Racial/Ethnic Variations of Social Support in Health Care Access Among Diverse Groups of Older Adults

Background: Improving access to quality health care has been recognized as one of the national goals by the U.S. Department of Health and Human Services. However, groups most subject to access problems include the racial/ethnic minorities. Concurrently, the literature reports the negative effects of social isolation in older people. Despite the benefits of social support, research on the relationship between social support and  health care access among older adults has been scarce. Using a usual source of care as a proxy for access to health care, the purpose of this study is to examine the role of social support in accessing health care among different racial/ethnic subgroups and age groups of older adults in the United States. It is hypothesized that the effect of social support on having a usual source of care will differ based on ethnic and racial differences.

Methods: A secondary analysis was conducted using data from the 2003 California Health Interview Survey. Respondents aged 50 and over were included in this study. Health care access was measured with a question asking whether respondents have a usual source of care. Social support was measured with four questions asking respondents how often someone was available to: help with daily chores when sick, get together with for relaxation, understand your problems, and love you and make you feel wanted. Demographic variables were included as covariates and logistic regression was used to examine factors associated with access to health care for aggregate group, and within each racial/ethnic group.

Results: Findings from the aggregate group analysis indicated that elders who reported having someone to help with daily chores when sick, to understand your problems, and to love you and make you feel wanted were more likely to have a usual source of care. Also, compared to the young-old group, old-old and the oldest group were more likely to have source of care. Subgroup analyses indicated that these associations were observed for the White only. No social support items were associated with having a usual source of care for Black and Asian elders. However, Hispanic elders with someone who understand their problems were more likely to have a usual source of care.

Discussions: The findings suggest that social support operates differently in the context of race and culture, and there are racial/ethnic differences in the effect of social support on access to care for elderly populations. The result that social support items were significantly related to health care access among White and Hispanic but not for Asian and Black is surprising given the emphasis on family and kinship in Asian culture and historical traditions of caring in Black community. It is possible that social support measure of this data did not reflect how two subgroups perceived the support from informal sources. Also, instrumental support or informational support may be a more critical factor for racial/ethnic minority elders. Future research should consider how racial/ethnic groups perceive social support differently and whether existing measures capture the various sources and features of social support.