SocialRelationships and

Mortality Among the Elderly

Edward P. Sabin
Towson State University

A growing literature documents the positive effect of social relationships on health, in general,
and in reducing mortality, in particular. Much remains to be learned about which relationships
have this effect, particularly among the elderly. This research, a secondary analysis of a national
sample of community-dwelling elderly aged 70 and over, addresses these questions. Data come
from the Longitudinal Study on Aging. Five scales constructed from relationship questions asked
in the survey are related to respondent mortality over a 4-year follow-up using multiple logistic
. The research confirms that certain relationships appear to reduce subsequent
regression
mortality: going to church/temple, volunteering, seeing friends or neighbors, and talking with
them on the phone (socioexpressive relationships). The effect can be seen among healthy and
more infirm elders. Helping relationships and household and kin relationships do not seem to
reduce the risk of elder moriality.

That relationships or human connectedness should enhance physical and

mental well-being seems reasonable to suppose and consistent with our
everyday experience. A growing literature supports this supposition and
documents the positive effect of relationships on health, in general, and in
reducing the risk of mortality, in particular. See Broadhead, Gehlbach,
DeGuy, and Kaplan (1989) and Ganster and Victor (1988) for literature
reviews on the linkage of relationships and social support to health. Several
studies have found a link between relationships and mortality in the general
population (Berkman & Syme, 1979; House, Robbins, & Metzner, 1982;
Kaplan et al.,1988; Litwak & Messeri, 1989; Orth-Gomer & Johnson, 1987;
Ruberman, Weinblatt, Goldberg, & Chaudhary, 1984; Welin et al., 1985) and
among the elderly (Blazer, 1982; Hanson, Isacsson, Janzon, & Lindell, 1989;

AUTHOR’S NOTE: The author thanks the following colleagues at Towson State University for
review and comments on an earlier draft of this article. William Bainbridge, chair, Department
of Sociology and Anthropology; Beth Vanfossen, director, Institute for Teaching and Research
on Women; and Gordon Bonham, director, Center for Suburban and Regional Studies.

The Journal of Applied Gerontology. Vol. 12 No. 1, March 1993 44-60

0 1993 The Southern Gerontological Society

44

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 45

Schoenbach, Kaplan, Fredman, & Kleinbaum, 1986; Seeman, Kaplan,

Knudsen, Cohen, & Guralnik, 1987; Zuckerman, Kasl, & Ostfeld, 1984). All
studies control for, or take into account, initial health status (among other
variables), because health is a strong potential confounder affecting social
relationships and risk of mortality.
To categorize supportive relationships, a number of researchers distinguish
between structural and functional measures of relationships (Broadhead
et al., 1989; Dean, Kolody, Wood, & Ensel, 1989; House & Kahn, 1985;
Schwarzer & Leppin, 1989; Thoits, 1982). Structural measures focus on
readily quantifiable variables such as the presence/absence of a relationship
or frequency of interaction. For example, is a person married? How fre-

quently does the person see relatives? These are quantitative (sometimes
termed network) measures of a relationship. Of course, the simple presence
or absence of a relationship says nothing about its intensity, quality, or about
the role of the relationship in a person’s life. In contrast, functional measures
focus on the quality of the relationship, for example, is it primarily instru-
mental or is it socioemotional/expressive? Visiting with friends is an example
of an expressive relationship, whereas receiving help from a relative is
typically defined as an instrumental relationship. Factor analyses of support-
ive relationships support distinctions between structural and functional mea-
sures of social support on one hand and between socioexpressive and
instrumental measures within the latter category (Blazer, 1982; Broadhead,
Gelbach, DeGuy, Kaplan, 1988; Dean et al., 1989; Vaux, 1987).
&
The protective effect of relationships on mortality depends, in part, on age.
For example, in the general population, marriage is consistently related to
lower risk of mortality (Berkman & Syme, 1979; House et al., 1982; Welin
et al., 1985). But the beneficial effect of marriage appears to decline with age
(Berkman & Syme, 1979; Litwak & Messeri, 1989) or not be present at all
in older samples. A structural relationship measure (marital status combined
with the number of living children and siblings) predicted mortality in one
older sample (Blazer, 1982).
Other relationships that appear to reduce the risk of mortality in the older
population are socioexpressive relationships with friends and relatives (Blazer,
1982; Seeman et al.,1987; Zuckerman et al.,1984) and religious participation
(Schoenbach et al.,1986; Seeman et al.,1987; Zuckerman et al., 1984). Older
respondents who report having a source of instrumental support show a lower
risk of mortality, other factors taken into account (Blazer, 1982). However,
in an international comparison, instrumental support did not predict mortality
in a sample of older Swedish men (Hanson et al., 1989).
Measures of the quality of the relationship (functional measures) tend to
predict health outcomes better than do network or structural measures

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46

(Broadhead et al., 1989; House & Kahn, 1985). In a study of nursing home
characteristics and resident outcomes, Spector and Takada (1991) found that
residents in homes with moderate to high participation in organized
activities were 40% to 50% less likely to die or decline than residents in low-
participation homes. Possible explanations for the observed link between
social relationships and mortality (Berkman, 1985; Cohen, 1988; Ganster &
Victor, 1988) include the following:

1. People in a social network may receive better health information (including

how to access services).
2. People with stronger social ties may receive more direct, instrumental, and
tangible help from others.
3. People who are part of a social network are more subject to social control and
peer pressure toward healthy behavior.
4. Maintaining social relationships and lower mortality could both be expres-
sions of a greater life coherence and will to live.
5. Relationships may be associated with positive psychological states, such as
feelings of intimacy and belonging, as well as with beneficial neuroendocrine
states that may dampen the ill effects of stress, produce feelings of relaxation
and joy, and enhance the immune response.

Although these propositions are suggestive, the literature is new and a

definitive test of these propositions is problematic. Obstacles to a definitive
test include (a) complex interactions likely among some of the factors just
listed; (b) variation in measurement of &dquo;relationships,&dquo; some measures of
which have been found to be unrelated to mortality; (c) difficulty in opera-
tionalizing other concepts in the five propositions; (d) small sample size (less
than 400) particularly in studies of elderly mortality; (e) the critical impor-
tance (despite difficulties) of adequately controlling for initial health status/
functional ability to identify the net effect of relationships on mortality
(Berkman, 1986; Zuckerman et al., 1984). For these reasons, research into
links between relationships and mortality among the elderly must be consid-
ered still in the exploratory or fact-finding stage.

Purpose of This Study

The purpose of this research is to evaluate the link between a number of
measures of social relationships and subsequent mortality in a large, repre-
sentative sample of older Americans. I examine the association of these
measures to mortality via multiple logistic regression to take into account

possible effects of other independent variables known to be associated with

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 47

social relationships and mortality including age, sex, education, race, health
self-rating, and limitations in activities of daily living (Cohen & Syme, 1985;
Ganster & Victor, 1988). The goal of this article is to solidify the knowledge
base regarding possible effects of relationships on mortality among the
elderly so that speculation and theory regarding them is on firmer ground.

Method

Data for this study come from the Longitudinal Study on Aging (LSOA)
collected jointly by the National Institute on Aging and the National Center
for Health Statistics. The LSOA provides baseline data and 4 years of
follow-up information on a national sample of persons aged 70 and over who
were dwelling in the community at the time they were first interviewed in
1984. Baseline data were collected through face-to-face interviews, and
subsequent data were obtained through two follow-up telephone surveys (in
1986 and 1988), written questionnaires for telephone nonrespondents, and
matching of respondents with the National Death Index maintained by the
U.S. Department of Health and Human Services.
The 1984 Supplement on Aging (SOA) component of the annual National
Health Interview Survey, with a response rate of 93.2%, served as the baseline
survey. Of the 7,527 SOA respondents, 6,780 persons answered the 1984
baseline questions for themselves, and proxies responded for 747 (9.9%) of
the sample because the target person was temporarily absent or incapacitated.
About 23% (1,719) of the baseline sample died during the 4 years following
the initial interview. Mortality status could be determined for 94.3% of the
respondents through the follow-up interview process. Death of 405 remain-
ing sample persons was determined through matching with the National
Death Index. The status of 25 respondents could not be determined, and these
were dropped from further analysis. All results use weights to compensate
for nonresponse and other factors in the complex sample design (see the
National Center for Health Statistics, Lepkowski, Landis, Parsons, &
Stehouwer, 1988, for a discussion of the weights).

Measurement of Independent Variables

As noted previously, a number of independent variables may be associated
with both social relationships and mortality. An observed relationship be-
tween the two could be spurious. The potential effects of such independent
variables-age, sex, health self-rating, number of activities of daily living

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48

(ADLs) limitations, education, and race-are controlled through the use of

multiple logistic regression. The technique of multiple logistic regression
was selected as the dependent variable (mortality) is dichotomous and rather
skewed about 23% of the sample died over the 4-year measurement period
(Hosmer & Lemeshow, 1989). We are looking for the net effect of relation-
ships on mortality after the effect of other independent variables on mortality
have been taken into account.
Age is measured in single years ranging from 70 to 99 or older. Sex is
coded as 1 for males and 2 for females. Education is measured in years of
schooling ranging from 0 to 18 (6 or more years of college). Health self-rating
scores range from 1 (poor) to 5 (excellent) based on responses to the question,
&dquo;Would you say your health in general is excellent, very good, good, fair, or
poor?&dquo; Race is a dichotomous variable with White coded 1 and non-White
coded 2. ADL limitations include difficulties in bathing, dressing, eating,
getting out of bed, walking, going outside, and toileting. ADL limitations
vary from 0 (no limitations) up to 7 limitations. Instrumental activities of
daily living (IADLS) include difficulties in preparing meals, shopping, man-
aging money, using the telephone, and doing housework.

Measurement of Relationships
As noted previously, structural measures of relationships are quantitative
and focus on the presence or absence of a relationship or frequency of
interaction. Functional measures focus on the quality of the mlationship-for
example, its socioemotional or expressive quality as opposed to an instru-
mental relationship. I divide measures of relationships initially into three
categories: structural, instrumental, and socioexpressive.
The LSOA survey contains questions on the social world of the older
respondent including living arrangement, contact with friends, immediate
family, other relatives, and activities outside the home. Fourteen of these
items are selected for the present study that are similar to items found in
the relationship/mortality literature. All questions refer to relationships that
the respondent has at Time 1 (the initial 1984 survey). Four items refer to the
simple presence or absence of a relationship-whether the sample person
lives alone, with a spouse, or with others and the existence of living children
and siblings. These variables are hereafter termed structural measures.
Three items refer to getting help for a disability or illness (two refer to
actual help received; one refers to getting help should the need arise). These
variables are hereafter termed instrumental measures. Seven items refer to
socializing or expressive activities inside and outside the home. These

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 49

variables are hereafter termed socioexpressive measures. The majority of all

relationship questions are factual with one item being hypothetical, &dquo;Would
someone take care of you?&dquo; and one item being attitudinal, &dquo;Do you feel your

present social activities are enough?&dquo; Proxy answers to hypothetical and

attitudinal items are deleted from all analyses involving them.

Creating Relationship Scales

Most research linking relationships to mortality use relationship scales
rather than single-item relationship questions. The 14 relationship items
selected from the LSOA are grouped into three categories (structural, instru-
mental, and socioexpressive) as shown in Table 1. Table 1 includes the
frequency of responses to each relationship item. To sum the coded responses
to the items, simple additive scales were created to see if the items so grouped
form at least minimal (quasi) scales with a Cronbach’s alpha of .50 or more
(Bardo & Yeager, 1982).
In this study structural measures do form a weak scale (alpha .504) but =

instrumental and socioexpressive measures do not. However, it is possible to

remove one item from the instrumental questions and one from the

socioexpressive questions and improve their respective scale properties. By

dropping &dquo;someone to care&dquo; from the instrumental measure, alpha increases
from .356 to .666. By dropping &dquo;enough social activities&dquo; from the expres-
sive measure, alpha increases from .464 to .597. The association of these
three relationship scales to respondent mortality will be assessed using
multiple logistic regression analysis. However, prior to this step, an alterna-
tive method of creating relationship scales is examined.

Factor Analysis of Relationship Items

An alternative approach to grouping relationship measures is factor anal-
ysis. A principle-components method factor analysis was performed on the
14 LSOA relationship items to assess the validity of the scaling method just
described and identify possible underlying dimensions in the items. Using a
conventional cutting point (eigenvalue = 1.1), four relationship factors were
identified (Table 2). Looking only at factor loadings of .400 or greater, all
items are related to one of the factors with the exception of &dquo;enough social
activities.&dquo; Because this item also failed to scale with other items as stated
previously, it is dropped from further analysis. One item, talk with relatives
on the phone, is related to Factors 1 and 4.
In general, results of the factor analysis (Table 2) support the division of
the relationship items into scales as previously described. Factor 1 is virtually

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50

Table 1. Frequency and Codinge of Relationship Items

a. Positive responses to all questions coded 1, negative coded 0 unless otherwise noted.
b. N = number of respondents less don’t know or did not answer.
c. Dummy variable coded, reference category is live with others, nonspouse.
d. Coded as shown to prevent multiple children and siblings from having undue weight
in the additive scales in this report.
e. First five questions refer to prior 2 weeks.

the same as the socioexpressive scale (minus &dquo;get together with relatives&dquo;)
and Factor 3 is the same as the instrumental scale. However, factor analysis
broke up the structural scale and suggests two additional scales: Factor 2,
hereafter called the someone to help scale, concerns the respondent’s living
arrangement and whether there is perceived to be someone who will take care
of the respondent if need be. Factor 4, hereafter called the kin and kin contact
scale, measures the number of close relatives (excluding spouse) the respon-
dent has and contacts with them. These two additional scales, corresponding
to Factors 2 and 4, yield a total of five relationship scales.

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 51

Table 2. Factor Analysis of Relationship Items Ranked by Varimax Rotation

Factor Loadingsa

a. Principle-components method performed with factor loadings less than .400 not
shown.

In summary, on the basis of the literature and factor analysis, relationship

scales are created in an effort to capture important dimensions in the 13 LSOA
relationship items. The scales are not mutually exclusive but overlap some-
what ; that is, some items are used by two scales. Persons scoring low in the
structural scale live alone and have no living children or siblings. Persons
scoring high in the structural scale live with a spouse or with others and have
three plus living children and three plus living siblings. Persons scoring low
in the instrumental scale received no help from a family member or friend
for an ADL or an IADL limitation, whereas persons scoring high received
(unpaid) help for an ADL and an IADL limitation. Persons scoring low in the
socioexpressive scale’ did not talk to friends, neighbors, or relatives on the
phone in the previous 2 weeks, did not get together with friends or neighbors
or go to church or temple in the previous 2 weeks, and did not volunteer in
the last year. Persons at the top of the socioexpressive scale engaged in all
these activities. Persons scoring low in the someone to help scale lived alone
and reported that they did not have someone to care for them for a few weeks,
if need be. Persons scoring high in this scale lived with a spouse or with others
and reported that they had someone to care for them. Finally, persons scoring
low in the kin and kin contact scale had no living siblings or children and no

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52

contacts with relatives, whereas persons scoring high in the scale had three
or more siblings and children and had regular contact with relatives.

Results

In Table 3,I show the results of a stepwise multiple logistic regression

analysis of mortality over a 4-year period on the independent variables. Each
column represents a separate analysis to evaluate the effect of different scales
of relationship items except for column 1, a baseline analysis using no
relationship scale. For ease of presentation, Table 3 shows only the Wald
statistic (the quotient of the beta coefficient divided by the standard error)
generated in the six multiple logistic regression analyses (Hosmer & Lemeshow,
1989). Beta coefficients and standard errors not shown in Table 3 are
available on request.
Retaining the sign of the beta coefficient, the Wald statistics in Table 3
show, as expected, that age is positively correlated to mortality, the effect of
other independent variables taken into account. As is well known, men
(coded 1, women coded 2) experience a higher mortality rate than women.
As expected from the literature, health self-rating (poor = 1, excellent = 5)
is negatively correlated and number of ADLs (ranging from 0 to 7) is
positively correlated with mortality. In this study, neither education nor race
is related to mortality when the effects of the other independent variables are
taken into account.
Table 3 shows that of the five relationship scales, only two (socioexpress-
ive and kin and kin contact) are related to respondent mortality in the
predicted direction; that is, elders scoring high on these scales are less likely
to die in the subsequent 4-year period than are elders scoring low, the effect
of other independent variables taken into account. A slight negative relation-
ship (not significant at the .01 level) between the structural measure of
relationships and mortality can be seen in column 2 of Table 3. The someone
to help scale (column 5) is unrelated to mortality.
Column 3 of Table 3 shows that the instrumental scale (receiving unpaid
ADL and IADL help) is related to mortality but in a direction opposite that
expected. A higher proportion of persons receiving this kind of help die over
the 4-year period-probably because this group is less able-bodied and
healthy than other elderly, multivariate controls for age, health, and number
of ADLs notwithstanding. If initial health/able-bodied status continues to
have an effect despite multivariate statistical control by means of multiple
logistic regression, might not initial health/able-bodied status also explain

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54

Table 4. Abbreviated Results of Relationship Scales and Individual Items With

Mortality Based on 68 Multivariate Logistic Regression Analyses

NOTE: Results expressed as the Wald statistic, quotient of beta coefficient divided by
the standard error, for the relationship scale or item only.
a. Actual N for individual items reduced by numbers shown in Table 1.
*Probability < .01; **probability < .001.

the negative relationship of the socioexpressive and kin and kin contact scales
(columns 4 and 6) to mortality? That is, the finding that elders who socialize
a lot are less likely to die over a 4-year period may be because they tend to
be healthier initially than elders who do not socialize much, multivariate
controls for age, self-reported health status, and able-bodiedness notwith-
standing.
Given the prime importance of controlling for initial health/able-bodied
status in an investigation of the relationship between social relationships and
mortality, it is judicious to use another method of control in addition to the

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 55

statistical control in multiple logistic regression. In Table 4,I show the results
of using the method of subgroup control in addition to multi variate statistical
control. The study sample is divided into two groups: (a) elders who report
themselves to be in good, very good, or excellent health and report no ADL
limitations (N = 4,169) and (b) elders who report themselves in fair or poor
health or who report one ADL limitation or more (N = 3,293).
Instead of showing the Wald statistics for all seven independent variables
used in each multiple logistic regression analysis (as shown in Table 3) for
the sake of brevity, in Table 4 I show only the Wald statistic for the
relationship item or scale in question. The other six independent variables-
age, sex, health self-rating, ADLs, education, and race-were used in each
of the 68 separate multiple logistic regression analyses on which Table 4 is
based. The relationship of the six independent variables to mortality in these
analyses is identical or very similar to those in Table 3.

Effect of Double-Controls
Does dividing the sample according to health and able-bodied status
undermine or strengthen the results of Table 3? Examining the horizontal
lines to the right of each of the five relationship scales in Table 4, we see that
the results of Table 3 hold true, in general, for both able-bodied elders who
rate themselves in good to excellent health and those who rate themselves in
fair to poor health or have one plus ADL limitation. Being more active
socially (the socioexpressive scale) seems to reduce the risk of mortality for
healthy and more infirm elders. The relationship scales unrelated to mortality
in Table 3 (structural and someone to help scales) remain unrelated to
mortality in Table 4. Receiving IADL or ADL help (IADL help only in the
case of the healthy, no ADL limitations sample) continues to have an

unexpectedly positive relationship to mortality in Table 4, although the effect

is weaker among the healthy, no ADL limitations sample. Finally, the slight
negative relationship between the kin and kin contact scale observed in Table 3
is found in Table 4 only for elders who rate themselves in good to excellent
health and have no ADL limitations. In the next section of this article, I
examine the contribution of individual items to the relationship scales and
discuss implications of these findings.

Discussion

In this research, two methods of grouping the responses of questions about

the elders’ relationships were examined to determine if relationships have an

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56

independent effect on mortality over a 4-year follow-up period in a national

sample of Americans 70 years of age and over. The first method is based on
categories found in the literature, and the second is based on factor analysis.
Taken together, these methods permitted the construction of five simple
additive scales with some overlap between them. In general, this research
confirms that certain relationships do appear to reduce subsequent mortality
among persons aged 70 and over after taking into account possible effects of
age, sex, health, and disability status on the linkage. Tables 3 and 4 show that
socioexpressive relationships are most important in this regard, a finding
consistent with House and Kahn (1985) Broadhead et al. (1989), and others
who found that functional measures of relationships tend to predict health
outcomes better than do network or structural measures.
Attending religious services within the previous 2 weeks, which about
half the sample of elders reported having done, is the most important
component of the socioexpressive scale in terms of reduced risk of mortality.
This is true particularly for elders in fair to poor health or those who report
one or more ADL limitations. Volunteering has a similar effect, although only
about 16% of elders reported volunteering during the last year (see Table 1).
Columns 2 and 3 of Table 4 show that volunteering has this effect only among
able-bodied elders in good to excellent health. It is likely that the number of
elders who volunteer who are in fair to poor health or who report ADL
limitations is small, limiting the importance of this question for this subgroup.
Getting together with friends or neighbors and talking with them on the phone
are important relationships with respect to mortality.
On the basis of the individual items making up the socioexpressive and
other scales, a pattern seems to emerge from these findings-relationships
that are an end in themselves (as opposed to instrumental relationships) and
voluntary (as opposed to family relationships/seem to be most important
with respect to reduced risk of mortality. Do other individual scale items
shown in Table 4 fit this pattern?
In contrast to the positive effect of marriage among the general population,
living with a spouse (an item in both the structural and someone to help
scales) does not seem to protect against mortality for an elder. The reduced
impact of marriage in this age group is consistent with findings of Kaplan
et al. (1988), Litwak and Messeri (1989), Seeman et al. (1987), and Zuckerman
et al. (1984), but it is still difficult to understand on intuitive grounds. One
approach to understanding it may be to examine the life situation of elders
who live alone. By no means can living alone be equated with loneliness. In
this sample, there is no relationship between living alone and &dquo;wanting to do
more social activities.&dquo; Moreover, many of the respondents living alone are

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 57

widows. Seeman et al. (1987) noted that widowhood may be a more expected
and normative life event for the elderly with fewer negative health/mortality
consequences compared with younger persons. The present research lends
support to that view.
Gerontological research has shown that spouses, where present, are the
primary caregivers of the frail elderly. None of the items on the someone to
care scale (living with a spouse, living with others, having someone available
for care if necessary) lowers the risk of an elder’s mortality, nor does the
helping relationship measured by the instrumental scale. This finding con-
firms Hanson et al. (1989) who found that instrumental support did not
predict mortality in a sample of older Swedish men but is inconsistent with
Blazer (1982) who found that elders having a source of instrumental support
show a lower risk of mortality. However, Blazer’s finding is based on a small
sample (N= 331). The lack of relationship between instrumental support and
mortality calls into question one of the possible reasons cited in the introduc-
tion for the link between relationships and reduced mortality-that people
with stronger social ties may receive more instrumental and tangible help
from others.
In Table 4, I show that the kin and kin contact relationship scale is
marginally related to elder mortality. Only one item in the scale, number of
living siblings, is related to mortality beyond the .01 probability level. This
relationship may be spurious because number of living siblings is negatively
correlated (r -.22) with age in this age group. Because age is also a powerful
predictor of mortality among elders (see Table 3), the negative correlation of
living siblings to age probably accounts for a good portion of the negative
relationship between live siblings and mortality, this despite multivariate
controls.
The same comments can be made concerning the living sibling item in
the structural scale where it also is the only variable related to mortality
beyond the .01 level. When we reduce the contribution of this item (for
reasons given above) to the two scales, it becomes clear that relationships
with household members and with close kin (however variable and valuable
they may be in other respects) do not lower the risk of mortality for elders.
That contacts with friends and neighbors and involvement in outside
activities (religious or other) reduces the risk of mortality but that living
arrangement and contacts with family or relatives, do not, is interesting.
Perhaps contact with friends, neighbors, or outside groups is more voluntary
than relationships with family or kin. The valence on voluntary relationships
may be more positive than that found in household relationships or with
relatives. The valence or attitude that respondents have about their relation-

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58

ships is a promising research area but one that is beyond the scope of present
research.
As stated in my introduction, definitive tests of reasons in the literature
for the effect of relationships on mortality are problematic. Nevertheless, the
findings of this research do support some of the propositions more than
others. The first three propositions in the introduction focus on what social
relationships do for people: provide them with health information/sources,
provide tangible or instrumental help, and exercise social control over them
for healthy behavior. The socioexpressive items most clearly related to
mortality-attending church or temple, volunteering, getting together with
friends or neighbors, talking with friends or neighbors on the phone-seem
to be activities that people do because they want to, because they are
satisfying, interesting, or fun. The items seem to share an end-in-themselves
quality and do not seem to serve as a means to some other end, which the
first three propositions imply. Propositions 4 and 5, which stress joie de vivre,
psychological well-being, and physiological factors, seem more consistent
with the voluntary and end-in-themselves dimension of the socio- expressive
scale items. The negative relationship (other factors taken into account) of
the socioexpressive scale items to mortality in this large sample of community-
dwelling elders validates the old adage on the beneficial effect of elders
staying active and involved. Oddly, relationships in the household or with
relatives, possibly because these are of a more instrumental, less voluntary
nature, do not reduce the risk of mortality.
In conclusion, this research has shown that certain relationships reduce
the risk of elder mortality and that the effect can be seen among healthy and
more infirm elders. Nevertheless, some questions remain unanswered. Is it

only the most isolated elders who experience a high risk of mortality (the
threshold effect) or does the effect become evident in gradations over a range
of relationships? Is the effect more pronounced among men compared to
women as some research suggests? How do elders feel about their relation-

ships ? Continued research in this area will permit better understanding of the
role of relationships in the lives of the elderly.

Note

1. To simplify data presentation, only one version, the five-item factor analysis version
(versus the six-item Table 1 version) of the socioexpressive scale, will be used in this report.
The relationship of each version to respondent mortality is virtually identical.

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,

Edward P. Sabin, Ph.D., is Assistant Professor and Coordinator of the Gerontology

Concentration in the Department of Sociology & Anthropology at Towson State Univer-
sity in Baltimore. Previous to this appointment, Sabin researched and wrote on Third
World health issues under several federal contracts.

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