Most people dont think about it, but relationships develop and continue
largely because of an informal system of balancing rewards and costs. According
to some social theories, if a relationship becomes imbalanced, the result
may be less involvement because either party is unable to pay his or her
social debt.
As people age, they become increasingly dependent on others for physical,
emotional and informational resources. They may need transportation for
groceries, to see their health provider, get exercise, or go to church.
They also may need help with household chores, yard work and finances.
University of Nebraska Medical Center College of Nursing associate professors
Betty Craft, Ph.D., and Sister Carol Grasser, Ph.D., received a $73,500,
one-year grant from the National Institutes of Health, National Institute
on Aging, to determine whether inability to reciprocate in a relationship
may cause older adults to neglect their health needs.
I think most people are unaware that being able to give back is important
to many older adults who may be dependent on others, said Dr. Craft, principal
investigator of the study. The older individual who needs assistance but
is unable to reciprocate with some kind of support to others may neglect
health-care practices such as appropriate diet, exercise, or health-care
monitoring, rather than ask for help.
These individuals risk still more health problems and functional impairments.
If all they feel they are doing is receiving and not giving, its possible
that they might not find life very meaningful, Dr. Craft said.
The health and well-being of older adults is becoming increasingly important
to health-care professionals as numbers of older persons and demand for
health-care services increase. The world’s population age 65 and older
is growing by an unprecedented 800,000 people a month, according to a report
issued in 2001 by the U.S. Census Bureau and the National Institute on
Aging (NIA).
Drs. Craft and Grasser are testing their Reciprocity and Health Process
Model to find out if reciprocity issues affects health care practices
of the older adult.
Last year, the researchers began conducting personal interviews in
the homes of 110 people, age 65 and over, who needed assistance with daily
living activities.
Accepting help goes against the way some older adults were raised,
Dr. Craft said. Some of our study participants said they would rather
be givers than receivers and that an imbalance, even if only perceived,
was intolerable for them.
Dr. Grasser, co-principal investigator of the study, said most people
in their study count on their family for help and half of those over age
85 need some sort of services, which are provided by their family members.
Some depend on friends and neighbors, she said.
Optimizing health for older adults has implications for quality of
life as well as for health-care costs through lengthening the period of
independence and preventing or postponing nursing home placement, Dr.
Craft. We are learning more about these relationships so we can design
ways to address the reciprocity problem.
Nutrition is one of the most common things compromised. Dr. Craft said
some study participants mentioned they dont have fruit very often because
they only get to the grocery store once a month.
About half the people weve interviewed say even when people are willing
to help them, they feel they dont want to bother others, she said. They
only want to ask for so much. They figure others are busy with children
and other things.
The researchers say that if their model is supported, the one-year grant
will lay the groundwork for further grants to study reciprocity issues
in depth, and ultimately to design ways for health providers and caregivers
to address problems related to inability to reciprocate.
Our study has relevance for health-care providers, those in direct
and indirect patient care, as well as in education to prepare our students
as health-care providers, she said. As health-care providers, we should
understand and be able to do something.
For those at risk it is important to intervene both with older individuals
themselves and with formal and informal caregivers, to help identify resources
for reciprocation, Dr. Craft said. Resources vary with each individual,
and might include wisdom, sense of history and concern for others assets
that are valuable and allow the older person to give back, but are sometimes
overlooked in present day society.
Faculty serving as consultants in the study are: Susan Noble Walker,
Ed.D., UNMC College of Nursing, Suzanne Ortega, Ph.D., University of Missouri,
Columbia, and David Johnson, Ph.D., Pennsylvania State University.