person while institutional (or social) support is understood by the author as assistance implemented or covered under the umbrella of a formal organisation. Social support is also considered to satisfy the basic social needs of a person through social interactions 22 -it can be the need for social contact, friendship, attachment, the need for mutuality, communication, social comparison, cooperation, social security, social inclusion, and social identity, or positive social evaluation. Social support has several aspects referred to as types of social support. Křivohlavý 23 introduces instrumental support that he perceives as assistance using specifi c instruments as well as assistance given to those in need. It is tangible and material help or provision of certain things to assist you. Th e same author describes information support which refers to providing information that will help you solve your situation and become oriented in the problem. It can be the advice of loved ones as well as professional advice. Emotional support is provided and communicated through emotional closeness based on love, empathy, and understanding. Finally, the author mentions evaluation support which helps to strengthen self-esteem and self-confi dence and maintains the eff ort for self-regulation, and encourages faith and hope. In order to receive the necessary support, you must be integrated into a social network in which social interactions exist and relationships are created that will enable you to receive social assistance. 24 In old age, therefore, social interactions are very important, but at the same time the elderly need some privacy and should not be overwhelmed by social stimulation. 25 For this reason, older people prefer to meet people they know well because they know what to expect from them. In older age, more emphasis is placed on depth and length of friendship and less close relationships are reduced over time while satisfaction with deeper relationships increases, says the author. Phillips 26 mentions that relationship quality rather than quantity has a very positive eff ect on seniors. Th e elderly who receive as well as provide social support are more satisfi ed than those who only receive or only provide it. Th e least satisfi ed are those who do not encounter any form of social support. Th us, not only social support as such is important, but above all the mutuality of support provision. 27

Methods and Data
Th e aim of the paper is to present partial quantitative fi ndings concerning the possibilities of social support in the context of the project 'Social exclusion of seniors 65+ living in the home environment in the Czech Republic'. Th e main objective of the whole project in which these partial results are published was to identify the forms, causes, and consequences of social exclusion of seniors aged 65 and older living in their own homes. In terms of age for research, seniors are defi ned as persons over 65 years of age. Seniors living in their own homes are those who have permanent residence in various types of housing -their own house or fl at, or rented premises. Th erefore, these are the elderly who do not live in social welfare institutions (e.g., elderly homes). Th e household is considered as a physically demarcated, institutionalised, inhabited, and organised space while, at the same time, as a group of people who live in and manage the household together and carry out a number of joint activities relating to this space. 28 For our research, a quantitative research strategy was used and the PAPI data collection methodology was applied in the fi eld survey. It is a personal interview with respondents where answers are recorded in a printed questionnaire. Th e questionnaire included 77 questions divided into 11 chapters on 26 pages. Some of the questions formed batteries. By virtue of the pilot survey, the questions were well understood and focused on the subjective perception of loneliness of seniors, the frequency and various forms of seniors' interactions with family and friends, the activities of seniors within the community, and the level of participation. Th e survey data consisted of 1,172 questionnaires, and 2 questionnaires were excluded for incompleteness. Th e research group consisted of seniors aged 65 and older living in their own homes. Th is was a representative quota sample of respondents. Survey quotas were set for the general population of 65+ years of age, sorted by age, sex, size of municipality, and region. Th is classifi cation was based on the available CZSO Demography data 2017. Th e quantitative data were processed by the SPSS soft ware (version 21.0), and later by Microsoft Excel (in some cases for descriptive statistics). Descriptive statistics were used to identify the essential characteristics in the research samples. Pearson's chi-square test (at the signifi cance level α = 0.05) was used to test the hypothesis about the dependence of qualitative indicators (Tables 2  and 5). Contiguous categories were combined if the occurrence of some values was too low.

Loneliness perceived in old age
For research purposes, it was important to identify the overall average level of loneliness in the research group, and then correlate this average value with selected variables. Th e survey results show that approximately a third of respondents feel lonely while two thirds do not feel so. For seniors who feel lonely, the level of loneliness is very individual. Loneliness is always a subjective experience.
Matoušek 29 points out that loneliness is not synonymous with objective social isolation. Th e research clearly indicates the considerable diff erences in the perception of loneliness based on several socio-demographic indicators. Th e analysis of (non)dependence (Table 2) shows a statistically signifi cant relationship between loneliness and marital status as well as loneliness and sharing or non-sharing of a household with another person. Living in marriage as well as sharing a household with another person leads to the feeling of loneliness far less oft en than if respondents are divorced/widowed/single or if respondents live alone; in addition, such respondents oft en perceive/ measure their loneliness in the second half of a ten-point scale. Th e same conclusions were reached by Kowaliková and Chytil 30 who also demonstrated the relationship between a single-member senior household and the level of loneliness. As a contrast, the authors mention Matoušek's 31 idea that many people can be alone without feeling lonely. Signifi cant dependence was also demonstrated between loneliness and state of health and between loneliness and self-suffi ciency assessment. Respondents who mentioned very good or rather good health, or self-suffi ciency, suff er far less from loneliness than respondents who reported very poor or rather poor health, or self-suffi ciency. Th e neither good nor bad evaluation of these two indicators did not bear on the perception of loneliness. On the contrary, the weakest relationship was identifi ed between loneliness and age (p = 0.825). Given the p-value, the feeling of loneliness seems to be independent of age.

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Th e research also showed a signifi cant diff erence in the perception of loneliness between men and women (p = 0.001). Th e reason may be women's greater emotional dispositions, but rather more important is the fact there are more women than men in higher age groups as well as among people without marriage or without other members of the household.

Family and friends as social support
One of the important tools for the prevention of loneliness is the family of an elder and their social interactions (Table 3). Th e research showed that less than half of the senior respondents have daily interaction with their family whether in person or by telephone. Most of the others have weekly interaction with their family, and a low percentage of respondents have only several interactions per year, or none at all.

Source: COST LTC 18066 'Social exclusion of seniors living in the home environment in the Czech Republic' subsidised by the Ministry of Education of the Czech Republic in the INTER-EXCELLENCE programme, INTER-COST subprogramme.
However, our research outcomes are in accordance with Phillips's 32 opinion that the quality of family relationship is more important than the quantity. Seniors claim that personal contact unlike telephone contact is infl uenced by residence and logically by the number of household members. Both types of interactions show a slight interdependence on the state of health where people suffering from poor health do not socially interact with their family as frequently as healthy people. We consider it alarming because, according to Petrová Kafk ová, 33 the poor health of an elderly person implies dependence on assistance and the support of others, especially families. Aft er all, our research also makes it obvious that the closest person to an elderly person is their spouse / husband or wife if they have one. Older respondents without a spouse cling to their children where the daughter is mentioned almost twice as oft en as the son. Tabaková 34 and Tošnerová 35 also state that responsibility for the care of an elderly person is most oft en assumed by one family member, mainly a daughter. In the Czech environment, these are oft en (in three quarters of cases) the primary caregivers. Th e interaction of seniors with family members is proved to be more frequent than interaction with friends as they grow older and lose their self-suffi ciency. Th e interaction between a senior and the family is most common on a weekly basis, either personal or by telephone (41% and 42% respectively). About 16% of respondents report daily interaction with their friends whether in person or by telephone. Also, having social interaction several times per month is not unusual. Interaction with friends already shows a slight dependence on the respondent's age. Haškovcová 36 states that especially able-bodied seniors may not feel comfortable about interaction with their peers who are not as physically and mentally fi t as they are because they are, in fact, looking at a possible future of their own, with which they are usually not internally reconciled. Another important factor mentioned by Haškovcová 37 is so-called collective memory, a technical term for shared experiences of one generation: the social and historical events that other generations have not experienced. Th e research also identifi ed the nature of mutual assistance and social support that is most frequent among close relatives, followed by friends and neighbours. Th e proportion of seniors providing assistance and support decreases with age, related both to family and friends and neighbours. For the elderly, receiving assistance slightly prevails over providing it in all three cases (

Source: COST LTC 18066 'Social exclusion of seniors living in the home environment in the Czech Republic' subsidised by the Ministry of Education of the Czech Republic in the INTER-EXCELLENCE programme, INTER-COST subprogramme.
Baštecká 38 mentions reciprocal social support where the senior not only receives but also gives help to others. It was found that 83% of respondents receive assistance from their close relatives, 66% from friends, and 46% from neighbours. On the contrary, 72% of the senior research sample provide assistance for their close relatives, 62% to friends and 45% to neighbours. Assistance for seniors increases with their age only in the case of support from close relatives. Th e receipt of assistance does not depend on whether the senior in question lives with someone or not. It is interesting that close relatives more oft en help women than men and friends more oft en help men than women (Hamplová 39 ).

Community life as social support
Wija 40 states that municipalities play an important role in creating the conditions for a high quality and active life of their population as well as in creating a supportive environment that allows older people to stay in their own natural environment and housing and fully participate in the life of the 'community' and in the development of intergenerational relationships ('age-friendly cities' according to WHO). However, our research showed ( Table 5) that there is no voluntary activity within the community that involves more than 40% of seniors. Th e elderly most oft en help each other (37%) and mutual assistance between seniors is more oft en seen in the community of municipalities with a population of less than 4,999. Only 27% of seniors in the research sample stated that they provide assistance for a younger generation, and it more oft en concerns younger respondents, namely seniors under 70, with at least a high school diploma. In the community, 19% of the interviewed seniors participate in natural history activities looking into the history of the surroundings where they live, and also most oft en in smaller places with a population of less than 4,999. Th ose who teach their skills are 14%, being more oft en men and respondents with a university degree. Also, 12% participate in house, neighbourhood or senior councils and commissions, which is more the case for residents of cooperative housing and larger cities with populations of 20-99 thousand. In terms of voluntary activities in the communities, the senior respondents mentioned assistance in organising social events, taking care of public space, engagement in fi re brigades, membership in various interest groups, or political involvement. Th e authors conclude that community activities of seniors in the research sample are associated with age, health, and education of the elderly and take place more oft en in small municipalities with a population of less than 4,999 where they infl uence the quality of life and cohesion of the population. Table 6 shows the data analysis of the relationship between the size of municipality and the involvement of seniors in selected voluntary activities. Th e involvement in assistance for the younger generation and other seniors, in teaching skills and talking history is higher in municipalities with a population less than 999, however, only at the level of signifi cance =0.10. At the same time, helping other seniors and talking history is lower in cities with a population more than 100,000 which contributes to a statistically signifi cant dependence between the size of municipality and these two activities (p = 0.0093 and p = 0.033 respectively). As expected, the participation in house councils is statistically far less frequent in municipalities with less than 999 inhabitants and above average in cities with population of 20,000 to 99,999 which leads to high statistical signifi cance (p = 0.0052). Participation in election commissions is generally low and does not depend on the size of municipality. A small number of seniors are involved in parish activities (6.1% of respondents), but this involvement is statistically signifi cant depending on the size of the municipality (p = 0.0098) with an above-average participation in municipalities with less than 999 inhabitants and a signifi cantly low participation in cities with population of 20,000 to 99,999. Overall, more than half of the respondents are involved in community activities which the authors perceive as very positive since maintaining these activities is key to ensuring higher levels of life satisfaction in old age. Our fi ndings considering the risk of social exclusion should lead to an active search for those seniors who are lonely. It is obvious that their links to informal support and assistance systems -especially family, friends, extended family, or neighbours, or possibly to formal support and assistance systems (seniors' clubs) 41 -should be reinforced through social work. In this respect, municipalities (municipal management) could play a key role and they should be aware of this fact and actively approach their seniors. Other institutions that could be involved are social service organisations -for example, the revision of the care service and its focus on prevention seems to be key in this regard. Th e lack of capacity to solve this problem is discussed by Kowaliková and Chytil 42 who state that there are no social services in the Czech Republic that would primarily provide aff ordable social support to the elderly in diffi cult life situations who live in a single-person household. At the individual level, we recommend people in the middle age and the 50+ generation to develop, support, and foster above all their social connections so that their 41 KOWALIKOVÁ, CHYTIL, Souvislost…, p. 77. 42 Ibid.