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Journal of Nutrition For the

Elderly
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Influence of Social Support

Systems on Dietary Intake of
the Elderly
a

William A McIntosh PhD & Peggy A Shifflett PhD

Associate Professor, Dept of Sociology, Texas A & M

University, College Station, TX 77843
b

Assistant Professor, Dept of Sociology, Virginia

Polytech Institute and State University, Blacksburg,
VA 24061
Published online: 18 Oct 2008.

To cite this article: William A McIntosh PhD & Peggy A Shifflett PhD (1984) Influence
of Social Support Systems on Dietary Intake of the Elderly, Journal of Nutrition For the
Elderly, 4:1, 5-18, DOI: 10.1300/J052v04n01_03
To link to this article: http://dx.doi.org/10.1300/J052v04n01_03

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Influence of Social Support Systems

on Dietary Intake of the Elderly
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William A. McIntosh, PhD

Peggy A. Shifflett, PhD

ABSTRACT. Various forms of social support have been found to

have positive associations with good health and preventative health
behavior while other forms have negative consequences. Considering dietary intake as a form of preventative health behavior, this exploratory research examines the association of various types of
social support systems with nutrient intake. The findings suggest that
social supports which include close physical proximity (marriage,
neighbors, religious salience) as opposed to simple emotional attachments to relatives, friends, and community, are significantly associated with higher intakes of specific nutrients. It is also suggested
that support systems in which the elderly individual may feel dependent (relatives, friends, community) could possibly have negative
consequences for dietary intake.

INTRODUCTION
An increasing amount of research continues to demonstrate that
the physical and emotional well-being of the individual is dependent
on informal social support (Langlie, 1977; Kaplan et al., 1977;
Turner, 1981). That is, health is relative to the supportive relaDr. McIntosh is Associate Profcssor. Dept. of Sociology, Tcxas A & M University. College Station, Texas. 77843. Dr. Shifflett is Assistan! Professor, Dept. of Sociology. Virginia
Polytechnic Institute and State University. Blacksburg, Virginia 24061. The marerial in this
report is based upon work supported by thc Science and Education Administration of the
U.S. Department of Agriculture under Competitive Grant No. 5901-0410-0126-0. Any opinions, findings, and conclusions or rccornmendations expressed in this paper are those of the
authors and do not necessarily reflect the views of the U.S.Depanment of Agriculture.
Journal of Nutrition for the Elderly. Vol. 4(1), Fall 1984
O 1984 by Thc Hawonh Press, Inc. All rights reserved.

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JOURNAL OF NUTRITION FOR THE ELDERLY

tionships that are found in groups of which the person is a member.

The social support approach is becoming important in studies of
the elderly. The salience of this approach to elderly populations is
clearly indicated by studies that show "the buffering effect of social
support to moderate the relationship between acute stress. . . and
criteria for well-being" (Kahn, 1979:85).
One aspect of social support research argues that good health is
fostered directly through supportive social relationships; however,
there are indirect effects. For example, research has demonstrated
that social support leads to preventative health behavior and provides aid during times of stress (MacKinlay, 1973; Langlie, 1977;
Gottlieb, 1981).
A major form of health preventative behavior is the choice of
foods individuals select as their everyday diet. While people may
not always be fully cognizant of the health costs and benefits of all
items of food, health is generally a consideration in the selection of
food by most (Lowenberg et at., 1979) including the elderly (Shifflett and Johnson, 1984). After reviewing the literature, questions
about various types of social support and their association with nutrient intake levels will be explored in this paper. The sample of
elderly used is not representative of all elderly; therefore, we do not
attempt to generalize our findings.

SOCIAL SUPPORT: A REVIEW

Social support can be provided by friends, relatives, neighbors,
work mates, voluntary organizations, religion and religious organizations, or the immediate community. Supportive ties to others
can provide significant emotional and informational services (e.g.,
concern during grief and illness, babysitting, recipes, food preparation) and material resources (e.g., money, meals). Indirect social
support, however, can also be obtained by identifying with a group
through participation in its interests and accepting its norms, values,
and beliefs (Kaplan et a]., 1977). Thus, for some people, religion
can provide social support similar to that which relatives and friends
provide (Caplan, 1974).
The research pertaining to social support generally indicates that
supportive relationships are associated with lower illness rates,
faster recovery rates, and higher levels of health-care behavior. The

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William A. Mclntosh and Peggy A. ShSqlert

relationship of social support to diseases in old age is of two sorts.

First, there are associations of lack of social support with onset of
diseases (e.g., tuberculosis (Chen and Cobb, 1960); arthritis (Cobb,
1976); and coronary heart disease (Caplan, 1971; Parkes, 1969;
Berkrnan and Syme, 1979). Second, other studies indicate that it is
social support which increases the probability of recovery from
heart and other ailments (Robertson and Suim, 1968; Croog et al.,
1972; Finlayson and McEwen, 1977; Smith, 1981).
Phillips and Feldman (1973) provided data to illustrate that social
support is important in sparing life in old age. They found that social
support is significant in the reduction of deaths in the six months
following birthdays. A second significant study was reported by
Berkrnan (1977). She provided data from the California Human
Population Laboratory study of 7,000 residents of Alameda County
which show that over a ten-year period, age adjusted mortality is
reduced among those who have good social network support.
It should also be considered, however, that not all human relationships may be supportive. At least one study found that unhappy
and broken marriages are related to heart problems, cancer, and
mental illness (Hugher and Cove, 1981). Furthermore, not all
friendships result in positive consequences for the individuals involved. Research on drug abuse, for example, indicates that individuals are generally introduced to drugs by friends; and it is
through the supportive relationships with the group that the individual learns the techniques of drug abuse (Becker, 1953; Akers et
al., 1979) and learns to overcome formal laws and informal social
controls (Burkett and Jensen, 1975; Conger, 1976).
Other relationships which might be expected to provide some
form of social support may, in fact, not do so. Localism, or strong
attachment to the local community and local figures within that community tends to provide a narrow, restricted view of the world. Cosmopolitanism, by contrast, entails a wider, more open, view of the
world permitting access to less restricted sources of information
(Merton, 1968). Medical research suggests that localities rely on
traditional health beliefs while cosmopolites enact preventive health
care behaviors to a significantly greater extent than localites (Suchman, 1972; Langlie, 1977).
In summary, social support has positive consequences for
physical and emotional health both in terms of avoidance and healing of various disorders once they have occurred. Also, some types
of relationships with other people may have negative health conse-

JOURNAL OF NUTRITION FOR THE ELDERLY

quences including the maintenance of outdated health beliefs and

practices.

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RESEARCH QUESTIONS
Research questions based on the literature reviewed have been
formulated. First, it has been noted that social support is associated
with better health and with preventative health behavior. Since
choice of foods is a type of preventative health behavior, we will explore the possibility that various types of social support are associated with higher intake of specific nutrients.
Second, the literature has suggested that not all human relationships may be supportive. Therefore, we will explore the question of
whether some types of relationships are associated with lower nutrient intake.
Third, some related literature has suggested that a strong attachment to the local community may be associated with a limited world
view in terms of preventative health behaviors. Thus, the final question to be explored is whether strong attachment to the local community is associated with lower nutrient intake.

METHODOLOGY
Research Setting
The research was conducted in the Central Shenandoah Planning
District VI, a 5-county region under the jurisdiction of Virginia's
Office on Aging. This area encompasses relatively isolated mountain enclaves (rural non-farm), valley communities (rural farm), and
small urban centers ranging from 6 to 26 thousand in population.
The study site includes counties (Rockingham and Augusta) with
growing populations and substantial in-migration of retirees from
northeastern urban centers. Other counties (Bath, Highland, and
Rockbridge) have declining populations due to out-migration of
younger people. This has resulted in the majority of the population
now falling into older age categories. The small urban centers are
experiencing increasing populations of in-migrants from northeastern areas as well as from the local rural farming communities.

William A. Mclnrosh and Peggy A. Shimen

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Study Population and Data Collection

The source of data for this study was elderly persons (N=805)
who participated at 13 nutrition sites in Planning District VI. A 25%
random sample (n=201) was selected as respondents. The sample
size was based on the fact that further longitudinal research was to
be conducted and the researchers were considering the potential attrition rate for the elderly sample over several years. In order to permit adequate subgroup comparisons, the sample was stratified by
age and sex. The method of data collection was a questionnaire administered in a face-to-face interview conducted summer and fall of
1980.

Dependent Variables
Indicators of nutrient intake were derived from a 24-hour dietary
recall which included asking each respondent to recall all of the
kinds and amounts of food eaten over the 24-hour period preceding
the interview (Guthrie, 1979; Evers and McIntosh, 1977). A standardized technique was used by the interviewers to collect accurate
data and to minimize individual variability. This technique consisted
of probing questions to stimulate the memories of the subjects about
their dietary intake. The menus from the nutrition sites, direct observation, and food inventories were used to validate the dietary
recalls. Also, Madden et al. (1972) found that a highly significant
relationship existed between actual and recalled nutrient values for
participants in a congregate feeding program for the elderly.
Data from these records were transformed to nutrient values
using composition data as published in the Home and Garden Bulletin No. 72 (Adams and Richardson, 1978). These data were
analyzed through the Department of Human Nutrition and Foods
Nutrient Intake Program at Virginia Polytechnic Institute and State
University, Blacksburg, Virginia. This program transformed the
items of food into nutrients (calories, protein, niacin, thiamin, Vitamins C and A and others).
Because approximately 50 food items consumed by members of
our sample were not included in the Home and Garden Bulletin No.
72, it was necessary to substitute equivalent foods. This was accomplished with the aid of a nutrition consultant and several publications listing the nutritive values of food items. These included

10

JOURNAL OF NUTRITION FOR THE ELDERLY

Adarns (1975), Church and Church (1966) and Watt and Merrill
(1963). In some instances it was necessary to derive the nutritive
value of an uncommon item from a standardized recipe. One exarnple was the food "panhaus" which required a breakdown into ingredients after obtaining the recipe orally from several local people.
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Independent Variables
The questionnaire contained items to collect social data. Proxy
measures of social support were derived from the following: (1)frequency of contact with relatives, friends, neighbors; (2) religious
salience: the degree to which religious beliefs were perceived to affect the everyday life of the respondent; (3) localism: a composite
scale (Roof, 1978), measuring attachment to the local versus the
outside world; (4) marital status: currently married as opposed to
widowed, divorced, separated, or single; and (5) living arrangements: living alone or with other persons.

Statistical Analysis
In the bivariate analysis, Pearson product-moment correlations
were computed between social support variables and nutrient intake
variables. This was accomplished by using the Statistical Package
for the Social Sciences (Nie et al., 1975). The Pearson correlation
coefficient r is used to measure the strength of relationship between
two variables.
Further verification of strength of relationships was provided by
the multivariate analysis using multiple regression. The objective
was to examine the impact of social support variables on nutrient intake while including sex, age, race, and income in the model.

RESULTS
Nutrient Intake
Analysis of the 24-hour dietary recall data indicated that average
intakes of all the nutrients examined achieved levels of greater than
two-thirds the Recommended Dietary Allowances (RDA) (1978
standards). However, the dispersions around the means suggest that
34% of the respondents had intakes of such nutrients as Vitamin A,

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William A. Mc~ntoshand Peggy A. Shtflert

II

riboflavin, Vitamin C, and calcium as low as 40% of RDA. These

data suggest that, regarding vitamin and mineral intake, the
respondents are similar to the poor whites identified in the Ten-State
Nutrition Survey (1972) and in recent studies of disadvantaged aged
(Abraham et al., 1981). In spite of the fact that 24-hour recall data
tends to exaggerate intake at the extremities of the distribution
(Guthrie, 1979) and that the recommended dietary allowances contain safety margins, the data suggest that a significant number of the
aged in the sample have less than adequate diets.

Bivariate Relationships
Table 1 shows that respondents who are married have higher intakes of calories, phosphorus, calcium, thiamine, Vitamin A, fat,
and food quantity. Respondents with social support from neighbors
have significantly higher amounts of phosphorus, iron, protein,
niacin, riboflavin, thiamine, and magnesium in their diets. The
respondents for whom religion is highly salient have higher intakes
of calories, calcium, riboflavin, and thiamine. Those respondents
living alone consume diets with significantly less magnesium and
fat. Finally, as we noted in the literature review, not all social supports are positive. The data in Table 1 illustrate that those with
stronger attachments to relatives have lower intakes of calories; and
those with strong attachments to friends have lower intakes of iron
and thiamine. Also, strong attachment to the local community is
associated with lower intakes of calcium, Vitamin A, Vitamin C,
potassium, and overall food quantity.

Multivariate Relationships
We next examined the combined effects of social support variables and sex, race, income and age. Sex, race, income and age
were included due to their commonly known relationship with nutrient intake (Slesinger et al., 1980). Males, both for social and biological reasons, tend to exhibit higher intakes than females, while intake generally declines with age (Watkin, 1980; Weg, 1980).
Whites and more financially secure persons also tend to have higher
intakes of nutrients (Ten State Nutrition Survey, 1972).
Table 2 shows that while sex and income are often very important
predictors, measures of social support such as marital status, religious salience, and a close relationship to neighbors remain

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Pearson Product Moment C o r r e l a t i o n C o e f f i c i e n t s Between S o c i a l Support and N u t r i e n t i n t a k e V a r i a b l e s .

Attachments
t o Relatives

Attachments
t o Friends

Attachments
t o Neighbors

Religious
Salience

Localism

Marital
Status

Living
Arrangement

Calories
Phosphorous
Calcium
Iron
Protein
Niacin
Riboflavin
Thiamine
Vitamin A
Vitamin C
Fat
Potassium
Magnesium
Food Q u a n t i t y
S i g n i f i c a n t a t t h e .05 l e v e l ;

**

S i g n i f i c a n t a t t h e .01 l e v e l ;

***

S i g n i f i c a n t a t t h e ,001 l e v e l

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William A. Mclntosh and Peggy A. Shiflett

15

significantly associated with nutritional health. Generally, those

respondents reporting these types of supportive relationships have
higher intakes of important vitamins (A and thiamine) and minerals
(calcium, phosphorus, and magnesium).

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DISCUSSION
The objective of this study was to explore several questions concerning the possible association of various types of social support
with the intake of nutrients. The first question dealt with all types of
social support measured in this project and their association with intake of specific nutrients. The bivariate analysis suggests that marriage, close attachment to neighbors, and religious salience, for our
sample, are associated with significantly higher intake of specific
nutrients.
As to whether some types of relationships are associated with
lower nutrient intake, we found that strong attachment to relatives
and friends are similar to living alone in terms of level of nutrient intake. These two types of relationships and living alone are significantly associated with lower intakes of calories, iron, thiamine, fat,
and magnesium.
The findings for the first two research questions suggest that, for
our sample, being married and having close ties to neighbors are
forms of social support with physical proximity greater than attachment to relatives and friends. Even religion, as measured by
salience, is "close-by.'' Perhaps the more readily available supports lead to better dietary intake, whereas the less available have
little impact. Another possible explanation of our findings is related
to dependence. Having to depend on relatives and friends may have
negative consequences for dietary habits.
The third question dealt with the association of a strong attachment to the local community (localism) and the levels of nutrient intake. Significantly lower levels of calcium, Vitamin A, Vitamin C,
potassium, and overall food quantity were found for those with a
strong attachment to the local community. This, again, suggests that
attachment to the local community may lead to dependence on a
limited world view in terms of making the necessary dietary changes
(Weg, 1980) as one ages.
In the multivariate analysis, the objective was to examine the impact of social support variables on intake of selected nutrients while
including sex, age, race, and income in the model. All variables
were regressed on level of intake for selected nutrients. While sex

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I6

JOURNAL OF NUTRITION FOR THE ELDERLY

and income remained in the general model as important predictors

of nutrient levels, social support systems such as marriage, close attachment to neighbors, and religious salience also remained in the
model as significant predictors of nutrient levels. Thus, the multivariate analysis further verified the strength of associations found in
the bivariate analysis.
These findings must be considered in the context of our limited
sample; however, even these exploratory findings have important
implications for nutritionists and social service providers working
with the elderly. Several specific possibilities include the encouragement of neighborhood cooking clubs, consumer clubs, or food
co-op situations among those in close proximity. This would provide
additional social contacts while avoiding transportation problems.
The potential for learning for the elderly involved is unlimitedknowledge of special dietary needs of elders, a more positive attitude toward eating, and better shopping habits are some possible
outcomes.
Another consideration stemming from the finding that strong attachment to friends and relatives and the local community was associated with lower intake of some nutrients is that those elderly
who must rely on friends or family may have an uncomfortable
sense of dependence. This suggests the need for nutrition program
planners to concentrate efforts toward more outreach particularly in
rural and small town areas. Those elderly who must depend on
family and friends should be encouraged to meet their peers and
develop cooperative associations such as those suggested above.
When basic needs are met within the peer group, a feeling of independence and contribution to group effort may be reestablished.
It is hoped that this study has generated some interest in the possible influence of social support systems on dietary habits of the elderly. With further research on the questions raised here, some policy
and practical issues may be identified which could lead to future improvements in nutrition programs for the elderly.
submitted: April 1983
revised: October 1983

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