Study examines whether perceived inability to give back in relationship causes self-health neglect

Most people don’t 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.

UNMC 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 the 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, it’s 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 affect the 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 said. “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 don’t have fruit very often because they only get to the grocery store once a month.

“About half the people we’ve interviewed say even when people are willing to help them, they feel they don’t 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,” Dr. Craft 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. 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., Pennsylvannia State University.