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Gender differences in the effect of social support on health-related quality of life: results of a population-based prospective cohort study in old age in Germany

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Abstract

Purpose

The causality between social predictors and HRQoL in old age remains almost unclear as only a few studies have examined the influence of social support on HRQoL in a longitudinal setting. Moreover, available studies investigating gender differences in the effect of social support on HRQoL in old age have been solely cross-sectional. Consequently, the aim of this study was to examine whether social support affects health-related quality of life (HRQoL) in old age and whether this effect is moderated by gender.

Methods

In a population-based cohort (N = 2443) of people aged 75 years and older in Germany, the development of HRQoL was prospectively observed over a 3-year period. Quality of life was quantified by using the visual analogue scale of the EQ-5D instrument. Social support was assessed by using the 14-item form of the questionnaire for social support (F-SozU K-14). In order to control for unobserved heterogeneity, fixed-effects regression analysis was used.

Results

In the total sample (β = 0.55, p < 0.05) and in men (β = 1.39, p < 0.001), a strong positive impact of social support on HRQoL was found. There was no significant effect of social support on HRQoL in women. The effect of social support on HRQoL was significantly moderated by gender (p < 0.05).

Conclusions

Findings accentuate the fundamental role of social support in HRQoL in old age. Particularly in men, it is therefore crucial to strengthen the social ties in old age.

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Acknowledgments

The authors thank two anonymous reviewers who provided insightful comments to strengthen the manuscript.

Members of the AgeCoDe Study Group: Principal Investigators*: Wolfgang Maier, Martin Scherer, Heinz-Harald Abholz, Cadja Bachmann, Horst Bickel, Wolfgang Blank, Hendrik van den Bussche, Sandra Eifflaender-Gorfer, Marion Eisele, Annette Ernst, Angela Fuchs, Kathrin Heser, Frank Jessen, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Köhler, Hans-Helmut König, Alexander Koppara, Carolin Lange, Hanna Leicht, Tobias Luck, Melanie Luppa, Manfred Mayer, Edelgard Mösch, Julia Olbrich, Michael Pentzek, Jana Prokein, Anna Schumacher, Steffi Riedel-Heller, Janine Stein, Susanne Steinmann, Franziska Tebarth, Michael Wagner, Klaus Weckbecker, Dagmar Weeg, Jochen Werle, Siegfried Weyerer, Birgitt Wiese, Steffen Wolfsgruber, Thomas Zimmermann. *Hendrik van den Bussche (2002–2011). We want to thank both all participating patients and their general practitioners for their good collaboration.

Authors’ contributions

A.H. made substantial contributions to conception and design of the study, the analysis and interpretation of data and drafted the manuscript. H.H.K. and S.R.H. made substantial contributions to the analysis and interpretation of data and drafting of the manuscript. C.B., C.L., T.P., S.S., S.We., J.S., T.L., H.B., S.Wo., K.H., W.M. and M.S. made substantial contributions to conception and design, and critically revised the manuscript. B.W. made substantial contributions to conception and design, contributed to the analyses and data interpretation and critically revised the manuscript. J.W., A.F., M.P. and E.M. carried out patient assessments, contributed to the interpretation of data and critically revised the manuscript. All authors read and approved the final manuscript.

Funding

This publication is part of the German Research Network on Dementia (KND), the German Research Network on Degenerative Dementia (KNDD), and the Study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) and was funded by the German Federal Ministry of Education and Research (Grants KND 01GI0102, 01GI0420, 01GI0422, 01GI0423, 01GI0429, 01GI0431, 01GI0433, and 01GI0434; Grants KNDD 01GI0710, 01GI0711, 01GI0712, 01GI0713, 01GI0714, 01GI0715, 01GI0716, and 01ET1006B; and Grants AgeQualiDe 01GY1322A, 01GY1322B, 01GY1322C, 01GY1322D, 01GY1322E, 01GY1322F, 01GY1322G).

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    Authors and Affiliations

    1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

      André Hajek, Christian Brettschneider & Hans-Helmut König

    2. Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

      Carolin Lange, Tina Posselt & Martin Scherer

    3. WG Medical Statistics and IT-Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany

      Birgitt Wiese & Susanne Steinmann

    4. Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany

      Siegfried Weyerer & Jochen Werle

    5. Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany

      Michael Pentzek & Angela Fuchs

    6. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

      Janine Stein, Tobias Luck & Steffi G. Riedel-Heller

    7. Department of Psychiatry, Technical University of Munich, Munich, Germany

      Horst Bickel & Edelgard Mösch

    8. Department of Psychiatry, University of Bonn, Bonn, Germany

      Steffen Wolfsgruber, Kathrin Heser & Wolfgang Maier

    9. German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany

      Wolfgang Maier

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    Ethical approval

    The ethics committees of the participating centers approved the study (reference numbers: 050/02 (University of Bonn), 2079 (Faculty of Medicine, University of Düsseldorf), 2817/2007 (Hamburg Medical Association), 309/2007 (Faculty of Medicine, University of Leipzig), 2007-253E-MA (Medical Ethics Commission II, University of Heidelberg at the University Medical Center of Mannheim), 713/02 (Faculty of Medicine, Technical University of Munich)). The study was conducted according to the principles expressed in the Declaration of Helsinki.

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    Informed consent was obtained from all individual participants included in the study.

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    The authors declare that they have no conflict of interest.

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    For the AgeCoDe Study Group.

    Members of AgeCoDe Study Group are given in Acknowledgments section.

    Steffi G. Riedel-Heller and Hans-Helmut König have contributed equally to this work.

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    Hajek, A., Brettschneider, C., Lange, C. et al. Gender differences in the effect of social support on health-related quality of life: results of a population-based prospective cohort study in old age in Germany. Qual Life Res 25, 1159–1168 (2016). https://doi.org/10.1007/s11136-015-1166-5

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