Social support and activities of daily living in older Afro-Caribbean and white UK residents - Letters to the Editor

Age and Ageing, March, 1998 by Marcus Richards

SIR--There is uncertainty about the nature and degree of social support in older Afro-Caribbean migrants to the UK, an important issue in view of the reported positive association between social support and health [1]. For example, Blakemore and Boneham [2] note the "extended and interconnected networks of family and friends which are rooted in the island communities from which (Afro-Caribbean people) came", yet comment that for some older Afro-Caribbean people these ties have been weakened or lost all together. To shed further light on this issue we compared degree of social contact and functional ability in a sample of 45 Afro-Caribbean people aged 65 and older (22 male, 23 female) with those of a random sample of 45 age- and gender-matched white people, drawn from a register complied by household enumeration of Bellenden electoral ward in Southwark, Greater London [3]. Financial support (to M.R.) was provided by the Alzheimer's Disease Society. Participation refusal rates were 43.8 and 43.9%, respectively.

Social networks were assessed by questions (based in part on those of Wenger [4]), addressing family size (living siblings and children), structure of household, number of other family members within easy reach, frequency of contact with friends and family living away, frequency of attendance at social functions and availability of a confidante. Functional ability was assessed by six questions [5], each examining possible difficulty with heavy chores (e.g. sweeping, vacuuming, changing sheets or bed linen, cleaning the toilet area, carrying heavy bags), light chores (e.g. washing dishes, cleaning kitchen surfaces, putting out rubbish, shopping), preparing and cooking a hot meal, putting on shoes and socks/stockings, bathing or washing all over and getting to or using the toilet. All questions were couched in the form `Are you able to...' and answers to each were graded as 0 (no difficulty), 1 (some difficulty) and 2 (help needed). Participants were also asked whether and from whom they received help with each activity of daily living. [chi square] or Mann-Whitney tests were used to investigate between-group differences. The results are summarized in Table 1.

Table 1. Demographic, social and functional information for the
two ethnic groups

                                               Group
Variable                                     Afro-Caribbean

Mean age, years (s.d.)                       71.4 (5.5)
Social class (% manual)                      62
Owner-occupier (%)                           64
Other person(s) in house (%)                 80
Median (range) no. family in area            17.0 (0-34)
Contact with family(a)                        2.5 (0-5)
Contact with friends(a)                       2.5 (0-5)
Difficulty with ADL (%)                      64
Receiving help with ADL from family (%)(b)   71

Variable                                     White

Mean age, years (s.d.)                       71.7 (5.9)
Social class (% manual)                      38(***)
Owner-occupier (%)                           40(*)
Other person(s) in house (%)                 58(*)
Median (range) no. family in area             2.5 (0-5)(***)
Contact with family(a)                        2.5 (0-5)
Contact with friends(a)                       2.0 (1-4)
Difficulty with ADL (%)                      40(*)
Receiving help with ADL from family (%)(b)   57

ADL, activities of daily living.

(a) Median (range) per month (outside house).

(b) Denominator of 83.

(*) P < 0.05, (**) P < 0.01, (***) P < 0.005.

Based on the Registrar General system [6], a significantly higher proportion of Afro-Caribbeans than whites were classified as being of manual (i.e. IIIM-V) occupational social class. A significantly higher proportion of Afro-Caribbean participants were owner-occupiers compared with white participants. This was partly accounted for by a higher proportion of white subjects renting council property and living in warden-controlled sheltered accommodation. Afro-Caribbean participants reported a larger number of family members within easy reach and a greater likelihood of at least one other person (usually a spouse, child or grandchild) living in the household. On the other hand, there were no significant differences between the ethnic groups in frequency of face-to-face contact with family members living away, frequency of face-to-face contact with friends, frequency of attendance at social meetings or availability of a confidante.

A significantly higher proportion of Afro-Caribbean participants experienced difficulty with at least one activity of daily living compared with whites. When type of activity of daily living was examined separately, this effect was accounted for by difficulty with heavy chores (P [is less than] 0.05). There was no significant difference between the ethnic groups in the proportion of participants receiving help from their families, either when all participants were included or when only those experiencing difficulty with at least one activity of daily living were considered. Three Afro-Caribbean and three white participants received professional or voluntary help from an outside agency.