Providing personal care for others has often been associated with caregivers’ physical and mental health problems [
1]. However, a substantial amount of past research attests to the positive effects of giving social support [
2‐
5]. Giving support could increase quality of life, happiness, and feelings of belonging [
3]. A longitudinal study also showed that providing support was associated with longevity [
2]. On the other hand, support providers may also experience negative feelings when they are not providing the support voluntarily, or when they know that their support may not be effective in helping the support receivers [
3]. Even though the effects of receiving or providing support are well-documented, studies on the determinants of support provision, especially by older adults, are limited [
6]. Several factors, such as sex, health conditions, social network characteristics, and family structure may influence social support exchange [
6,
7]. Furthermore, considering the declining mental and physical health, and the narrowing personal social network that older adults experience as their age advances, the likelihood of providing social support by older adults also decrease with age.
Different types of support may have different trajectories and determinants as the older adults age. A longitudinal study in the USA found that the provision of emotional support (e.g. empathy, reassurance, and trust) was stable over the 10-year follow-up while the provision of instrumental (e.g. financial assistance, help with daily tasks) and informational (e.g. advice or guidance) supports declined with age [
8]. Studies that investigate changes in instrumental support provision by older adults over a long period of time in Europe are scarce [
9]. In assessing instrumental support provision in the European settings, it is important to take into account the different welfare regimes and family structure across Europe. In southern European countries (e.g. Spain and Italy) where people hold the more traditional family norms and social services are less available, support exchange may be concentrated within their households. On the other hand, in countries with more generous welfare-state policies and where co-residence with adult children is less common (e.g. in Scandinavian countries such as Sweden and Denmark), it is likely that routine support exchanges include people outside their own households [
10,
11]. Furthermore, the decreasing trend of co-residence of the older parents with their adult children in Europe [
12] suggests that the provision of social support to other households is an important field to explore. Therefore, in this paper we used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) to explore the trajectories of instrumental support provision by older European adults to people outside their own household.
The present study used data from nine countries that participated in wave 1,2,4,5,6 of SHARE to 1) describe the trajectory of instrumental support provision by older people in three European regions throughout the 11 years of follow-up; 2) estimate the extent to which age at baseline, sex, and region influences the variations in the trajectory of instrumental support provision.
Previous research and hypotheses
Dunkel-Schetter et al. [
6] suggest that there are several conditions that promote support provision, such as when both the potential recipient and provider are in a good relationship, when the situation the potential recipient is in is appraised as being stressful, or when they accept social norms that dictate the provision of support (e.g. filial obligation). Also, social provision is more likely to occur when the support provider feels empathy toward the distressed person, feels responsible for the distressful situation, believes that the distressed person has no control over their situation, or perceives that the distressed person is actively coping with their situation or seeking for help. Willingness to provide help generally increases with the level of distress. But a high level of distress that persists over a long period of time, such as a chronic health condition, may elicit lower social support. Also, past experience of support provision is an important determinant of future support provision. Providers whose support was underappreciated, repeatedly rejected, or was not effective may be less likely to provide support again [
6].
Furthermore, social support exchange is also determined by personal characteristics, sociocultural factors, socioeconomic factors, and social network characteristics [
6,
7]. Social support exchange mainly occurs within the personal social network. An individual’s social network includes all their social contacts within various types of relationships, e.g. family, friends, co-workers, neighbours, and other acquaintances. Social network characteristics such as size, density, source of ties, homogeneity, and frequency of contacts, could shape the social support exchange within it [
7]. Social networks that are characterised by trust, reciprocity, frequent contact, and close proximity between members promote social support provision [
14]. Past study has also reported that being in larger and denser social networks enables people to provide support [
15].
On the other hand, personal characteristics (e.g. age, sex, health conditions) could determine social support provision directly or indirectly through their influence on an individual’s personal social network. A cross-sectional analysis of SHARE data showed a lower prevalence of instrumental support provision in the older age group [
16]. Similarly, a study in the USA reported a decline in the provision of, and an increase in the receipt of, instrumental support with age [
8]. However, age itself may not have a direct effect on social support exchange [
17]. Age is likely to act as a proxy for other factors such as changes in biological, physiological, or social aspects that people experience as they are getting older [
17]. Therefore, to examine the changes in social support provision in ageing populations, we need to take into account other factors that, on the one hand, commonly change with age, and on the other hand, affect social support provision.
It has been suggested that older adults tend to have a smaller-sized social network. As people age, they are likely to perceive that their time is getting shorter and thus focus more on relationships that satisfy emotional regulation goals e.g. family and close confidants (socioemotional selectivity theory) [
18]. This reduction in social network size may also be the result of losing peripheral network members that typically have weaker ties, due to life events e.g. job entry, marriage, parenthood, and loss of a spouse (convoy theory) [
19,
20]. A decreasing social network size may indicate a reduction in the number of potential support recipients, which may lead to a lower likelihood of support provision.
As mentioned above, marital status could shape the personal social network. Social networks of married, or previously married, people have more kin-ties than the networks of unmarried people. A study among adult white Americans found that unmarried people and divorcees were more likely to exchange instrumental support with friends, neighbours, or co-workers than people who were married/had a partner or were widowed [
21]. While changes in marital status mostly occur during young or mid-adult life, marital status also changes naturally in older age due to the loss of a spouse [
12] and could change the characteristics of older people’s social networks and support provision.
Another key determinant of social support that is likely to deteriorate with age are physical and cognitive functions [
22]. As the health of older adults is compromised, they may become more dependent and as such are more likely to receive support rather than provide it. Past studies have shown that, over time, self-rated health in North American and European countries has a declining trajectory [
23]. Furthermore, prior analysis of SHARE data showed that the rate of having severe limitations in activities of daily living (ADL) gradually increases with age, with a steep increase after the age of 90 [
16], indicating increasing dependency with age. Therefore, we expect that:
Sex has a substantial influence on social networks, possibly as the result of the distinct life experiences of men and women [
24]. Due to the traditional gender roles of women as homemakers and men as breadwinners, men appear to benefit more from an occupational network than women [
25], while women’s social networks tend to mostly consist of friends and family [
26]. Furthermore, as mothers are commonly more involved in child rearing and in their children’s education-related activities than fathers are, women may acquire more social network members from interactions with other parents [
19].
The difference in social network characteristics between men and women could determine both the type of support provided and the beneficiary of it. Previous studies have reported that, compared to men, women tend to be the main care provider for the family. This pattern holds even among older adults in the more advanced age group [
27,
28]. Women are more likely to be involved in emotional support and personal care than are men. On the other hand, men are more likely to exchange instrumental support (e.g. giving lifts, helping with work in the yard) than women [
21,
29]. However, a previous study using SHARE data reported that across Europe, women provided more sporadic and more intensive (almost daily) instrumental support for their parents (who were not in the same household) than men did [
29]. Therefore, in this study we expect that:
Regional or national differences, in terms of health, economic, and social aspects, have been consistently reported by studies that used SHARE data. For instance, older adults in countries characterised by a universal welfare state, e.g. northern European countries (Sweden and Denmark), reported a higher self-rated health, fewer chronic conditions, and lower physical limitations while the opposite was reported by respondents in the southern region which has the more family-based welfare models (e.g. Spain and Italy) [
30,
31]. Even though the prevalence of ADL limitation increases with age in all countries, in Greece, Spain, and Italy, a considerable increase in dependency was observed between ages 50 and 70 years. A similar increase occurred among people older than 70 years in Sweden and Switzerland [
32]. In terms of support provision, data from wave 1 of SHARE showed that about a third of older adults provided help for others [
12]. Some regional differences were also reported, e.g. women in southern countries were more likely to provide intensive care for their dependent parents than women in other European regions [
33]. Contextual factors such as culture, norms, and social policy (e.g. welfare regimes) are likely to be the driving force behind this regional difference.
Obviously, the role of family members in support and care varies across countries and regions in Europe due to the type and generosity of welfare services in different welfare regimes; i.e. the extent to which the government distributes and redistributes access to welfare and resources to the citizens, usually through its health care system and social policies such as education, social insurance, and pension programmes [
34]. According to Esping-Andersen’s welfare typology [
35], countries in the northern region, e.g. Sweden and Denmark, represent a ‘social democratic’ welfare state regime, i.e. a more universal and generous welfare state that is characterised by high taxes, high income redistribution, high female participation in the workforce, high standard of living, and high trust in the public system. The central region includes ‘conservative’ (i.e. Austria, Belgium, France, Germany) and ‘liberal’ welfare regimes (i.e. Switzerland). A ‘conservative’ welfare state is characterised by low female participation in the workforce, a moderate redistribution of income, higher unemployment, and dependency on social contributions. A ‘liberal’ welfare regime has a low level of total state spending, low expenditure on social services and high inequality. Italy and Spain are grouped in the southern region which has a ‘fragmented’ welfare system characterised by diverse income protection, limited or partial coverage of health services, and reliance on the family and charitable sectors [
36].
Family is arguably the first line of support for its members. However, the type and the extent to which support is exchanged between family members varies considerably across countries and types of welfare regimes and is partly related to differences in values and norms. Countries in northern Europe are often grouped as “weak family countries”, while countries in southern European region are grouped as “strong family countries” [
37]. This grouping is based on the strength of family loyalties, allegiances, and authority [
37]. Furthermore, data from the first wave of SHARE supported this variation in family characteristics (marital status, number of living children, co-residence with adult children and frequency of contact) across Europe [
11]. For instance, northern European countries (Sweden and Denmark) had the highest proportion of respondents who were divorced and, at the same time, Italy and Spain had the lowest divorce level. Co-residence with adult children was at its lowest in the northern region (around 13%) and its highest in the southern region (around 48%). This regional difference in co-residence was even higher within the oldest age group (34% in Spain vs 1% in Sweden). Similarly, daily contact with children was more common in the southern region (around 85%), followed by the central region, and the northern region (around 43%) [
11]. Further analysis of SHARE data has shown that while the most common family type in Europe is familialism (characterised by a support for family obligation norm in which parents and children have frequent contact and live in close proximity), this type was more common in southern European countries. However, previous research has indicated that the strong welfare state has not necessarily resulted in a “crowding out” of family support and that instead the families have a more complementary role in northern Europe, examples of which are parents who offer support from a distance and children living apart from each other but still in frequent contact [
38].
Considering that the countries with family-based models have a higher co-residence and that these countries have a relatively less welfare service, we expect that families in southern European countries will prioritise social support provision for their household members. Additionally, the more traditional family norm and the lower female participation in the workforce in southern European countries may lead to relatively larger sex differences in social support provision. On the other hand, the generous welfare services provided for people in northern European countries (“weak family countries”) may alleviate the burden of providing care for their relatives, allowing them to foster broader social networks and provide help outside their household [
34]. Therefore, we hypothesised that:
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Hypothesis 3: Northern European countries will have the highest, while southern European countries will have the lowest likelihood of instrumental support provision by older adults for people (family, friends, or neighbours) outside of their household.