Relational Aggression and Subjective Well- Being in Independent Senior Living Communities

Transcription

1 Relational Aggression and Subjective Well- Being in Independent Senior Living Communities By Jacquelyn Benson, MA, Senior Research Associate Mather LifeWays Institute on Aging

2 both the quantity and quality of our social relationships are unequivocally important when it comes to our physical and mental health, and our risk of mortality. Social Relationships and Health Socially connected individuals are happier and healthier than their more isolated counterparts. Over the past few decades, researchers have established that both the quantity and quality of our social relationships are unequivocally important when it comes to our physical and mental health, and our risk of mortality. Although the link between social relationships and health is well established, we have only just begun to identify explanations for this link. Recently, social scientists have discovered that the link between social relationships and health is explained by our behaviors (e.g., smoking, exercise, diet), various psychosocial factors (e.g., social support, mental health, cultural norms), and physiological processes (e.g., stress response) (Umberson and Montez, 2010). However, additional research is needed in terms of considering potential social variation that may exist. For example, understanding the associations between social relationships and health among an older adult population is an area of research ripe for further investigation. Social Aging As we age, our social networks or circles may change for a multitude of reasons (Kahn and Antonucci, 1980). For example, social network changes may be the result of role changes brought on by retirement or widowhood. Upon experiencing one or more of these role changes, an older adult may eventually decide to move to a retirement or senior living community to avoid risk of social isolation (Heisler, Evans, and Moen, 2004) Indeed, extant research suggests that living in a continuing care retirement community (CCRC) may assist in maintaining social networks as one grows older (Stacey-Konnert and Pynoos, 1992). Moving to a senior living community may also be precipitated by health events that prevent an individual from continuing to live on their own without experiencing great difficulty and challenge. Whatever the reason, more older adults are relocating to senior living communities than ever before (Longino, 1997). This growing preference for congregate living arrangements among older adults points to a greater need to investigate the potential benefits and challenges of transitioning from community living to congregate housing in later life. Social Relations in Senior Living Communities Adapting to life in a senior living community may be challenging due to the communal living style that is inherent to the communities structure and design. Common concerns for many older adults moving to senior living communities surround issues of privacy and autonomy. Residents must adjust to living in closer proximity to neighbors, having to adhere to dining, transportation, or laundry room schedules, rules and regulations regarding furniture placement, home decor, and the use of home appliances, and sharing space and other amenities that are offered in the living community. Prospective residents also share concerns not just about the proximity of neighbors but about the neighbors themselves. Territorial conflict or tension may arise between residents whereby some residents have difficulty tolerating individual or group differences in their communities (Cutchin, 2003). For example, residents who are physically and mentally healthy may 2

3 Relational aggression is defined as a manipulative, nonphysical form of aggression meant to negatively impact the development of friendships by social exclusion or harming the social status of a victim by spreading negative rumors or gossip. express concern about spending time and sharing space alongside other residents exhibiting greater health problems and vulnerabilities. Differences regarding gender and race may also contribute to conflict or tension among residents in senior living communities (Cutchin, 2003). Expanding the Research Focus With respect to research examining the link between social relations at senior living communities and health outcomes, the vast majority of this literature focuses on examining relations between staff and residents and the consequences for staff and resident well-being (Rosen, Pillemer, & Lachs, 2008; Trompetter, Scholte, and Westerhof, 2011). This literature primarily includes investigations of elder mistreatment perpetrated by informal and formal caregivers. However, the research community has taken a greater interest in studying resident-to-resident social relationships, with positive relations among residents serving as the primary investigative focus. Resident-to-Resident Aggression in Senior Living Communities A New Public Health Concern? Recently, gerontologists from Cornell University published an article with the National Institutes of Health stating that resident-to-resident aggression in long-term care communities may be more prevalent than aggression inflicted upon older adults by staff or informal caregivers (Rosen et al., 2008). The authors argued that resident-to-resident aggression was an understudied and potentially significant public health problem and made a call to the research community for further investigation. Since this call, a few empirical studies have been published on this issue; however, the primary focus has been on populations of older adults in skilled nursing facilities, where episodes of overt physical and verbal aggression are viewed as a symptom of dementia or other cognitive impairment. A gap still exists in exploring other types of aggression namely relational aggression among populations of higher-functioning older adults living independently within other types of senior living communities (e.g., assisted living, independent living, or CCRCs). Defining Relational Aggression Relational aggression is defined as a manipulative, non-physical form of aggression meant to negatively impact the development of friendships by social exclusion or harming the social status of a victim by spreading negative rumors or gossip (Hawker and Boulton, 2000). This type of aggression requires a certain level of social intelligence (Kaukiainen et al., 1999), is often indirect, common among females (Craig and Pepler, 2003), and arises most often within groups and organizational settings (Crick and Grotpeter, 1995; Einarsen, 2000). The majority of research conducted on this topic excludes the older adult population, instead focusing on relational aggression among children in school settings, or among employees in workplace settings. Only one known study exists examining relational aggression among a Dutch population of older adults living in assisted living facilities (Trompetter, Scholte, and Westerhof, 2011). In this study, Trompetter and colleagues surveyed 121 older adults from six assisted living facilities about their personal experiences as victims of relational 3

4 aggression. The participants were also administered questionnaires about their subjective well-being. Results indicated that approximately one out of every five residents (19%) experienced relational aggression perpetrated by a fellow resident in their assisted living facility. Experiencing relational aggression also resulted in more depression, anxiety, and social loneliness, and lower satisfaction with life. A dearth of research on the prevalence and impact of relational aggression among older adults in senior living communities remains. While the Dutch study offers a first step in understanding the phenomenon of resident-toresident relational aggression, its findings require replication for further understanding and generalizability. Moreover, measurement of subjective well-being is diverse, and definitions are broad in scope further exploration using additional measures to understand subjective well-being is needed. Finally, additional factors may merit exploration regarding their potential to increase the likelihood of reporting relational aggression victimization. The Pilot Study In 2012, Jacquelyn Benson, a senior research associate at Mather LifeWays Institute on Aging, conducted a pilot study exploring the topic of relational aggression in three independent senior living communities within the Chicagoland area. The following research questions guided the study: 1) Is relational aggression victimization associated with subjective wellbeing? 2) Is increased need for assistance with activities of daily living demonstrated by the use of an assistive device or health aid, or employment of a personal caregiver associated with relational aggression victimization? Merit for exploring the second research question was based on qualitative data collected from one-on-one unstructured interviews with four senior living community executive directors with more than 30 years of shared experience in the senior living industry. The data demonstrated that the utilization of an assistive device or health aid (e.g., canes, walkers, oxygen tanks), or employment of a personal caregiver, may be positively related to relational aggression victimization in senior living communities. Two bodies of research lend theoretical support for the hypothesized linkage between assistive device use or employment of a personal caregiver and relational aggression victimization. Based on research surrounding assistive device use and social stigma, a commonly cited reason for device abandonment among older adults is embarrassment and fear of social judgment (Gitlin, 1995). Moreover, research on predictors of relational aggression and bullying behaviors in institutional settings suggests that individuals are targeted when they are unable to uphold the standards or values of the institution. For example, in independent living facilities, residents are expected to be able to function with minimal intervention or support to perform activities of daily living (e.g., bathing, feeding, dressing, etc). Taken together, it is logical to propose that the more physical 4

5 assistance required by a resident in a senior living community, the greater the likelihood of that person becoming a victim of relational aggression. Fifty percent of all participants identified as victims of relational aggression to some degree. Survey and Sample Description Participants completed paper and pencil surveys that included questions on demographics, physical health, subjective well-being, social support, and relational aggression victimization. Six scales were used to measure subjective well-being: Diener s five-item Life Satisfaction Scale, a threeitem Positive Affect Scale, a three-item Negative Affect Scale, a three-item Loneliness Scale, the five-item Geriatric Depression Scale, and a five-item Anxiety Scale. Relational aggression victimization was measured using 11 items that were adapted from the scale developed by Trompetter and colleagues (2011). A total of 176 independent living residents of three senior living communities in the greater Chicagoland area participated in the study. The average age of participants was 85 (range: 63 to 102). The majority of the sample was female (71%), white (96%), and unmarried (66%). The sample was highly educated, with 61% of participants having a Bachelor s degree or higher. Eighty-nine percent of the sample had children, with 59% living within 10 miles of their geographically closest child. Fifty-two percent of participants had lived in their respective senior living community for two years or less. At the time of the survey, only a small minority (8%) of participants reported that they were providing informal caregiving to a spouse or significant other who lived with them. Only 15% of participants were currently employing their own personal caregiver or health aide to provide them with support in completing various activities of daily living or personal care (e.g., shopping, dressing, cooking, housekeeping, etc.). Fifty percent of all participants identified as victims of relational aggression to some degree, ranging from rarely, sometimes, often, to almost always. The modal response among those reporting any incidence of relational aggression was rarely. Results The first research question was tested in two steps. First, t-tests and chisquares were conducted to determine if being a victim of relational aggression is associated with the six measures of subjective well-being (life satisfaction, loneliness, positive affect, negative affect, anxiety, and depression). Results indicate that being a victim of relational aggression was significantly associated with each measure of subjective well-being. Older adults who reported relational aggression victimization also reported lower life satisfaction and positive affect as well as greater loneliness, negative affect, and anxiety than those who did not report relational aggression victimization. Further, older adults who experience relational aggression were also more likely to experience depression. Next, multiple and logistic regression models were computed to determine if relational aggression victimization was associated with the six measures of subjective well-being when other important factors were also considered. Prior to conducting the regression analysis, a correlation matrix was created to select which of the potential control variables were significantly 5

6 associated with any of the six measures of subjective well-being. Sex, age, marital status, education, physical health, and social support all showed significant associations with at least one measure of well-being and were used as control variables in each regression model. Each regression model was computed hierarchically to determine if relational aggression victimization was independently associated with each measure of well-being. The first step of each model contained the control variables: sex, age, marital status, education, physical health, and social support. Relational aggression victimization was then entered independently in the second step. As demonstrated in table 1, relational aggression victimization was significantly associated with loneliness (accounting for 7.2% of the variance), b =.27, t = 3.67, p <.000, and positive affect (accounting for 5.3% of the variance), b = -.33, t = -3.05, p <.01. Relational aggression victimization was also significantly associated with depression, OR = 8.85, 95% CI = 1.58 to 49.50, p <.05 (Table 2). These results suggest that experiencing relational aggression is associated with higher loneliness scores, lower positive affect scores, and being approximately nine times more likely to experience depression. Relational aggression victimization was not associated with life satisfaction, negative affect, or anxiety in the regression analyses. It is important to note that these results do not imply causality because the information about residents experiences with relational aggression and their well-being was collected at the same time. That is, we cannot conclude that being victimized causes residents to become depressed or more depressed. These results only allow us to conclude that residents who report being victimized are also more likely to report that they are depressed, lonelier, or have low positive affect. Although the current study assumes that relational aggression leads to feeling depressed, lonely, and less positive, it is possible that residents with lower well-being elicit relational aggression from others, or are more likely to interpret certain interactions as aggressive, compared to residents with higher well-being. Longitudinal studies, in which residents experiences with relational aggression are measured at one time point and their subjective well-being is assessed at another date, are needed to determine if relational aggression leads to lower well-being. The second research question was also tested in two steps. First, a t-test and chi-square were conducted to determine if assistive device/health aid use and employing a caregiver were significantly associated with reporting relational aggression victimization. Results indicate that older adults who reported experiencing relational aggression used more assistive devices than older adults who did not report experiencing relational aggression. Further, those who reported that they currently employ a personal caregiver to assist them with daily tasks were also more likely to report having been a victim of relational aggression. Next, hierarchical logistic regression was used to determine if the number of assistive device/health aids used or employing a caregiver are associated with reporting relational aggression victimization. The first step of the logistic regression model contained the control variables: sex, age, marital 6

7 the study findings suggest that even infrequent experiences with relational aggression victimization are associated with lower subjective well-being such as depression, loneliness, and positive affect. status, education, physical health, and social support. Employing a caregiver and assistive device/health aid use were entered together in the second step. Results indicate that neither variable was associated with relational aggression when the control variables were included in the logistic regression model. Taken together, these results suggest that when employing a caregiver or using an assistive device/health aid are considered in the context of other factors, namely physical health, they are no longer related to reports of relational aggression victimization. Conclusions and Future Directions for Intervention This pilot study is among the first to examine the prevalence of resident-toresident relational aggression and examine its association with residents subjective well-being and indicators of physical health. The results suggest that relational aggression victimization is a common experience for many residents of independent senior living communities. Fortunately, most residents report that although they have experienced relational aggression, it occurs infrequently. That is, relational aggression is not a normal part of their everyday experiences in the senior living community. Nonetheless, the study findings suggest that even infrequent experiences with relational aggression victimization are associated with lower subjective well-being such as depression, loneliness, and positive affect. The cross-sectional nature of this study prevents any causal conclusions. That is, it cannot be concluded that relational aggression victimization causes residents to become depressed and lonely, or experience a decrease in positive affect. It may be that depressed and lonely individuals lacking positive affect are more likely to perceive certain interactions with other residents as relationally aggressive. Longitudinal research is needed to determine if relational aggression lowers well-being over time. Despite the steps this study takes in understanding the prevalence of resident-to-resident relational aggression in senior living communities and its associations with residents subjective well-being, continued research is needed to fully understand this phenomenon. For example, additional sources of data (e.g., qualitative interviews, observational data, and staff reports) may clarify the conditions that make relational aggression more or less common in independent senior living communities. Additional outcomes of resident-to-resident relational aggression victimization can be explored as they pertain to resident s customer satisfaction, and/or staff productivity and workplace satisfaction. Further, although self-reported physical health was only used as a control variable in this study, based on its strong correlation to relational aggression victimization and subjective well-being, in future studies it would be judicious of researchers to directly examine its relationship to relational aggression victimization. The results of this study suggest that this topic is ripe for testing interventions. In concurrence with Trompetter and colleagues (2011) recommendations, suggested interventions could include educational training for staff and residents. Residents should be aware of the implications that negative social interactions can have on their health and thus be encouraged to develop and maintain positive social relations with other residents. It would be prudent to include senior living staff in the trainings, as prior research suggests that aggression between residents and staff is prevalent in other senior living communities (e.g., nursing homes). 7

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