Introduction
Social aspects such as social networks, social participation and experienced trust are all included in the umbrella term social capital which has been found to be essential for mental health and mental wellbeing (Almedom Reference Almedom2005; De Silva et al. Reference De Silva, McKenzie, Harpham and Huttly2005). Given that mental ill-health is a prominent public health problem in the growing older population worldwide, profound knowledge and understanding of the social mental health determinants are needed. Yet, few studies have answered the question why or how social capital is important for mental wellbeing, especially in the ageing population where social capital research is limited (Almedom Reference Almedom2005). This paper aims to deepen the knowledge and specify the role of social capital in experienced mental wellbeing among older people.
Mental wellbeing is viewed as part of a process, where positive functioning and social interaction in various social contexts are emphasised for their important role in mental health and wellbeing in all ages. In the present study mental wellbeing is defined according to the functional model of mental health (Lahtinen et al. Reference Lahtinen, Lehtinen, Riikonen and Ahonen1999), which describes mental health as a foundation for experienced mental wellbeing and effective functioning in individuals. Further, mental health and wellbeing are defined as a balanced interaction between the individual and their environment and is influenced by numerous factors on both micro and macro level: psychological and biological predisposes of the individual, social interactions in different social contexts, societal structures and resources, and cultural values in the community.
The functional model of mental health shares several theoretical concepts with the activity theory (Burbank Reference Burbank1986; Havighurst and Albrecht Reference Havighurst and Albrecht1953; Lemon, Bengtson and Peterson Reference Lemon, Bengtson and Peterson1972), such as the view of the social context (both micro and macro level) and social interaction and participation as key components of mental wellbeing. The activity theory is used as the theoretical framework of this study as it elaborates on the relation of social interaction and participation with mental health and wellbeing for older adults explicitly. This theory describes the psycho-social ageing process and emphasises the importance of maintained social activity and participation: to enhance mental wellbeing, the ageing individual must substitute new meaningful social roles for those that are lost because of age (Havighurst and Arbrecht Reference Havighurst and Albrecht1953; Lemon, Bengtson and Peterson Reference Lemon, Bengtson and Peterson1972).
Previous research has not used the theoretical perspective and concepts of social capital to identify how social interaction and activities affect mental wellbeing among older adults. This research gap is noteworthy, since the theoretical framework of social capital during the last 20 years has become widespread and progressively applied in research studying the psycho-social aspects of health and wellbeing among general populations or specific age groups (Kawachi, Subramanian and Kim Reference Kawachi, Subramanian, Kim, Kawachi, Subramanian and Kim2008; Nyqvist Reference Nyqvist2009). By drawing on the social capital theory in theorising mental wellbeing among older adults, this study aims to compensate for this lack of empirical and theoretical knowledge.
The social capital theory by Putnam (Reference Putnam1993, Reference Putnam2000) is the most commonly used perspective of social capital in health research (Helliwell and Putnam Reference Helliwell and Putnam2004; Kawachi, Subramanian and Kim Reference Kawachi, Subramanian, Kim, Kawachi, Subramanian and Kim2008; Nyqvist Reference Nyqvist2009) and it distinguishes social interaction in social networks and social participation as core concepts. Consequently, the theoretical frameworks of the functional model of mental health and the activity theory correspond with Putnam's definition of social capital. However, as for many other theories on mental health determinants, neither the functional model of mental health nor the activity theory use social capital as a key concept. Yet, they indirectly target social capital by using the concepts of social interaction and participation in their definition of mental wellbeing. This paper seeks to deepen the theoretical as well as empirical knowledge of the causal mechanisms of social capital and its impact on the experienced mental wellbeing in older people.
Theoretical frameworks of social capital
According to Putnam (Reference Putnam1993) social capital is defined as networks, norms and trust that facilitate co-operation and co-ordination for mutual benefits within social organisations or communities. Further, social capital is developed, used and given value by the interaction between individuals (Putnam Reference Putnam2000). In line with this perspective, social capital can be divided into bonding (informal close ties among homogenous groups, e.g. close friends and family) and bridging (formal less close connections among heterogeneous groups, e.g. association organisations) social capital. Thus, social capital refers to the connections between individuals, the values that arise from these connections and social interaction (Putnam Reference Putnam2000). Within this approach, social capital is viewed as a collective concept, emphasising the formal social contacts as part of bridging social capital and is often measured by social networks and participation, trust and social cohesion in a neighbourhood or community (Putnam Reference Putnam1993).
By contrast to the perspective of Putnam (Reference Putnam1993, Reference Putnam2000) which highlights collective values and social integration, the concept of social capital has also been theorised within an individual approach. Along with cultural, symbolic and financial capital, social capital forms the theoretical framework of Bourdieu (Reference Bourdieu and Richardson1986). This paper does, however, not draw on this theoretical framework, as Bourdieu's main interests are in the examination of dynamics of power, class distinction and domination in social life, as well as in the related roles of economic, cultural and symbolic capital along with social capital. Hence, Bourdieu's approach stems from the rather negative perspective of social capital with actors engaged in conflicts of their own interests, whereas according to Putnam, trust and voluntary associations create consensus and collective welfare.
Consequently, social capital is in this paper defined in accordance with the tradition of Putnam (Reference Putnam1993, Reference Putnam2000). In line with this, we look at the values that the connections and interactions between individuals generate, operationalised by social network (informal and formal social contacts), social participation and trust. Putnam's theory was chosen due to the different aspects of social interaction and participation that it encompasses, both on a micro and macro level. This can be related to the coinciding key points of the activity theory, which focuses on the social determinants of mental wellbeing in older adults. Similar to the concept of social capital, the activity theory comprises informal interaction and activities with family and close friends, as well as formal social participation in association activities and various voluntary organisations (Lemon, Bengtson and Peterson Reference Lemon, Bengtson and Peterson1972). However, in his research Putnam (see Helliwell and Putnam Reference Helliwell and Putnam2004) identifies the relation between social capital and subjective wellbeing and happiness, although he does not specify the causal mechanisms that affect mental wellbeing through social capital in detail.
Social capital as a resource for mental health and mental wellbeing in older people
Various aspects of social capital and their impact on mental health and ill-health have been measured with quantitative assessments in previous research (Almedom Reference Almedom2005; De Silva et al. Reference De Silva, McKenzie, Harpham and Huttly2005). Nonetheless, within this growing body of research identifying a positive association between social capital and mental health, only a small number of original studies have looked at social capital (defined as social capital in the studies) and mental health among older adults explicitly (Almedom Reference Almedom2005; De Silva et al. Reference De Silva, McKenzie, Harpham and Huttly2005).
Various factors identified as important aspects of the social capital concept, such as social networks and support (Forte Reference Forte and Cattan2009; Litwin Reference Litwin2001) and social participation (e.g. in social activities and voluntary organisations) (Bowling and Gabriel Reference Bowling and Gabriel2007; Forte Reference Forte and Cattan2009; Li and Ferraro Reference Li and Ferraro2006) are key mental health resources among older people. The importance of these aspects of social capital tend to increase with age along with decreased functional level and a greater need for practical help and support in everyday life (Forte Reference Forte and Cattan2009; NHS Health Scotland 2004). Yet, social networks and social participation tend to decrease with age (Forte Reference Forte and Cattan2009; NHS Health Scotland 2004) which has been identified as an important risk factor for mental ill-health (e.g. depression) among older people (Li and Ferraro Reference Li and Ferraro2006; Seeman Reference Seeman2000; Steunenberg et al. Reference Steunenberg, Beekman, Deeg and Kerkhof2006).
Moreover, positive correlations have been found between structural aspects of social capital such as social network types and positive mental health in older adults (Litwin Reference Litwin2001). For example, in Litwin's study (2001), extensive social networks encompassing both friends and family were associated with positive mental health, while restricted networks lacking contacts with friends were negatively associated with positive mental health. Further, Greaves and Farbus (Reference Greaves and Farbus2006) found that by providing various social activities and enhancing social networking among socially isolated older people, quality of life was increased and depressive symptoms decreased. Likewise, survey-based studies have recognised the positive impact of cognitive aspects of social capital on mental health (De Silva et al. Reference De Silva, McKenzie, Harpham and Huttly2005). For example, Nyqvist et al. (Reference Nyqvist, Finnäs, Jakobsson and Koskinen2008) found positive correlations between experienced interpersonal trust and sense of security and mental health among a general adult population in Finland.
Social capital is a multi-dimensional concept with several established indicators requiring various assessment approaches for full examination and understanding (Almedom Reference Almedom2005). Despite a growing body of research on social capital and mental health (McKenzie and Harpham Reference McKenzie and Harpham2006), studies targeting the ageing population are few (Almedom Reference Almedom2005; De Silva et al. Reference De Silva, McKenzie, Harpham and Huttly2005). Studies using qualitative data and analysis methods are called for to deepen the understanding of the mechanisms of social capital and their impact on mental health and mental wellbeing among older people.
In an attempt to add to the understanding of health and mental wellbeing in the ageing process, Bryant, Corbett and Kutner (Reference Bryant, Corbett and Kutner2001) carried out a study based on semi-structured interviews identifying a model of healthy ageing. The findings indicated that one of the components required for healthy ageing was access to adequate social networks, interaction and support, while the overarching theme related to healthy ageing was access to meaningful social activities (Bryant, Corbett and Kutner Reference Bryant, Corbett and Kutner2001). According to the study, the positive effects of social networks and interpersonal relationships may be explained by their ability to alleviate stressful circumstances encountered in later life. However, the study's focus was on healthy ageing, a broad concept encompassing both physical and mental components of health and wellbeing. Moreover, even though partly captured in the identified concepts relevant for healthy ageing, the study of Bryant, Corbett and Kutner did not look exclusively at the concept of social capital in older adults.
In conclusion, while the quantitative associations between social capital aspects and mental health and ill-health in older people have been recognised in previous research, there is a lack of research which attempts to determine the causal mechanisms through which social capital influences mental wellbeing of individuals, especially in older populations. Thus, we know that social capital is important for mental wellbeing among older adults, but our understanding of why or in what way it is important is restricted.
Aim and research question
The aim of this study is to determine the causal mechanisms through which social capital (i.e. social network, social participation and trust) has an effect on mental wellbeing of older adults. The specific research question is: How does social capital affect the experienced mental wellbeing of older adults?
Methods
Data collection
Data from the Western Finland Mental Health Survey, 2008 (Forsman et al. Reference Forsman, Herberts, Aromaa, Tuulari and Wahlbeck2009) were included in the analysis. The survey included an open-ended question on thoughts on and experiences of the connection between wellbeing and other people and the answers of older respondents (60 or older, survey response rate 62%) were transcribed and included in this study data material. The survey study sample, which was representative for the Finnish population, was obtained from the Population Register in Finland and provided a large quantity of replies on a question central to the aim of this study.
To complement the large quantity of respondents' rather short replies, supplementary data material was warranted. On the basis of providing insights into the perceptions, opinions and attitudes of the targeted study group on a certain subject (Krueger and Casey Reference Krueger and Casey2009), focus group interviews were chosen. By conducting focus groups, the participants’ own experiences and views on mental wellbeing and the connections to social capital were explored.
The participants of the study were older adults living in the community or at a nursing home in Western Finland. Two focus group interviews with six and five participants respectively were conducted in Vaasa, Finland in March 2011. In order to reach a study population representing various life circumstances and living conditions in an ageing population, one of the interviews took place with residents at a nursing home, while the other interview was arranged within a local retirement association. Hence, in both groups the participants knew each other well. These settings provided different premises for social interaction and participation, as community-dwelling older adults usually have easier access to social networks and activities than nursing home residents.
Information on the focus group interviews and signing up for the voluntary participation was provided by the researchers at scheduled meetings with nursing home personnel or at meetings in the retirement association. The participants provided informed consent before taking part in the interviews. Two researchers conducted the focus group interviews (mean duration one and a half hours), which were recorded and transcribed.
According to Finnish legislation (Medical Research Act 488/1999),Footnote 1 ethical approval is required only for medical research, defined as research including interventions. The current study was based on an anonymous general population postal survey and focus group interviews, with participants who provided informed consent and whose confidentiality was maintained within the data. Neither the focus group interviews nor the general population survey are ‘medical research’ according to Finnish legislation. Hence, ethical approval was not needed, nor applied for.
The two sets of data material were both used for answering the research question and they contributed equally to the analysis. They supplemented each other well as the interview material provided more in-depth answers to the research question whereas the survey-based answers might have added an element of candour as the respondents were completely anonymous to the researcher. This study is thus based on two independent sources of collected data – a general population-based survey and focus group interviews – which strengthens the validity of the findings (Patton Reference Patton2002). The older adults who answered the open-ended question in the survey (N=869) had a mean age of 68 years (standard deviation=6, age range=60–81). Sixty-four per cent of the study participants were women and 88 per cent were Finnish-speaking, while the mother tongue of 12 per cent of the participants was Swedish. Seventy per cent were married or cohabiting, while 30 per cent were living alone.
The participants of the focus groups (eight women and three men) were older than the survey participants, with a mean age of 76 years (standard deviation=6, age range=73–90). Five of these participants were living in a nursing home, seven were widowed or lived alone, and four participants were married. They all had Swedish as their mother tongue. None of the focus group participants were diagnosed with cognitive disorders (e.g. dementia).
Analysis
The interview guide used for the two focus groups contained two main themes, mental wellbeing and interpersonal relationships. The interviews began with discussions on general wellbeing and the participants discussed freely various factors they felt were important for maintaining mental wellbeing. In both focus groups, these discussions naturally led to the second main theme of interpersonal relationships, targeting various aspects of social capital. The participants were throughout the interviews encouraged to expand on issues regarding how the different aspects of social capital were related to their own mental wellbeing.
Qualitative content analysis is a research approach frequently used in various research traditions – for example, in social or nursing sciences – to receive valid findings from text-based data materials, carefully considering the context of the text in the analysis process (Graneheim and Lundman Reference Graneheim and Lundman2004; Krippendorff Reference Krippendorff2004). Qualitative content analysis was chosen because of its step-by-step methodologically controlled analyses in comparison to other qualitative approaches, hence allowing for replication (Krippendorff Reference Krippendorff2004). By using the approach by Krippendorff (Reference Krippendorff2004), the initial phase of analysing the texts involved condensation by identifying and selecting the textual units throughout the data material (i.e. the sentences or paragraphs containing central aspects related to each other through their content and context). The condensation of the text was undertaken after carefully and repeatedly reading through the transcribed material, focusing on the research question and the interview guide throughout the process.
The analysis was further performed by systematically coding the condensed data material, initially into preliminary themes or codes based on the textual units. Several categories emerged within the themes during the analysis process. All quotations relating to particular categories were grouped together and examined in terms of broader and overarching themes on a higher abstraction level.
The grouping of the textual units (e.g. quotations related to the same central content) was an inductive process where initially there were various potential categories which during the process of sorting quotations were rearranged and recoded to be mutually exclusive. Constant comparisons ensured that similarities and differences between the emerging categories were explored. Quotations typical for each category respectively were thereafter highlighted and described.
The researchers discussed the analysis – the coding, categorising and the interpretation of the findings – throughout the work process to gain a mutual agreement. Illustrative and typical quotations from the data material, representing the analysed categories, have been included in the article to offer the reader a comprehensive overview of the findings. These quotations were translated and back-translated from Swedish or Finnish to English to ensure accurate interpretation of the data.
Strengths and limitations of the study
One limitation of the study is the Nordic context, which is generally considered as having higher levels of social capital compared to other areas (Iisakka Reference Iisakka and Iisakka2006). In line with this, the participants appeared active and engaged in various informal social or association activities. This could be a source of bias limiting the generalisability and comparability of the findings. However, the aim of the study is not to generalise or compare social capital and experiences of mental wellbeing among different older populations, but to theoretically elaborate how and in what way social capital influences mental wellbeing.
There is a risk of bias related to the recruitment of study participants; potential participants with limited social abilities or those who for some reason avoid social interaction might have been excluded from the focus groups. In an attempt to include people vulnerable to social isolation, nursing home residents were included, yet there are other groups of older adults with limited social networks and abilities whose insights may not be represented in this study. These are, for example, community-dwelling older adults living in less populated rural areas or suffering from severe mobility or other functional limitations, which prohibit social interaction and participation. These vulnerable groups were not represented in the interviews, although they might have been reached through the survey.
In addition, all the participants in the focus groups had Swedish as their mother tongue, which in previous research has been shown to be correlated with higher levels of social capital in Finland (Nyqvist et al. Reference Nyqvist, Finnäs, Jakobsson and Koskinen2008). On the other hand, the majority was living alone and nearly 50 per cent of the focus group participants were nursing home residents, which might indicate lower levels of social capital. These mixed characteristics should balance the proportions and the preconditions of social capital among the participants in the focus groups.
The mean age of the interview participants was notably higher compared to the mean age of the survey respondents. Due to the survey inclusion criteria of 81 years of age or under, the focus groups had no upper-age limitation and therefore also included older participants. Thus, the wide age range of the participants ensured a representative sample with regards to age. Moreover, no differences within the data emerged with regards to age or gender.
The group element of the interviews might have limited the exploration of important concepts impacting on older people's wellbeing, with participants not wanting to share deeply personal issues with the other participants. On the other hand, this study was also based on anonymous survey data and the characteristics of the survey study sample complemented the ones of the interview participants well; in addition to the lower mean age of the survey sample, the proportion of Finnish-speaking older adults living in the community was high, balancing the characteristics of the whole study sample. No differences appeared between the data sets, which indicated that the materials supplemented each other well.
Findings
Three main categories emerged from the analysed data material. The first category, Meaningful social activities, describes the participants’ views on various social activities, how they are related to the experienced mental wellbeing and what they bring to the everyday life of older adults. The category Family and good friends comprises vivid descriptions of life-long relationships and their importance for mental wellbeing and the category The residential location encompasses experiences on what the living situation means for social contacts and interpersonal relationships.
Meaningful social activities
Analysis of the data revealed that the participants regarded social contacts as an important element for wellbeing. Moreover, the participants perceived that loneliness might lead to the onset of mental ill-health. As illustrated below, this was something they feared they would experience, especially if they encountered illness and were in strong need of daily help and support.
The biggest barrier to wellbeing would probably be being completely alone. (Participant H)
To just sit there within your four walls … I hope that we'll receive good care when we need it and that we'll not just be left alone somewhere without any support or help. I can't think about it because it scares me. (Participant N)
This described fear of being left alone appeared to originate partly from the experiences of other older people, but perhaps mostly from negative statements on elderly care in the media. Both the connection between social contacts and mental wellbeing (e.g. Litwin Reference Litwin2001) and the reversed relationship between wellbeing and loneliness (e.g. Cattan et al. Reference Cattan, White, Bond and Learmonth2005) have been extensively studied in previous research. However, to avoid experiencing loneliness, the participants described how they actively tried to maintain their social network and the contact with friends by participating in different social activities. In line with previous research, various kinds of social activities were identified as being essential cornerstones of mental wellbeing (Bryant, Corbett and Kutner Reference Bryant, Corbett and Kutner2001). However, this study adds to previous research by identifying several explanations as to why these activities are important for the experienced mental wellbeing in older adults, such as providing a purpose in life:
Well, I participate in some activities almost every day. If you don't participate you'd probably not even get dressed for the day … To sit at home and do things by yourself … So it's good to have something to do. (Participant H)
Friends from social activities bring variation and content to life alone. (Participant O)
In addition, the participants appreciated the fact that regular or scheduled activities added structure to their lives and provided them with something to look forward to:
And I was thinking what expectations I have for the future at my age. And then I thought well I'm probably going to travel somewhere and something fun will surely happen … Moreover, you have to think that it's [life] not over yet, even though it might sometimes feel like it.
That you have to be able to look forward to something, an invitation, a friend saying that: now we're having an Easter party – How nice, of course I'll come. (Participant H)
Overall, something to plan for and look forward to brought joy and life satisfaction. Regular activities also seemed to provide purpose to everyday life, as well as feelings of hope for the future, which was emphasised as crucial, although – or perhaps because, the participants were all aware of their position in the lifecourse. Social activities and related interpersonal relationships had a central role in these plans and expectations for the future.
Drawing on Putnam's social capital theory, the participants were to a great extent involved in various forms of association activities and voluntary work (e.g. through retirement and voluntary associations). These activities were accessed through the individuals' social networks. When discussing what these activities meant for the participants’ mental wellbeing, it was highlighted that being part of a social group with common aims and purposes creates a sense of belonging. Additionally, being able to help other people – through organised voluntary work, but also generally in everyday life – had a positive impact on the older people's mental wellbeing, as it instilled feelings of being needed and appreciated:
And I think that if you've helped with one thing or another then you're very happy and pleased and you think back on that occasion with positive thoughts. If you see an opportunity to help someone then do that, be active, don't hesitate to help … It gives you satisfaction. I become happier, more content that I'm able to help another person. (Participant A)
Voluntary work provides variation in life as a retiree and it feels like you are doing something good for other older adults. (Participant E)
Besides organised association activities and voluntary work, the participants mentioned that they visited restaurants or had friends or family over for dinner, during which they had long conversations and shared current life events. Other popular activities often enjoyed with friends were handcrafts, choir singing, physical activities in various forms and going to the movies or theatre, as illustrated below. These activities seemed to contribute to mental wellbeing through shared experiences and memories provided by the social activities among friends and family.
Yes, we can decide to go to the movies and to the theatre [both with the retirement association and with other friends] … We travel … Or I invite them over; at Christmas I had quite a few friends over to whom I served this and that. (Participant F)
The participants who lived at a nursing home also explained that they tried to live as normal a life as possible by attending social activities outside the nursing home setting. A finding that confirmed the activity theory perspective (Burbank Reference Burbank1986; Havighurst and Albrecht Reference Havighurst and Albrecht1953) was that the participants emphasised the importance of maintaining daily life routines and social networks when encountering life-changing events, such as retiring from work life or moving into a nursing home. As exemplified by the quotation below, maintaining a social life enabled a smoother adjustment to the occurred changes in life.
But you're bound here and you shouldn't expect them to come and visit you often, you should get out somewhere where you meet your old acquaintances. … Overall, I'd say that when you retire, the most important thing is to try to lead your life as usual and not to cut off the old contacts, intending to start a new life … There should be a continuation in all of it, that's the easiest I think rather than if there's a sudden disruption. (Participant G)
Continuation of the social life appeared to be essential for the participants, although not always possible due to various forms of changes occurring along with the ageing process. In line with previous research (NHS Health Scotland 2004), various physical health problems and functional limitations were perceived as decreasing quality of life and mental wellbeing – both among the community-dwelling participants and the nursing home residents – and these problems extensively interfered with maintaining social networks and engaging in social activities. Nevertheless, great effort was taken to limit this interference, as social participation and interpersonal interaction were described as important mental health protective factors that balanced the negative experiences related to declining physical health:
Despite physical illness with great suffering my mental health remains quite good thanks to family, friends, the parish and the sitting dance group. (Participant L)
The participants talked about social participation and what it provides in terms of social contacts and support. They also referred to the importance in maintaining the social abilities, which rapidly decrease if disengaged from social networks and activities. One example of this was public performances that were avoided because of a sudden loss for words:
You know, the social ability is lost quite quickly. And I realised that I'm usually prepared to talk to people and speak officially too, but now I've become even scared to … If I'm going to speak in front of an audience my thoughts go flying, I don't know what to say. (Participant B)
Lacking in social abilities due to fears of not being able to handle social situations sufficiently was an evident risk factor for social exclusion from social networks and related social activities. On the other hand, the participants experienced improved self-esteem with increasing age, as many no longer felt ashamed if they embarrassed themselves in social situations. These factors were described as useful resources for social interaction in later life.
Family and good friends
The second category identified as affecting mental wellbeing among older people referred to social relationships. The closest family (i.e. spouse, children, grandchildren and/or other close relatives) was described as the most important social contact for mental health and wellbeing. They provided various forms of social support and feelings of being loved. The intergenerational relationships were strongly perceived as an important part of the participants’ lives and mental wellbeing. It was often described how grandchildren add meaning to life and that looking after grandchildren brings joy. Further, efforts to maintain intergenerational contacts were pronounced:
My grandchildren bring joy to my life. I get to sew and knit clothes for them. We're in touch every week by e-mail or mobile phone and we hug when we meet. (Participant J)
This contradicts previous research by Litwin (Reference Litwin2001) which found that relationships with friends were more closely associated with older individuals’ wellbeing than contact with family members. According to Litwin's study, this might have been due to the nature of relationships between friends and family members; unlike family relations, friends tend to be chosen and these relationships are usually associated with fewer obligations. On the other hand, other research has indeed found that family is amongst the most important mental health-promoting factors among older adults (NHS Health Scotland 2004). Similarly, research has shown that being appreciated and feeling loved and cared for are important factors for older people's experienced wellbeing (Bowling and Gabriel Reference Bowling and Gabriel2007).
However, in addition to the immediate family, good and reliable friendships were perceived as an essential mental health resource also in the present study:
Well, family means the most, but friends come quite close because the younger generation in my family, they have their life and their job and they have a lot to do and they don't have that much time for me … Friends come close, they're the same age usually and they have time too like I do so you can talk to them practically anytime. (Participant B)
Adding to existing empirical knowledge, the findings highlight that friendships contribute to mental wellbeing in later life. One reason for friends of similar age being essential social contacts of the participants was that these friends usually have more spare time for socialising than family members of younger generations do, as the latter tend to lead stressful lives with working careers, busy family lives and social activities.
Further, many of the participants had experienced a nearly life-long close friendship which was highly praised as an important part of their lives. The quotations below illustrate how these friends had accompanied the participants through their lives, experiencing good and bad events together. Qualities that were highlighted were mutual trust and the fact that these friends knew the participants better than any other person.
And we're some friends who have stuck together since the year of 1962. We've followed each others’ family life. (Participant H)
It's very important to have friends, at least one, who really listens and who you can really trust. Especially when you encounter challenges in life, friends are worth their weight in gold, my husband above all. (Participant P)
To experience a long life filled with both joy and sorrow together with a life partner or friends seemed to form good prerequisites for deep and reciprocal relationships. It was also valuable for the participants to be able to reminiscence about past events with their friends, as demonstrated in the quotation below. This created a sense of security and confidence, as they could be completely natural in their company.
But I mean, having your childhood friends to whom you can say a year and that happened in the 50 s then and then, ‘yes, I remember all that’. That's a treasure, really. So, I've thought about that when looking at all these younger people who move an awful lot – while we've actually lived in the same location. (Participant H)
According to this finding, the fact that different generations do not share common experiences and events from the past may affect how the older and the younger generations relate to each other. However, while some participants reported that these long-lasting relationships were both present and important, others touched on the difficulties they had encountered or expected to experience when close friends pass away. Participants who had lost their friends through death discussed the distress this had caused, especially as many felt that close friends are very difficult to find in old age. The life-long friendships are thus irreplaceable:
But, as mentioned over and over again, you don't make any new friends anymore in late life, but your old friends are those who are closest to you and these, as I said, are no longer with us anymore. (Participant G)
On the other hand, the participants accepted death as part of their own as well as close friends’ lives. In addition to an accepting approach to death, a positive outlook on life and current situation as an ageing individual were identified as important mental health-promoting and protective factors that provided good prerequisites for an adequate social life.
This optimistic perception of life could, however, also be a reflection of an attempt to maintain sound relationships. The participants described how they tried to avoid extensive complaining about their situation and any disabilities or limitations restricting their lives, as they expected this to put a strain on their interpersonal relationships. This finding suggests that a favourable outlook on life among older people might not necessarily be based on genuine feelings of content but rather on the apprehension of being regarded as a nuisance.
The residential location
The third category identified as influencing the mental wellbeing of older people was their residential location. Analysis of the data implied that no differences between the views or experiences of community-dwelling and nursing home residents existed. However, in terms of issues related to the residential location and the participants’ social lives, some differences were naturally identified. These mainly concerned the varied access to social contacts and social activities.
The residential location and owning their own home were perceived as important to all participants, and those who lived in a nursing home described that they sometimes longed for homes they had left when they moved into the nursing home. Another aspect of close friendships that emerged from the data material was the impact of the residential location; many of the participants had lived in the same location for a long time period and they appreciated the fact that they knew their neighbours well and could seek both company and various forms of support from them:
Every morning we exchange newspapers because she lives one floor below me and I go downstairs with the newspaper and I go inside using her key that I have and exchange the newspapers and we'll talk for a while… (Participant B)
The close ties and frequent interaction with neighbours encompass an interesting perspective of the findings, as Putnam's (Reference Putnam1993, Reference Putnam2000) social capital theory emphasises social networks on the community level and highlights the ties between neighbours. Having lived in the same location for a long time meant that the neighbourhood area and the close surroundings were familiar and well-incorporated with everyday routines. According to the participants, public places such as the grocery store or the hairdresser were important meeting places, where many hours could be spent just talking to people:
For me it's so very important to be able to go to different stores, not for shopping, but for meeting people, and I have lots of acquaintances that I've met by visiting these stores. And I think it's so valuable for each of us to have this kind of social network. And I don't invite them over and they don't invite me, but just to be able to socialise, and we may spend hours talking and we say hello from a distance when we see each other. (Participant A)
Other participants talked about their changes in residential locations during their lifecourse which had resulted in restricted or a complete lack of contact with friends from different life-stages. Nevertheless, some participants explained that by actively striving to sustain social contacts, the long-lasting relationships with friends were maintained despite not being geographically close:
Well, at my age, when those who you truly call your close friends are few and they also might have moved and live in different locations and so on … But those who I call my friends I can trust completely. There are some who, despite having been away from [the city] for 32 years, still call me. (Participant G)
It seems that in order to enhance mental wellbeing, older people must be engaged and proactive in maintaining their social contacts. This is a critical point, as the obstacles for socialising is clearly more limited among older compared to younger people. In order to stay in contact with friends and relatives, the participants emphasised the use of telephones and in some cases, computers and internet. These means were especially important if the geographical distance between the residential locations was far, but telecommunication was also frequently used to their benefit when contacting close-by family and friends. Participants living in nursing homes with functional disabilities and restricted possibilities to leave the nursing home facilities to meet up with friends and relatives also explained that they used frequent phone contact to maintain their social relationships:
Further, I think it's very important today to have access to phones, mobile phones and computers and so on. And many of us use computers regularly every day, maybe even several hours a day, and it really enables lots of social contact … Like you [referring to another group member] would not be able to have contact with your sister if it wasn't for computers and phones. (Participant A)
And regarding friends, if you don't have too many that come and visit you, then you can keep in touch with old friends by phone. (Participant D)
It is interesting that the technological devices were frequently mentioned by the participants as important tools for maintaining social contacts. This aspect of mental wellbeing among older adults is currently given attention within ageing research due to the rapid technological advances of society and the new possibilities in relation to mental health-promotion work (Futurage 2011). Simultaneously, the importance of providing technological resources as well as necessary skills to the older population are emphasised in order to avoid social inequalities between different age groups that may occur due to varied technological prerequisites (e.g. internet access).
Discussion
The main findings from our study indicate that relationships with immediate family and life-long friends are important for the experienced mental wellbeing among older adults. This is due to shared life events and related memories as well as the social support and feelings of being loved. These close interpersonal relationships are also important for the mutual trust and sense of security that have developed during a long time period. Furthermore, meaningful social activities are an essential part of everyday life for maintaining social contacts and enabling interpersonal relationships. Meaningful social activities also provide feelings of being needed and appreciated and additionally, they enhance a sense of belonging to the social groups and contexts. These findings add to the limited body of research on the causal mechanisms of older people's social capital and their impact on experienced mental wellbeing.
Three main categories were identified from the analysed data material. The meaningful social activities category refers to the importance of arranged social activities that provide purpose in life.
The participants described extensive engagement in various social activities – both informal activities with family and friends and formal association activities. The frequency and level of engagement did not appear to decrease with age, but the focus of the activities might have changed during the lifecourse due to a shift of interests and priorities. This finding indicates that older adults need to have access to meaningful social activities and maintain active and engaged by social interaction in different social contexts. Participation in social activities is important for several reasons – a sense of belonging, enhanced social networks and feelings of being needed and appreciated, as well as added purpose in everyday life and having something to plan for and look forward to. These are the causal mechanisms emerging from the findings, linking experienced mental wellbeing with social participation.
This finding supports the activity theory, which emphasises that older adults have similar needs for social contacts and activities as younger people, and that they need to maintain their activity level by replacing activities that they have disengaged from (Burbank Reference Burbank1986; Havighurst and Albrecht Reference Havighurst and Albrecht1953). What the current study adds to the body of empirical and theoretical knowledge is why maintaining being engaged in various social activities is important for experienced mental wellbeing in later life, that is, due to a sense of belonging to a social context and purpose in life arising from meaningful activities. Further, social activities generate expectations for the future while contributing to a social group enhances self-confidence.
Moreover, the findings confirmed that social interaction among individuals within informal or formal groups or organisations are essential for mental wellbeing (Lahtinen et al. Reference Lahtinen, Lehtinen, Riikonen and Ahonen1999). Previous research has found that social capital may be a result of various social activities which do not necessarily aim to strengthen social capital (Putnam Reference Putnam1993). Further, Putnam's theories on social capital (Reference Putnam1993, Reference Putnam2000) stress social participation in association activities (bridging social capital comprising formal contacts on a collective level), which also emerged as an important factor for mental wellbeing in the present study. However, informal social contacts and activities were identified as the key factors for experienced mental wellbeing in older people, hence adding to the work of Putnam that emphasises the benefits of bridging social capital.
The category Family and good friends describes life-long interpersonal relationships as being a main component of mental wellbeing in later life. The current study adds to the previous research by identifying long-lasting informal social contacts and their positive impact on older people's mental wellbeing. These social contacts are important because of the sense of security and reciprocal love and appreciation, support and trust that they provide. To have close and life-long friends was regarded as an invaluable resource that generated irreplaceable support in later life. In addition, the life-long close relationships had provided joy and shared memories that created a sense of belonging and confidence which in turn enhanced the experienced mental wellbeing.
Consequently, informal social contacts such as interpersonal relationships with immediate family and friends are in this study highlighted as the key mental health resource, which contradicts Putnam's idea of social capital with its main focus on formal contacts (e.g. within institutions or organisations). The findings do, however, also add to the aspects of Putnam's theory by emphasising the benefits of social capital on a collective level. Nevertheless, although the collective benefits of social interaction and participation is underlined, the theoretical framework according to Putnam's tradition does not overlook the individual benefits of social networks (Helliwell and Putnam Reference Helliwell and Putnam2004) and participation in social activities (Nyqvist Reference Nyqvist2009). However, the findings from this study go further and point out the causal mechanisms linking mental wellbeing and social capital. The findings also indicate that the characteristics and the meaning of social capital differ depending on the target group. Among older adults the informal contacts created in earlier life-stages seem to be an essential component of social capital in later life, while the situation among younger age groups may be different. Furthermore, different obstacles need to be considered when aiming to maintain and promote mental health and experienced mental wellbeing among older adults, including physical limitations restricting face-to-face social interaction and participation. Declining social abilities may also increase the exclusion from social activities, with prominent consequences such as loneliness and social isolation.
Additionally, the findings emphasise the importance of having access to a social context for the wellbeing of older adults. Related to this, the current study showed that the residential location and the living arrangements are important for the experienced mental wellbeing of older adults, providing a context for their social life. The social capital of older adults seemed to be highly connected with the neighbourhood and the community they live in, which is in line with Putnam's theory (1993) of social capital as a community asset. These findings are coherent with the theoretical framework for defining mental health in this study (Havighurst and Albrecht Reference Havighurst and Albrecht1953; Lahtinen et al. Reference Lahtinen, Lehtinen, Riikonen and Ahonen1999), highlighting the importance of social roles and contexts for mental wellbeing. The current study adds to previous theories and evidence by identifying the causal mechanisms connecting living arrangements with mental wellbeing. The mechanisms that emerged from the study material are familiar neighbourhoods and surroundings that function as a stable foundation for everyday life and well-incorporated regular routines, as well as close relationships with neighbours and other acquaintances. These are enabled through long time periods residing at the same location.
In conclusion, informal social contacts formed in earlier life appear to have an impact on experienced mental wellbeing in later life because of shared life events, social support, and mutual appreciation and trust. This finding calls for actions to enhance and maintain adequate social networks and social participation among older adults who might be at risk of decreased social interaction. Further, meaningful social activities are an essential part of older people's everyday life because of the maintained interpersonal relationships and sense of belonging, as well as the accompanied feelings of being needed and appreciated. Possibilities to participate in various activities should therefore be provided to older adults within the community. Declining physical and social abilities are evident risk factors for increased exclusion from social activities and also for feelings of loneliness and social isolation. Moreover, the importance of life-long relationships for older adults should be taken into consideration in the planning of elderly care, as changing residential location might restrict social interaction and networking.
Acknowledgements
The authors would like to thank Johanna Nordmyr for assisting in the focus group interviews, for transcribing the recorded interviews and for valuable discussions during the work process. The authors would also like to thank the research group of the Western Finland Mental Health Survey for their valuable comments and discussions during the work process. Funding was received from Svenska kulturfonden (The Swedish Cultural Foundation in Finland) and Professor Jan-Magnus Janssons fond för geriatrik och forskning kring äldreomsorg (Professor Jan-Magnus Jansson's Foundation for Geriatric and Elderly Care Research).
