Social Support and its Correlation with Loneliness and Subjective Well-being: A Cross-cultural Study of Older Nepalese Adults

ORIGINAL ARTICLE

Social Support and its Correlation with

Loneliness and Subjective Well-being:

A Cross-cultural Study of Older Nepalese Adults

Hom Nath Chalise

Geriatric Center Nepal, Kathmandu; and Department of Public Health, Asian College for Advanced Studies

(Purbanchal University), Satdobato, Lalitpur, Nepal

Population aging in Nepal is a recent phenomenon, due more to demographic changes than to

socio-economic development. The study had three goals: to analyze the social support exchange

among elderly men and women; to discover the main sources of support in loneliness and subjective

well-being in the elderly; and to study the cross-cultural differences in support among elderly

Chhetri (N = 137, mean age = 69.1 [7.2] years) and Newar people (N = 195, mean age = 68.8

[7.7] years) in one ward in Kathmandu. The data were collected using face-to-face interviews. The

dependent variables were loneliness and subjective well-being (SWB). The results for both ethnic

Chhetri and Newar respondents show that their major support comes from their children living in

the same household and their spouses. I conclude that the sources of social support and social sup-

port exchange are similar between the two castes ⁄ ethnicities and that there are no cross-cultural dif-

ferences between them in terms of support for loneliness and SWB-life stability, although there are

cross-cultural differences in their SWB-life satisfaction. Providing social support to friends and

neighbors appears to be related to less loneliness and increased SWB in both castes ⁄ ethnicities.

Keywords elderly; loneliness; Nepal; social support; subjective well-being

doi:10.1111/j.1753-1411.2009.00034.x

Research background

Measures of social support, subjective well-being (SWB), and loneliness are of central

importance in research on elderly people (Chalise, Saito, Takahashi, & Kai, 2007).

Although numerous investigators have suggested that social support has a major impact

on the health and well-being of the elderly, it is less clear how this effect might operate

(George, 1989). There is also a lack of research on the different sources of social support

and how they affect the social support received and provided with regards to the loneli-

ness and SWB of older adults (Chalise et al., 2007).

Correspondence concerning this article should be addressed to Hom Nath Chalise, PhD, Founder Director, Geriatric

Center Nepal, G P O Box No. 23200 UPC – 119, Kathmandu-9, Battisputali, Nepal. Email: [email protected]

Acknowledgments: First, I gratefully acknowledge all the elderly participants, interviewers and social workers

without whom this study would not have been possible. I would also like to acknowledge Professor Ichiro Kai,

University of Tokyo for his valuable suggestions at every step of the data analysis in this research.

Asian Social Work and Policy Review 4 (2010) 1–25

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Journal compilation � 2010 Blackwell Publishing Asia Pty Ltd 1

Social support is often assessed under three categories: perceived support, sup-

port behavior (received support), and support resources (Barrera, 1986; Vaux, 1985).

Perception of support refers to one’s subjective assessment of the availability and ade-

quacy of support. Research suggests that this perception affects one’s well-being as much

as support received (Thoits, 1995; Wethington & Kessler, 1986). Support behavior

describes the actual emotional and ⁄or instrumental assistance received. Support

resources are simply the social support networks i.e., the sources of one’s social capital or

the advantage gained through social interaction (Wu & Hart, 2002).

As people age they often need increased social support. The most common sources of

social support are their spouse (or partner), children and siblings, followed by close

friends (Lynch, 1998). The convoy model of social support (Kahn & Antonucci, 1980)

postulates that each individual is surrounded by a convoy; a set of people with whom the

individual maintains reciprocal emotional and instrumental support. The prevalence of

each type of support, however, varies according to union, parental and socioeconomic

statuses, as well as gender, age, and ethnicity (Barrett, 1999; Campbell, Connidis, &

Davies, 1999; Wu & Pollard, 1998). For example, research has found that the perception

of available support is higher among married people and increases with socioeconomic

and employment status, but decreases with age (Turner & Marino, 1994). Women gener-

ally report more perceived support than men (Ross & Mirowsky, 1989).

Loneliness in old age is a significant challenge for gerontological researchers and prac-

tices with the increasing growth of life expectancy worldwide. The experience of loneli-

ness impacts on individuals across the life spectrum and has physical, psychological and

social repercussions (Lauder, Sharkey, & Mummery, 2004). Loneliness lowers the quality

of life and is associated with poor medical prognosis in old age (Victor et al., 2000). There

is a strong relationship between depressive symptoms and loneliness (Holmen, Ericsson,

& Winblad, 1999; Prince, Harwood, Blizzard, Thomas, & Mann, 1997), and loneliness

predicts the increased use of health services (Geller, Janson, McGovern, & Valdini, 1999)

and early institutionalization (Tilvis, Pitkala, Jolkkonen, & Strandberg, 2000). Loneliness

has been shown to predict cognitive decline and increases the risk of mortality (Tilvis

et al., 2000).

SWB is a broad term that refers to a diverse group of indicators commonly used to

measure various aspects of life quality (George & Bearon, 1980). SWB measures reflect

underlying psychological states encompassing affective (e.g., happiness) and cognitive

(e.g., satisfaction, values, aspirations) dimensions (Diener, 1984; Schimmack, Radha-

krishnan, Oishi, Dzokoto, & Ahadi, 2002). Measures of SWB represent an individual’s

general evaluation of circumstances or perceptions within specific life domains (Chatters,

1988). Two commonly used global measures of SWB are happiness and overall life satis-

faction (Taylor, Chatters, Hardison, & Riley, 2001). Happiness is generally regarded as

an affective measure that involves emotional states, whereas life satisfaction is a cognitive

measure that involves a summation of intellectual evaluations of satisfaction from several

life domains.

Past research indicates that cognitive and affective components of SWB are influenced

by personality (Diener & Lucas, 1999) and by culture (Diener & Suh, 1999). According to

Hom Nath Chalise Social Support and its Correlation with Loneliness and Subjective Well-being

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2 Journal compilation � 2010 Blackwell Publishing Asia Pty Ltd

Diener andDiener (1995), little attention has been paid to whether the predictor of psycho-

logical well-being differs in various cultures. They further add that variables that influence

peoples’ evaluations of their psychological well-being do vary across culture.

Research on social support (and related concepts) carried out in different contexts

and cultures have demonstrated that there is a strong relationship between health and

well-being throughout the lifespan, but particularly in old age (see Antonucci, Sherman,

& Akiyama, 1996; Chalise et al., 2007). Research studies have repeatedly found that peo-

ple who receive a high level of social support enjoy enhanced health and well-being,

improved physical health, less depression, improved life satisfaction and less loneliness.

So far,most such studies have been conducted in developed countries and cultures and it

is largely unknownwhether the findings can be generalized to other societies and how socio-

cultural factors can be implicated there (Chen et al., 2004). Nevertheless, a major problem

in social support research is the lack of an adequate theoretical framework for understand-

ing the impact of social support on health (see Fernandez-Ballesteros, 2002; Schreurs & de

Ridder, 2000, p. 90). At the same time, a major problem with SWB research in gerontol-

ogy is the lack of consistency in defining, measuring, and using terms like psychological

well-being, happiness, life satisfaction, and morale (see Mannell & Dupuis, 1996).

Study of social support, loneliness and SWB of the elderly in a developing country like

Nepal is quite new. Further, an elucidation of the relationship between the sources of social

support (such as husbands, children and friends) and loneliness and SWB will help to

elaborate our knowledge on this topic, which has had inadequate treatment in the litera-

ture. Nations tend to respond to the challenge of population aging in diverse ways because

they differ significantly in demographic composition, economic development, social and

political institutions and core cultural values (Liang, 2003). These differences are likely to

have a profound impact on the course of individual aging, health and well-being in old age.

Formal and informal support for the elderly in Nepal

The Nepal government provides pensions for government employees. They are provided

to civil servants, military personnel, police officers, and teachers. In 1995, the government

of Nepal introduced a new scheme for people over 75 years of age in five districts. The

scheme was extended to cover the whole country in the fiscal year 1995 ⁄1996 and the

amount provided to each beneficiary was Rs. 100 a month. The amount was increased

to Rs. 150 (nearly US$ 2.00) in 1999. The amount was increased to Rs. 500 (nearly

US$ 6.00) in fiscal year 2008 ⁄2009 and the minimum age for eligibility for such allow-

ances was also lowered to the age of 70 years. The program also provides similar allow-

ances to widows over 60 years of age and disabled individuals over 16 years of age

(Chalise, 2006). Although the amount paid to the elderly and to the widows over 60 is

nominal and does not cover most aged people (those aged between 60 and 69 years), it

has become popular among elderly Nepalese.

Like many other countries in Asia, most elderly people work in the informal sector

and children are regarded as security for old age. Culturally speaking, taking care of

parents is the responsibility of children, especially sons and daughters-in-law. Although


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most forms of support flow to the elderly, support also flows from the elderly to their

children in the form of goods, labor, and services. The elderly help their sons and daugh-

ters-in-law in different forms of household work. They may also participate in family

decision-making and assume leadership roles in the family and community.

Most elderly Nepalese elderly tend to work in the informal sectors and lack a regular

income after retirement. According to Chalise and Brightman (2006), < 7 percent of the

elderly receive a pension and most pension recipients are former security personnel

(military and police). The bulk of the elderly population of Nepal receives no pension

and most of them depend on family support and personal savings or continue working as

before. According to Subedi (2003), despite their old age, a large proportion (54%) of the

elderly contributes in non-economic activities related to the household.

Research objectives

The present study examines the importance of sources of specific social support (that is, the

spouse, children living with the elderly, children living apart from them and friends and

neighbors) in the mental health (namely, loneliness and SWB) of elderly people using cross-

sectional data fromKatmandu City. The specific objectives of this study are as follows:

1 To analyze the situation of social support exchange among elderly men and women

from different sources.

2 To find which are the main sources of social support for loneliness and SWB in the

elderly.

3 To study the cross-cultural validity of significant sources of loneliness and SWB

among elderly Chhetri and Newar people.

Research methodology

A face-to-face interview research method using a structured questionnaire was adopted

for the study. Data for this study were taken from a cross-sectional survey of elderly

Nepalese people in July–August 2005. The study site was Katmandu Metropolitan City,

the capital and largest city of Nepal, with a population of 671,846 (Central Bureau of

Statistics, 2003). For the purpose of this study an administratively and geographically

well-defined ward was selected. The ward was chosen for reasons of convenience, such as

its accessibility and cooperation from the inhabitants. It has a total population of 34,488

people living in 7848 households. According to an unpublished source in the Central

Bureau of Statistics, 1287 of these households have at least one older adult aged 60 years

or more. The sample was derived from a larger study and the sampling process has been

reported elsewhere (Chalise et al., 2007). We chose a convenience sample of 137 older

adults from the 1287 households based on the following criteria: (i) one older adult from

each household; (ii) belonging to Chhetri caste ⁄ ethnicity; (iii) consenting to participate

in the study; (iv) able to communicate in Nepali; and (v) without apparent cognitive

impairment, as judged by their family members. Further, due to considerable differences

between them, other castes ⁄ ethnicities were not included in this study.


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This study analyses the results of elderly Chhetri and Newar residents, representing

two different castes ⁄ ethnic groups in Nepal that have their own distinct language and cul-

ture. The Chhetri comprise the highest proportion of all caste ⁄ ethnic groups in Nepal

and the Newar comprise the indigenous population of the Kathmandu valley, where the

proportion of Newar is still the highest in this area.

Ethical consideration

The study protocol was approved by the Institutional Review Board of the Graduate

School of Medicine of the University of Tokyo on 2005 June. The purpose of the study

was explained and verbal informed consent was obtained from all participants before the

interviews. The interviews were conducted in the respondents’ homes and averaged an

hour. No other family members were present at the time of the interview.

Variables measurements and reliability

The validity and reliability of research instruments used in this study were carefully pre-

served throughout the procedures involving data collection; namely, the selection of the

items in the questionnaire, the translation of the questionnaire, the methods used by the

interviewers and statistical analysis.

Independent variables

Details of the social support and controlled variables are explained below.

Social support variables

A multitude of measures for this variable is available and a gold standard assessment tool

does not exist (Hogan, Linden, & Najarian, 2002). For the present study, the social sup-

port questionnaire was developed on the basis of a review of the literature in the area and

incorporated factors relating to the social context and living arrangements of older Nepa-

lese adults. The researcher developed 13 structured questions about the various types of

support received and provided during the previous year (including three types of avail-

able support) with six different sources of support, which are listed in Appendix A and B.

The researcher measured support availability as well as support received and provided,

using a dichotomous response (yes ⁄no) during the previous year with reference to each

source of support.

Due to the very low frequencies of a few social support items, the author included

only seven items of social support received (SSR) and social support provided (SSP) of

the 13 items included in the questionnaire. The social support items include: (i) someone

to listen to you when you need to talk; (ii) someone with whom to share most of your

worries and fears with; (iii) someone who gives you good advice; (iv) someone who gives

you love and affection; (v) someone who gives you a good time; (vi) someone who will

help you if you are confined to bed; and (vii) someone to take you to the doctor if needed

with four sources of social support (a spouse, children living with you, children living

apart from you and friends or neighbors) for this study. Although, the purpose of this


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study was not to develop an SSR and SSP scale, the internal consistency and reliability of

each source’s specific SSR and SSP measured using Cronbach’s alpha varied from 0.68 to

0.94 in the two castes ⁄ ethnicities sample. This showed that the internal consistency of the

sources of SSR and SSP items included was satisfactory.

Controlled variables

On the basis of the literature review, the author selected some confounding factors that

affect social support. They are age, sex, marital status, education, functional ability, liv-

ing arrangements and self-perception of economic satisfaction. The literature shows that

these variables also affect loneliness and SWB of the elderly.

The functional capability of the older adults was measured using five items (using

public transport, shopping for groceries, preparing meals, doing light housework and

taking medicine) from the seven-item instrumental activities of daily living (IADL) scale

(Lawton & Brody, 1969). For the present study, responses were dichotomized as ‘‘unable

to do it at all’’ and ‘‘can do it with some difficulty ⁄need some help’’ (coded 0) and ‘‘with-

out help’’ (coded 1).

Living arrangements were classified ‘‘living with children’’ or ‘‘living with others’’.

Marital status was classified ‘‘married’’ or ‘‘widow or widower’’. Widow or widower

includes unmarried, divorced, and separated respondents. The proportion of unmarried

divorced and separated respondents was very low. Financial satisfaction, as a widely used

measure of self-perceived financial condition, was assessed by the respondents’ estimate

of their present financial condition on a five-point Likert scale, with ‘‘not satisfied’’ coded

as 1 and ‘‘very satisfied’’ coded as 5. The respondents’ educational level was categorized

as illiterate, informally literate, below school leaving certificate: formally completion of

10 years of schooling (SLC) and above SLC. Sex was measured as ‘‘male’’ or ‘‘female’’.

Age was measured as a continuous variable.

Dependent variables

In this study loneliness and SWB (SWB-life satisfaction and SWB-life stability) are the

dependent variables.

Loneliness

A three-item loneliness scale (Hughes, Waite, Hawkley, & Cacioppo, 2004) developed

from the Revised UCLA Loneliness Scale (R-UCLA; Russell, 1996) is used. Hughes

et al. (2004) tested its psychometric properties in two studies and found Cronbach’s

alpha 0.72 in both. They also found very high correlation (0.82) between the three-item

loneliness scale and the R-UCLA loneliness scale. The internal consistency of this scale

was 0.81 and 0.84 in the elderly Chhetri and Newar participants, respectively.

SWB

For the present study SWB is measured using the life satisfaction index K (LSIK)

(Koyano & Shibata, 1994). The LSIK is a multidimensional construct with three

components: cognitive ⁄ short term, cognitive ⁄ long term and emotional ⁄ short term


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well-being. This scale also had very high reliability and validity when tested on a

national representative sample of elderly people in Japan (Koyano & Shibata, 1994).

This scale has nine items.

Confirmatory factor analysis of LSIK in the present study showed that the original

second-order model did not fit well with the Nepalese culture (not shown here). When the

author modified the LSIK by deleting two items that had a very low correlation the

model fit well. This study, then, assesses SWB using two factors separately, the SWB-life

satisfaction (cognitive ⁄ long term) and SWB-life stability (emotional ⁄ short term). The

internal consistency and reliability of SWB-life satisfaction and SWB-life stability was

satisfactory in the samples of both castes ⁄ ethnicities of the elderly participants.

Data analysis

First, distribution, in the form of frequencies and percentages, and mean and range for

all independent and dependent variables were reviewed. Difference in the characteristics

between elderly men and women were compared by bivariate analysis using the Student’s

t-test for continuous variables and Fisher’s exact test for dichotomous variables. A paired

sample t-test was used to compare differences on mean scores of social support between

SSR and SSP with sources of social support. The correlation between dependent vari-

ables (loneliness, SWB-life satisfaction and SWB-life stability) was tested using Spear-

man’s correlation coefficient. The author conducted a separate multiple regression

analysis on the Chhetri and Newar samples. In the multiple regression an analysis each of

the sources of social support received or provided was entered separately with all the con-

founding factors included together. Finally, in order to test for interaction between

sources of social support and caste ⁄ ethnicity, the author followed a method also used by

Sugisawa, Okabayashi, Naktani, Fukaya, and Shibata (2002), to test for difference of

slopes. The test statistic (t) was calculated according to the formula, t ¼ b1�b2ffiffiffiffiffiffiffiffiffiffiffiffiffiffi

SE21þSE2

2

p , where

b refers to the unstandardized regression coefficients and SE refers to the standard errors

of b. The analysis was conducted using SPSS 14.0 (SPSS Inc, Chicago, IL, USA) for

Windows.

General characteristics of elderly Chhetri

The socio-demographic characteristics of the 137 elderly Chhetri participants is shown in

Table 1. The participants ranged in age from 60 years to 93 years with a mean age of

69.1 (± 7.2) years. Of these, 63 (46.0%) were men, 70 (51.1%) were married, and 74

(54.0%) were illiterate (could not read or write). The proportion of married men was

considerably higher than that of elderly women (68.3% vs 36.5%, P < 0.001). In the

same way, the proportion of illiterate elderly women was considerably higher than that

of elderly men (65.1% vs 44.6%, P < 0.05). Regarding self-perception of economic satis-

faction, nearly half of the elderly reported this to be fair. A total of 86.1% of the older

adults were living with their children. The IADL score of the elderly Chhetri was 4.04

(± 1.6). Their SWB-life satisfaction and SWB-life stability scores were 2.4 (± 1.6) and

1.5 (± 1.3), respectively. Their mean loneliness scale score was 4.7 (± 1.7).


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Table 1 General characteristics of the Chhetri sample (N = 137)

Variables Total

(N = 137)

Male

(N = 63)

Female

(N=74)

P�

N % N % N %

Age (years) mean 69.1 68.7 69.5 0.470

SD� 7.2 6.7 7.6

Range 60–93 60–86 60–93

Marital status

Married 70 51.1 43 68.3 27 36.5 0.000

Educational level

Illiterate 74 54.0 41 65.1 33 44.6 0.007

Literate (Informally) 19 13.9 8 12.7 11 14.9

Below SLC§ 19 13.9 8 12.7 11 14.9

SLC and above 25 18.2 6 9.5 19 25.7

Self perceived economic satisfaction

Not satisfied 35 25.5 10 15.9 25 33.8 0.001

Fair 69 50.4 30 47.6 39 52.7

Satisfied 33 24.1 23 36.5 10 13.5

Living Arrangement

With children 118 86.1 54 85.7 64 86.5 0.137

IADL (Five items)–

Mean 4.0 4.3 3.9 0.137

SD� 1.6 1.5 1.6

Range 0–5 0–5 0–5

Loneliness scale (Three items)��Mean 4.7 4.3 5.1 0.002

SD� 1.7 1.4 1.8

Range 3–9 3–9 3–9

SWB-life satisfaction (Four items)��Mean 2.4 2.7 2.2 0.030

SD� 1.6 1.5 1.6

Range 0–4 0–4 0–4

SWB-life stability (Three items)§§

Mean 1.5 1.8 1.3 0.036

SD� 1.3 1.3 1.3

Range 0–3 0–3 0–3

Notes: �Dependent variable was sex (men = 1, women = 0). �Standard deviation. §SLC: School

Leaving Certificate (formally completion of 10 years of schooling). –Possible range 0–5, higher

score indicates better functional ability. ��Possible range 3–9, higher score indicates higher loneli-

ness. ��Possible range 0–4, higher score indicates higher life satisfaction. §§Possible range 0–3,

higher score indicates higher life stability.


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General characteristics of the Newar elderly

The distribution of socio-demographic characteristics of the 195 Newar elderly samples is

shown in Table 2. Respondents ranged in age from 60 to 97 years with a mean age of

68.8 (± 7.7) years. A total of 101 (52.0%) were men, 105 (53.8%) were married, and 106

(54.5%) were illiterate (could not read and write). The proportion of elderly married men

was considerably higher than that of elderly married women (67.3% vs 39.4%,

P < 0.001). In the same way, the proportion of illiterate elderly women was higher than

that of elderly men (59.6 vs 49.5, P < 0.1). Regarding self-perception of economic satis-

faction, 43.1%, of the elderly reported it to be fair. Most older adults (87.7%) were living

with their children. The IADL score of the elderly was 4.2 (± 1.5), the loneliness score

was 4.8 (± 1.7), SWB-life satisfaction score was 2.3 (± 1.6) and SWB-life stability score

was 1.2 (± 1.3).

Social support exchange situation with sources of social support among elderly Chhetri

The distribution of the mean SSR and SSP score for the elderly Chhetri is shown in

Table 3. The mean SSR score was highest for those who received support from children

living with them (4.0) followed by a spouse living with them (2.2), children living apart

from them (1.4), and from friends ⁄neighbors (1.3). There was a gender difference in the

mean SSR and SSP hierarchy. The mean SSR score of elderly men was highest for those

who received support from children living with them (3.8), followed by a spouse living

with them (3.6) friends ⁄neighbors (1.4), and children living apart from them (1.3). In the

same way, the mean SSR score of elderly women was highest for those who received sup-

port from children living with them (4.2), followed by support from children living apart

from them (1.3), from friends ⁄neighbors (1.2), and from the spouse living with them

(1.0). The result of the t-test showed there was a difference between elderly men and

women in the SSR from spouse (P < 0.001).

In the same way the mean SSP score was highest towards children living with them,

then towards their friends ⁄neighbors, spouse and children living apart from them. But

the trend is different between elderly men and women. In elderly men, the mean SSP

score is highest to their spouse (3.2) then to the children living with them (3.0),

friends ⁄neighbors (2.4), and children living apart from them (1.2). But, in the elderly

women, the mean SSP score is highest towards children living with them (2.9), then to

friends ⁄neighbors (2.1), children living apart from them (1.2), and their spouse (0.7). The

result of the t-test shows there is difference between elderly men and women in the SSP to

spouse (P < 0.001).

When the source specific mean score of SSR and SSP are compared (Table 3), the

mean score of SSR of respondents from their spouse, children living together and children

living apart from them was higher than their mean SSP score. In the case of friends ⁄neigh-bors mean SSP score was higher than the mean SSR from friends ⁄neighbors. The result ofthe paired samples t-test (Table 4) shows the difference between SSR and SSP in terms of

sources of social support in the elderly Chhetri sample. The author found a difference

(P < 0.05) between SSR and SSP in terms of the sources of support: the spouse, children

living with them, and friends ⁄neighbors in both elderly men and women.


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Table 2 General characteristics of the Newar sample (N = 195)

Variables Total

(N = 195)

Male

(N = 101)

Female

(N = 94)

P�

N % N % N %

Age (years) Mean 68.8 68.7 68.9 0.819

SD� 7.7 6.9 8.5

Range 60–97 60–87 60–97

Marital status

Married 105 53.8 68 67.3 37 39.4 0.000

Educational level

Illiterate 106 54.5 50 49.5 56 59.6 0.121

Literate (Informally) 35 17.9 18 17.8 17 18.1

Below SLC§ 22 11.3 14 13.9 8 8.5

SLC and above 32 16.4 19 18.8 13 13.8

Self perceived economic satisfaction

Not satisfied 55 28.2 27 26.7 28 29.8 0.922

Fair 84 43.1 47 46.5 37 39.4

Satisfied 56 28.7 27 26.7 29 30.9

Living Arrangement

With children 171 87.7 87 86.1 84 89.4 0.499

IADL (Five items)–

Mean 4.2 4.4 4.0 0.069

SD� 1.5 1.4 1.6

Range 0–5 0–5 0–5

Loneliness scale (Three items)��Mean 4.8 4.6 5.0 0.060

SD� 1.7 1.7 1.8

Range 3–9 3–9 3–9

SWB-life satisfaction (Four items)��Mean 2.3 2.4 2.3 0.671

SD� 1.6 1.6 1.6

Range 0–4 0–4 0–4

SWB-life stability (Three items)§§

Mean 1.2 1.3 1.2 0.812

SD� 1.3 1.3 1.3

Range 0–3 0–3 0–3

Notes: �Dependent variable was sex (men = 1, women = 0). �Standard deviation. §SLC: School

Leaving Certificate (formally completion of 10 years of schooling). –Possible range 0–5, higher

score indicates better functional ability. ��Possible range 3–9, higher score indicates higher loneli-

ness. ��Possible range 0–4, higher score indicates higher life satisfaction. §§Possible range 0–3,

higher score indicates higher life stability.


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Social support exchange situation with sources of social support among elderly Newar

The distribution of mean SSR and SSP scores for the elderly Newar is shown in Table 3.

The mean SSR score was highest from participants’ children living with them (4.2)

followed by their spouse (2.3), children living apart from them (1.2), and friends ⁄neighbors (1.1). As in the older Chhetri adults, the author found a gender difference in

the hierarchy of mean SSR and SSP in older Newar adults as well. The mean SSR score

by elderly men was highest from children living together with them (4.0), followed by

their spouse (3.4), friends ⁄neighbors (1.3), and children living apart from them (1.0). In

the same way, the mean SSR score for elderly women was highest from children living

with them (4.5), followed by their spouse (1.3), children living apart from them (1.3), and

friends ⁄neighbors (1.0). The result of the t-test showed there was a difference between

elderly men and women in the SSR from their spouse (P < 0.001).

Table 3 Descriptive statistics of the mean SSR� and SSP� of the Chhetri and the Newar sample

Chhetri elderly Total (N = 137) Men (N = 63) Women (N = 74) P§

Mean SD– Range Mean SD– Range Mean SD– Range

SSR variables

Spouse 2.2 2.8 0–07 3.6 2.8 0–07 1.0 2.1 0–07 0.000

Children living together 4.0 2.3 0–07 3.8 2.4 0–07 4.2 2.3 0–07 0.323

Children living apart 1.4 1.8 0–06 1.3 1.6 0–06 1.6 1.9 0–06 0.428

Friends ⁄neighbors 1.3 1.6 0–06 1.4 1.7 0–06 1.2 1.4 0–05 0.411

SSP variables

Spouse 1.9 2.5 0–07 3.2 2.7 0–07 0.7 1.6 0–06 0.000




Newar elderly Total (N = 195) Men (N = 101) Women (N = 94) P§

Mean SD– Range Mean SD– Range Mean SD– Range

SSR variables

Spouse 2.3 2.6 0–07 3.4 2.5 0–07 1.3 2.3 0–07 0.000




SSP variables

Spouse 2.2 2.7 0–07 3.0 2.8 0–07 1.4 2.4 0–07 0.000




Notes: Figure in bold shows the significant values P < 0.05. �Social support received. �Socialsupport provided. §Bivariate analysis t-test of social support between elderly men and women.

–Standard deviation.


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The mean SSP score was highest for children living with them (3.2), followed by

their spouse (2.2), friends ⁄neighbors (1.9), and children living apart from them (1.2).

As in the SSR, the hierarchy of the mean SSP score was different between elderly

men and women. In elderly men the mean SSP score was highest for children living

together with them (3.1), followed by their spouse (3.0), friends ⁄neighbors (2.2), and

children living apart from them (1.0). In the same way, for elderly women, the

mean SSP score was highest for children living together with them (3.3), followed

by friends ⁄neighbors (1.5), and their spouse as well as children living apart from

them (1.4). The result of the t-test showed there was a difference between elderly

men and women in the SSP to spouse (P < 0.001) and friends ⁄neighbors(P = 0.004).

Further, when the sources specific mean SSR and SSP scores are compared (Table 3),

the mean SSR score from the spouse (2.3) and from children living with them (4.2) were

higher than mean SSP score to their spouse (2.2) and children living with them (3.2) by

elderly. But the mean SSP score for friends ⁄neighbors (1.9) was higher than what they

received from their friends ⁄neighbors (1.1). The result of the paired sample t-test

(Table 4) shows that there was difference a between SSR and SSP in terms of the elderly

participants’ sources of social support. The difference between SSR and SSP was found

for the children living together (P < 0.05) and friends ⁄neighbors (P < 0.05) in both

elderly men and women in the Newar sample.

Relation between loneliness and SWB

Table 5 shows correlation among loneliness, SWB-life satisfaction and SWB-life stability

of both the Chhetri and the Newar samples. The correlation between SWB-life satisfac-

tion and SWB-life stability was 0.597 (P < 0.001), and 0.395 (P < 0.001) in the Chhetri

and the Newar samples, respectively. In the same way the correlation between loneliness

and SWB-life satisfaction was )0.558 (P < 0.001) and )0.365 (P < 0.001) in the Chhetri

Table 4 Paired sample statistics of the mean SSR and SSP of the Chhetri and the Newar elderly

Variables SSR-SSP Total Men Women

Mean P Mean P Mean P

Chhetri elderly

Spouse 0.33 0.000 0.38 0.023 0.28 0.005

Children living together 1.01 0.000 0.75 0.000 1.24 0.000

Children living apart 0.26 0.051 0.16 0.377 0.34 0.070

Friends ⁄neighbors )0.91 0.000 )0.98 0.000 )0.85 0.000

Newar elderly

Spouse 0.17 0.076 0.38 0.020 )0.04 0.691

Children living together 1.05 0.000 0.84 0.000 1.27 0.000

Children living apart )0.05 0.592 )0.01 0.941 )0.10 0.486

Friends ⁄neighbors )0.70 0.000 )0.96 0.000 )0.43 0.001

Note: Figure in bold shows the significant values P < 0.05.


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and the Newar elderly, respectively. A further correlation between loneliness and SWB-

life stability was )0.507 (P < 0.001) and )0.257 (P < 0.001) in the Chhetri and the

Newar elderly, respectively. This shows that loneliness and SWB are inversely correlated.

Social support exchange, loneliness and SWB

Table 6 shows the coefficient estimates of regressing loneliness, SWB-life satisfaction and

SWB-life stability score with sources of SSR and SSP for the Chhetri and the Newar sam-

ple elderly separately. The author analyzed the interaction between gender and social

support by including the interaction terms in the multiple regression analysis and found

no significant interaction. The author also compared the regression coefficients between

men and women using statistical tests for differences of slope, but no significant differ-

ence was found. Both elderly men and women samples were then combined in the multi-

ple regression analysis. The result of multiple regression analysis and comparison of

regression coefficients (Table 6) is explained below separately for loneliness, SWB-life

satisfaction and SWB-life stability.

Social support exchange and loneliness

SSR from spouse was associated with lower loneliness in both the Chhetri (b = )0.217,P < 0.001) and Newar (b = )0.253, P < 0.001) elderly participants. The author did

not find any evidence that there was any difference between the Chhetri and the Newar

elderly (t = 0.478, P > 0.10). SSR from children living together was also associated

with lower loneliness in both the Chhetri (b = )0.233, P = 0.001) and the Newar

(b = )0.290, P < 0.001) elderly sample, and no difference was found in both samples

(t = 0.551, P > 0.10). The author further found that SSR from friends ⁄neighbors hada marked impact in reducing loneliness in the Newar samples (b = )0.161, P = 0.041)

relative to the Chhetri samples (b = )0.116, P > 0.10).

In the same way, SSP to spouse was associated with lower loneliness in both the

elderly Chhetri (b = )0.238, P < 0.001) and the Newar (b = )0.235, P < 0.001) par-

ticipants. SSP to children living together was also associated with lower loneliness in both

the elderly Chhetri (b = )0.172, P = 0.021) and Newar (b = )0.284, P < 0.001)

Table 5 Correlation between loneliness and SWB

Caste ⁄ ethnicity SWB-life SWB-life

satisfaction

stability

Loneliness

Chhetri

SWB-life satisfaction 1

SWB-life stability 0.597** 1

Loneliness 0.558** 0.507** 1

Newar

SWB-life satisfaction 1

SWB-life stability 0.395** 1

Loneliness 0.365** 0.257** 1

Note: **Correlation is significant at the 0.01 level (2-tailed).


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sample. SSP to friends ⁄neighbors was also associated with lower loneliness in both

elderly Chhetri (b = )0.152, P = 0.026) and Newar (b = )0.147, P = 0.027) groups.

The author further did not find any evidence of any difference between the elderly

Chhetri and Newar participants in all the above cases.

Table 6 Contribution of sources of social support to loneliness and SWB-life satisfaction and

SWB-life stability in Multiple Regression Analysis in the Chhetri and Newar elderly

Variables Chhetri Subjects Newar Subjects t�

b Beta (SE) b Beta (SE)

Loneliness

SSR

Spouse )0.217** )0.359 0.058 )0.253** )0.376 0.048 0.478

Children living together )0.233** )0.324 0.078 )0.290** )0.381 0.068 0.551

Children living apart 0.023 0.025 0.077 )0.256** )0.260 0.064 2.787**

Friends ⁄neighbors )0.116 )0.109 0.084 )0.161* )0.138 0.078 0.392

SSP

Spouse )0.238** )0.354 0.063 )0.235** )0.366 0.045 )0.039Children living together )0.172* )0.226 0.074 )0.284** )0.405 0.051 1.246

Children living apart )0.014 )0.013 0.084 )0.259** )0.281 0.059 2.387*

Friends ⁄neighbors )0.152* )0.178 0.067 )0.147* )0.160 0.066 )0.053SWB-life satisfaction

SSR

Spouse 0.216** 0.381 0.055 0.053 0.084 0.049 2.213*

Children living together 0.111 0.164 0.076 0.343** 0.483 0.062 )2.365*Children living apart )0.021 )0.024 0.073 0.159* 0.172 0.062 )1.879Friends ⁄neighbors 0.045 0.045 0.080 0.086 0.079 0.074 )0.376

SSP

Spouse 0.260** 0.413 0.059 0.019 0.032 0.045 3.248**

Children living together 0.053 0.075 0.071 0.151** 0.230 0.050 )1.129Children living apart 0.011 0.011 0.080 0.184** 0.213 0.057 )1.761Friends ⁄neighbors 0.153* 0.191 0.064 0.127* 0.147 0.063 0.325

SWB-life stability

SSR

Spouse 0.099* 0.217 0.047 0.132* 0.256 0.041 )0.529Children living together 0.068 0.125 0.064 0.127* 0.218 0.057 )0.688Children living apart 0.088 0.123 0.060 0.131* 0.174 0.054 )0.533Friends & neighbors 0.088 0.110 0.066 0.191* 0.213 0.063 )1.129

SSP

Spouse 0.117* 0.229 0.052 0.132* 0.268 0.038 )0.233Children living together 0.068 0.119 0.059 0.048 0.090 0.045 0.270

Children living apart 0.041 0.052 0.066 0.126* 0.178 0.050 )1.027Friends & neighbors 0.141** 0.219 0.053 0.146** 0.208 0.053 )0.067

Notes: �This t statistics is the difference of bs between two sub samples calculated as t ¼ b1�b2ffiffiffiffiffiffiffiffiffiffiffiffiffiffi

SE21þSE

22

p ;

Newar was used as the reference group; *P < 0.05; **P < 0.01.


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The result of loneliness further showed that SSR from children living apart was asso-

ciated with significant reduction in loneliness in the elderly Newar (b = )0.256,P < 0.001), while no such effect was present in the elderly Chhetri (b = 0.023,

P > 0.10). In the same way, SSP to children living apart was also associated with a sig-

nificant reduction in loneliness in the elderly Newar (b = )0.259, P < 0.001), while no

such effect was present in the elderly Chhetri (b = )0.014, P > 0.10), although the

direction of the coefficients was the same. The difference between the elderly Chhetri and

the Newar was significant for both SSR from children living apart (t = 2.787, P < 0.01)

and SSP to children living apart (t = 2.387, P < 0.05).

Social support exchange and SWB-life satisfaction

SSR from a spouse and SSP to a spouse were related with higher SWB-life satisfaction in

the Chhetri samples but not in the Newar ones. SSR from a spouse (b = 0.216, P < 0.1)

and SSP to a spouse (b = 0.260, P < 0.1) had a marked impact on the higher SWB-life

satisfaction in the Chhetri samples but no such effect was found on the Newar samples

(bSSR spouse = 0.053, P > 0.1; bSSP spouse = 0.019, P > 0.1), although the direction of

the coefficients was the same. The difference between the elderly Chhetri and Newar par-

ticipants was significant for both SSR from a spouse (t = 2.213, P < 0.05) and SSP to a

spouse (t = 3.248, P < 0.01).

SSR from children and SSP to children, regardless of where they lived, were

related to higher SWB-life satisfaction in the elderly Newar, but not in the

elderly Chhetri group. SSR from children (bSSR children living together = 0.343,

P < 0.01; bSSR children living apart = 0.159, P < 0.05) and SSP to children

(bSSP children living together = 0.151, P < 0.01; bSSP children living apart = 0.184, P < 0.01)

were associated with higher SWB-life satisfaction in the Newar samples, while no

such effect was present in the Chhetri elderly (bSSR children living together = 0.111,

P > 0.1; bSSR children living apart = )0.021, P > 0.10; bSSP children living together = 0.053,

P > 0.1; bSSP children living apart = 0.011, P > 0.1).

The author found SSP provided to friends ⁄neighbors was related with higher SWB-

life satisfaction in both the Chhetri (b = 0.153, P < 0.05) and Newar (b = 0.127,

P < 0.05) elderly. The author did not find evidence that there was any difference

between the Chhetri and Newar elderly group (t = 0.325, P > 0.10).

Social support exchange and SWB-life stability

SSR from a spouse was associated with higher SWB-life stability in both the Chhetri

(b = 0.099, P = 0.038) and Newar (b = 0.132, P = 0.008) elderly group. In the

same way, SSP to a spouse was associated with higher SWB-life stability in both the

Chhetri (b = 0.117, P = 0.026) and Newar (b = 0.132, P = 0.001) group. Further,

SSP to friends ⁄neighbors was also associated with higher SWB-life stability in both

the Chhetri (b = 0.141, P = 0.008) and the Newar (b = 0.146, P = 0.006) elderly.

The author did not find evidence that there was any difference between the elderly


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Chhetri and Newar group (tSSR spouse = )0.529, P > 0.10; tSSP spouse = )0.233,P > 0.10; tSSP friends ⁄ neighbors = )0.067, P > 0.10).

Further, among the Newar elderly participants, SSR from children living together

with them (b = 0.127, P = 0.008), from children living apart from them (b = 0.131,

P = 0.008), and from friends ⁄neighbors (b = 0.191, P = 0.008) and SSP to children liv-

ing apart from them (b = 0.126, P = 0.008) were also related to higher SWB-life stabil-

ity but did not increase SWB-life stability among the elderly Chhetri participants,

although the direction of the coefficients was the same. When comparing the regression

coefficients using statistical methods, the author found no difference between the Chhetri

and the Newar samples on SWB-life stability.

Discussion

This research is among the first to examine the relative importance of source-specific

social support (received and provided) on mental health (SWB and loneliness) among

older Nepalese adults. This research attempts to extend our limited understanding on

effects of the sources of social support (received and provided) on the loneliness and

SWB of older adults. On the basis of a comprehensive model that controls some common

confounding factors, the sources of social support (received and provided) identified are

significant predictors of loneliness and SWB (life satisfaction and life stability) among

older adults. Further, this study looks at the cross-cultural differences of the significant

variables in two castes ⁄ ethnicities of Kathmandu, Nepal.

A previous study by Chalise et al. (2007) on elderly Brahmin respondents from the

same survey data cannot be directly compared with the result of this study due to differ-

ent social support items included in the SSR and SSP, and differences in the data analysis

technique. But some findings of that study are included in this section.

Situation of social support exchange

In this study, the results from the elderly Chhetri and Newar participants showed that

the major support exchange of older adults was with children living together with them

and their spouse. The mean SSR score showed that elderly women received more support

from their children than the elderly men, as in the previous study of the Brahmin elderly

(Chalise et al., 2007). This finding is also consistent with other findings that women

received more emotional support from family members than their husbands (Taylor,

1985). Other studies (Akiyama et al., 1996; Antonucci, Akiyama, & Takahashi, 2004)

have shown that adults feel closer to their older mothers than to their older fathers and

are expected to interact with their parents accordingly (e.g., provide more assistance to

their mother when needed).

The results of this study showed that the mean SSR and SSP score to a spouse by the

elderly men was higher compared with elderly women in both castes ⁄ ethnicities, whichwas similar to the study of elderly people in the Brahmin caste (Chalise et al., 2007). This

may be due to the higher proportion of married men compared with women, and other

reasons may be due to traditional Hindu ideals held by high-caste Hindu women (Chalise

et al., 2007). Traditional Hindu ideals dictate that women should be shy, patient, good,


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sequestered, devoted, faithful, and restrained (Benett, 1983) and, as the oft quoted book

of Manu (Buhler, 1984) states, women must always be protected by a man, be it her

father, husband or son. Furthermore Gray (1991) writes that dharma (duty) defines the

nature of the whole household and it is through domestic practices that men directly

uphold dharma. Men are associated with the goal of moral action in the world to sustain

the cosmos: women are the means of doing this and accordingly they are subordinated to

their husbands. As the personification of dharma in the household, the husband is worthy

of respect (mannu parne) from his wife and from those to whom she gives birth (Benett,

1983). There is also culturally a common saying, ‘‘a wife should treat her husband like a

god’’. Even nowadays many conservative elderly women do not like to pronounce the

name of their husband in light of the cultural taboos of dharma.

This study further identified the differences between the SSR and SSP with reference

to sources of social support. The results showed differences in the social support

exchange between elderly participants with children living with them and friends ⁄neigh-bors in both Chhetri and Newar older adults. This was also true for both the elderly men

and women in both castes ⁄ ethnicities. The author also found a difference in the social

support exchange with a spouse in the elderly men in both the castes ⁄ ethnicities. In addi-

tion, the findings of this study show that the elderly received more support from a spouse

and children living together with them, but provided more support to friends ⁄neighbors.A finding from Korea showed that women provide more support to their husbands,

yet they are not reciprocally rewarded with support from their husbands (Kim, Hisata,

Kai, & Lee, 2000). Adult children in Taiwan provide net financial support to their parents

(Lee, 1994). Rossi and Rossi (1990), in particular, found that widowed parents tend to

receive more assistance than they give to their children, while married parents tend to give

more assistance than they receive. According to Dowd (1984) exchange is based on power

and resources and as individuals grow older they have less power and fewer resources.

They are therefore at a disadvantage in the exchange market because of their increased

age, as they are frequently in the position of receiving valued goods from people who are

in more powerful or prestigious positions. Culturally, elderly Nepalese people expect more

social support from their children (especially from their sons and daughters-in-law) and in

turn the elderly also provide support to them in the form of goods, labor and services.

Relation between loneliness and SWB

This study found that loneliness and SWB (SWB-life satisfaction and SWB-life stability)

were negatively correlated. Other studies support this finding. Borge et al. (1999) found

that SWB was strongly negatively correlated with the degree of loneliness (r = )0.64,P < 0.001). Steverink et al. (2001), in one study of elderly, also found that loneliness

and life satisfaction were negatively correlated (P = )0.39, P <0.01). And Cohen et al.

(1997) found that the absence of loneliness was a significant predictor of SWB in elderly

people dwelling in the community.

Significant variables of loneliness

Results of multiple regression analysis showed that when the effects of age, sex, marital

status, education, IADL, living arrangements, and economic satisfaction were controlled,


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SSR from a spouse, children living together with them as well as SSP to a spouse, chil-

dren living together with them and friends ⁄neighbors related to lower loneliness in both

the Chhetri and Newar elderly groups. No difference was found between the elderly

Chhetri and Newar participants on the above results when the regression coefficients

were compared statistically using the test for difference of slope. A previous study of the

Brahmin caste (Chalise et al., 2007) showed that SSR from children living together with

them and SSP to a spouse, children living together with them and friends ⁄neighbors wererelated to lower loneliness in older adults.

This study further found that SSR and SSP to children living apart from them were

related with lower loneliness in the elderly Newar, but not in the elderly Chhetri partici-

pants. The different in the result may be due to the difference in the living arrangements

of the children of two caste ⁄ ethnicities. Most of the elderly Newar in this sample tradi-

tionally live in Kathmandu and any children they have who do not live with them live

near them, so they have frequent opportunities for interaction with them. But the Chhetri

sample of this study included a large number of elderly migrants, whose children living

apart from them are not living nearby in many cases. Opportunities for interaction with

them may not therefore be possible.

Studies from other countries showed that frequent contacts with friends, especially

close ones, greatly reduce the risk of loneliness among elderly (Bitzan & Kruzich, 1990).

However, contacts with sons and or daughters (Bondevik & Skogstad, 1998; Felton &

Berry, 1992) and neighbors (Bondevik & Skogstad, 1998) were also related to lower levels

of loneliness. According to Seeman and Berkman (1988), a spouse can be an important

source of emotional and tangible support. Further, Page and Cole (1991) found that

marital status was the strongest demographic predictor of self-reported loneliness in

adults. Holmen, Ericsson, Andersson, and Winblad (1992) found that the lowest fre-

quency of loneliness was among those who lived with a partner, and the highest loneliness

was among older adults who were widowed.

Significant variables of SWB

This study showed that SSR from a spouse and SSP to a spouse and friends ⁄neighborswere related to higher SWB-life satisfaction in the elderly Chhetri participants. On the

other hand, SSR from children and SSP to children, both living together with the

participants and apart from them, as well as SSP to friends ⁄neighbors were related to

higher SWB-life satisfaction in the elderly Newar participants. But SSP to friends ⁄neigh-bors was related to higher SWB-life satisfaction in both castes ⁄ ethnicities and no evidence

was found that there was any difference between the two castes ⁄ ethnicities when the

regression coefficients were compared.

Further, SSR from a spouse and SSP to a spouse and friends ⁄neighbors were related to

increasing SWB-life stability (happiness) in the elderly Chhetri. SSR from a spouse, chil-

dren living together with them, children living apart from them, friends ⁄neighbors as wellas SSP to a spouse, children living apart from them and friends ⁄neighbors were related to

increasing SWB-life stability in the elderly Newar group. Interestingly, SSR from a spouse

and SSP to a spouse, as well as SSP to friends ⁄neighbors were related with increasing


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SWB-life stability in both the elderly Chhetri and Newar participants. In addition, there

was no evidence of any difference on predictor sources of SWB-life stability between the

elderly Chhetri and the Newar groups when the regression coefficients were compared.

Findings based on this study, SWB-life satisfaction and SWB-life stability cannot be

directly compared with other studies, as, to the knowledge of the author, no such a study

that differentiates life satisfaction and life stability in relation to sources of social support

measuring SWB exists.

According to Diener and Diener (1995), little attention has been paid to whether the

predictors of psychological well-being differ in various cultures. They further add that

variables that influence peoples’ evaluations of their life satisfaction vary across cultures.

A study from Japan shows that among older Japanese who were married with children,

social support from their spouse had a greater association with positive well-being than

social support from their children and others. In contrast, among those without a spouse,

only greater support from children was significantly correlated with higher positive well-

being, less distress, and less cognitive impairment (Okabayashi, Liang, Krause, Akiyama,

& Sugisawa, 2004). Some earlier studies from developed countries have shown that inter-

generational aid had no association with the well-being of older parents (Arling, 1976;

Lee, 1979; McCulloch, 1990).

According to Taylor et al. (2001), social support from family and friends all contribute

to an individual’s SWB. The frequency of contacts with friends and the availability of close

friends were positively related with happiness (Ellission, 1990) and well-being (Adams,

1989; Lennartsson, 1999). Studies of older adults showed that the quality of social contacts

had a stronger association with SWB than the quantity of social contacts (Pinquart &

Sorensen, 2000). Studies from the USA have shown that relationships with friends were

more strongly related to SWB than those with children (Antonucci, 1990; Blau, 1973;

Haring-Hidore, Stock, Okun, & Writer, 1985). A study by Venkatraman (1995) further

corroborates this finding with evidence that for both older Americans and Indians, social

support (emotional support) from a spouse was much more important than that from

adult children, friends and relatives in affecting their SWB (Venkatraman, 1995).

The finding of this study shows the social support exchange with friends ⁄neighbors isrelated to higher SWB in both the Chhetri and Newar elderly groups. This result is

consistent with many results in developed societies (Dean, Kolody, & Wood, 1990). Fur-

ther results showed that providing social support to friends ⁄neighbors was related to

higher SWB in elderly participants in both castes ⁄ ethnicities.

Limitations of the study

An interpretation of these studies should be considered within the context of the study’s

strengths and limitations. There are a number of limitations to this study. First, the data

were cross-sectional, so it is difficult to establish the casual directions of correlations

between dependent variables and independent variables (Bowling, 1997). Therefore,

future research needs to test the causality between sources of social support and loneli-

ness and the SWB of the elderly using a longitudinal design. Second, data come from only

one ward of Katmandu metropolis and includes only one respondent from each family of


� 2010 The Author


the selected two caste ⁄ ethnic groups, so the results may not be generalized to other castes,

ethnicities, and populations. For the future research a more representative sample from

the larger geographical area should be included.

Third, several aspects of social support have not been addressed in this study. Analysis

of social support of this study is based on a dichotomous (yes or no) design of social sup-

port responses, and does not take into account the frequency or intensity of social support.

Further, measures of social support did not include the perceived satisfaction with social

support (received and provided). Many studies show that perceived support has a direct

effect on the health and well-being of older adults (Thoits, 1995; Wethington & Kessler,

1986). Several important covariates, such as undesirable life events (acute stressors), and a

sense of personal control or mastery and self-esteem (psychological and coping resources),

known to be important determinants of social support (Thoits, 1995), are not included in

this study. There may be some bias in the reporting of women due to the cultural norms of

dharma, and this study also does not address the intergenerational relations.

Fourth, a three-point scale for loneliness may not be sufficiently discriminatory to

measure loneliness. For future study, the revised UCLA loneliness scale may be a better

choice. Thus, the validation of the suitability of applying the revised UCLA loneliness

scale in the Nepalese elderly population is a subject worthy of future research.

Implications

Because of the paucity of aging-related data from developing countries and different cul-

tures, studies describing different types of aging research will make a contribution to our

understanding about aging. This study is the first attempt at measuring the SWB and

loneliness among Nepalese elderly in the capital city of Nepal. Further research is

required with other caste ⁄ ethnicity in rural and urban areas.

One implication of this study is that a positive interaction between family members is

necessary to decrease loneliness among the elderly. As providing social support by the

elderly is found to benefit their mental health, there should be opportunities for the

elderly to participate formally or informally in social programs. Further, to increase

the sense of filial responsibility in children, formal and informal programs (i.e., through

the school curriculum, radio and TV programs) should be given priority.

A national policy for the elderly population should be formulated that focuses on the

health care and social security of the elderly. Measures should be taken by the govern-

ment as well as by non-governmental organizations to provide health care and social

security, especially for elderly widows and widowers who do not receive support or

proper care from their sons, daughters, and other relatives. An ideal living arrangement

for the elderly is living with their children, so the government should provide incentives

for families to take care of their frail elderly relatives. There should also be a provision of

community care for the elderly.

Conclusions

Despite these limitations, several conclusions can be drawn from this study. Elderly

Nepalese people were found to be actively engaged in the exchange of social support with


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their families and friends. The main social support exchange for the elderly was with chil-

dren living with them and a spouse, but providing social support to friends ⁄neighborswas also important to reduce their loneliness and enhance their SWB among both elderly

Chhetri and Newar participants. The results show there is a gender difference in SSR and

SSP and that social support exchange was similar in the elderly Chhetri and Newar

groups. Based on the results of this study, similarities were found on the significant

sources of social support on loneliness and SWB-life stability, but differences exist on

SWB-life stability. Cross-cultural similarities were found regarding social support pro-

vided to friends ⁄neighbors: reduced loneliness and increased SWB. A more in-depth

study should continue along this line of investigation to improve and extend the findings

of this study by including other castes and ethnicities.

References

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Akiyama, H., Elliott, K., & Antonucci, T. C. (1996). Same-sex and cross-sex relationships. Journal

of Gerontology: Psychological Sciences, 51B, 374–82.

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Appendix A: Questionnaire about social support received

1. Did someone listen to you when you needed to talk during the last year?

1. Yes 2. No 3. Don’t know 4. Not applicable

If yes, ask the source of support (multiple choice questions)

1. Spouse 2. Children and in-laws living together 3. Other members of the family living

together 4. Children and in-laws living apart 5. Relatives 6. Friends ⁄neighbors2. Did you share your most private worries and fears with someone during the last year?

3. Did someone give you good advice at a time of crisis during the last year?

4. Did someone help you with transportation during the last year?

5. Did someone help you with small repairs during the last year?

6. Did someone help you with household work during the last year?

7. Did someone help you by giving you money during the last year?

8. Did someone help you by giving clothes (or presents) during the last year?

9. Did someone show you love and affection during last year?

10. Did you have a good time with someone during the last year?

11. Does someone help you if you are confined to bed?

12. Does someone take you to a doctor if you need one?

13. Does someone prepare a meal if you are unable to do it yourself?

Appendix B: Questionnaire about social support provided

1. Did you listen to someone when he ⁄ she needed to talk during the last year?

1. Yes 2. No 3. Don’t know 4. Not applicable

If yes, ask the source of support (multiple choice questions)

1. Spouse 2. Children and in-laws living together 3. Other members of the family living

together 4. Children and in-laws living apart 5. Relatives 6. Friends ⁄neighbors2. Did someone share his ⁄her most private worries and fears with you during the last year?

3. Did you give good advice to someone at a time of crisis during the last year?

4. Did you help someone with transportation during the last year?

5. Did you help someone with small repairs during the last year?

6. Did you help someone with household work during the last year?

7. Did you help someone by giving them money during the last year?

8. Did you help someone by giving them clothes (or presents) during the last year?

9. Did you show someone love and affection during the last year?

10. Did you accompany someone to have a good time during the last year?

11. Do you help someone who is confined to bed?

12. Do you take someone to a doctor if s ⁄he needs it?13. Do you prepare a meal for someone if s ⁄he is unable to do it him ⁄herself?


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Documents

Social Support and its Correlation with Loneliness and Subjective Well-being: A Cross-cultural Study of Older Nepalese Adults