Original Article

Investigating the Perceived Social Support in Aging and Its Related Factors in the Elderly of Neyshabur, Iran

Please cite this article as follows: Safari S, Nezamdoust M, Kamyari N, Golghandashti N, Taziki M, Abasi H. Investigating the perceived social support in aging and its related factors in the elderly of Neyshabur, Iran. J Educ Community Health. 2025; 12(1):27-32. doi:10.34172/jech.3100

Introduction

With the improvement of health indicators in the world and the consequent increase in life expectancy, the older adult population is increasing; therefore, it is predicted that in the coming years, the increase in the older adult population will be followed more rapidly. Aging, as the last stage of human development, is a distinct experience and an inevitable process that is associated with physical challenges and changes (1,2). In Iran, by comparing the population pyramid over the past decades, it can be concluded that the elderly population will increase rapidly in the coming decades (2). The aging rate of the population in Iran is expected to reach 31% of the total population in 2050 (3). Therefore, appropriate health and treatment plans should be prepared and implemented for this age group (4). Aging, as the last stage of human development, is a distinct experience and an inevitable process that is associated with physical challenges and changes, such as an increased risk of diseases, and psychological challenges such as loneliness and isolation (2). On the other hand, the elderly facing these challenges that affect their lives need adequate support from others (4). Perceived social support (PSS) is people’s perception of the level of support provided by social networks (5).

PSS means understanding the support of others and having a reliable network in times of need, especially in times of crisis. The greater the PSS from others, the greater the social health of individuals (6). Social support can help older adults reduce anxiety and stress by creating a sense of belonging and receiving attention and support from others, such as family members and friends (7). One’s perception of the support is more crucial than the actual amount of support received; in other words, the notion and mindset of the individual regarding the assistance obtained is more influential than the quantity of assistance provided to them (8). Social support plays an important and vital role in all aspects of human health, quality of life, and life satisfaction (9). In a study conducted in Iran, most of the elderly had a medium level of PSS (10). PSS helps the elderly reduce anxiety and stress by creating a sense of belonging, receiving attention, and support from others, such as family members and friends, thus improving health and well-being resulting from better sleep and better digestive status (7,10-13). According to the results of previous studies, PSS is associated with age, income, experience of financial pressure, exposure to abuse and psychological trauma, loneliness, depression, socioeconomic status, duration of physical loneliness, self-confidence, and stress (14-16). The sensitivity of mental problems and the vulnerability of the age group, the change in family structure from extended to nuclear, and the prevalence of mechanized life have required the elderly to shoulder the burden of their lives fully. It is hoped that by conducting this study, it will be possible to identify the perceived amount of social support and relevant common factors to select the best strategies to improve the physical and psychological conditions of the elderly. Therefore, the present study was conducted with the aim of investigating the PSS and its related factors in the elderly.

Materials and Methods

This cross-sectional study was conducted on 481 elderly people referred to Comprehensive Health Services Centers (UCHSCs) in Neyshabur in 2023. Sample size was estimated using G.Power software version 3.1.9.2. Considering the first type error of 0.05, a test power of 0.95, and a small effect size of 0.2 according to Cohen’s guide (17), the sample size was estimated to be 436 people, which was increased to 481 people by taking into account a 10% drop-out rate. Stratified random sampling was performed and the sample size taken from each stratum was proportional to the size of the strata. Neyshabur has eight UCHSCs. In this way, each of the eight UCHSCs in Neyshabur was considered as a cluster, and according to the population of older adults covered by each center (cluster) and the size of the sample, the cases were selected from older adults referring to health centers for a particular service. For data collection, the researchers attended the comprehensive health services centers in Neyshabur. Then, the samples were selected from the elderly who referred to the comprehensive health centers to receive health services based on the inclusion and exclusion criteria of the study. The inclusion criteria were being 60 years and above, living in Neyshabur, having a health record, having the ability to understand and speak Persian, providing informed written consent to take part in the study, and not having a disabling physical or mental illness that causes an inability to participate in the study. The exclusion criterion was unwillingness to participate in the study. The study was conducted after explaining the objectives of the study and emphasizing the confidentiality of the information. It should be noted that the questionnaires were completed through interviews.

Measures

The samples completed a two-part tool that included demographic information and the Multidimensional Scale of Perceived Social Support (MSPSS). The demographic information included age, gender, education level, employment, living status (to live with), number of children, history of drug use, Wealth Index (WI), anxiety status, and amount of physical activity (minutes per week). The WI is a composite measure of the cumulative living standard of a household. It is calculated using data on a household’s ownership of a selected set of assets, including televisions, bicycles, and cars, materials used for housing construction, including floor material, type of drinking water source, and restroom and sanitation facilities. The WI considers characteristics that can be associated with wealth status, avoiding variables that do not constitute an asset or outcome variables. In order to calculate the WI as a composite scale of the cumulative standard of living of the elderly, data on the ownership of assets of the elderly were collected, and principal component analysis was used. Finally, people were ranked from the poorest to the richest according to the amount of their wealth (not income) (18).

Multidimensional Scale of Perceived Social Support

This scale is a 12-item questionnaire designed to assess PSS from three sources: friends, family, and important people in life. Each item in the questionnaire is scored on a 7-point Likert scale, ranging from completely disagree (score: 1) to completely agree (score: 7). In order to determine the total score of this scale, the scores of all items are summed and divided by the number of items. The highest score is 7 and the lowest score is 1. In general, a score of 1 to 3 is considered low PSS, a score of 3 to 5 is considered moderate PSS, and a score of 5 to 7 is considered high PSS (19). Sadri et al conducted a study in Iran and assessed the reliability of this questionnaire using the internal consistency method (0.91), and they confirmed its validity as well (20).

Data Analysis

Data analysis was performed using SPSS version 16.0. Descriptive statistics such as mean ( ± standard deviation) were used for quantitative variables, and frequency and percentage were used for qualitative variables. Before performing parametric tests, the normality of data distribution was investigated by the Kolmogorov-Smirnov test. Then, to compare the means of the two independent groups, an independent t test was used. Additionally, analysis of variance was used to compare the means of more than two groups, and multiple linear regression was used to investigate the relationship between the dependent variable and independent variables. The appropriate statistical test was selected based on the type of variables and their measurement levels. All analyses were performed at a significance level of 0.05.

Results

The mean age of the participants in this study was 68.89 ± 7.32 years. Most of the participants (50.7%) were female. In terms of employment, 43.5% were unemployed. In terms of marital status, 66.5% of the elderly were married. Moreover, most of the participants (74.6%) had a history of drug use (Table 1).

The results of the present study showed that various factors like gender, employment status, marital status, education level, lifestyle, physical activity, and economic status affect the level of PSS. Overall, men, employed and retired people, married people, people with higher education, people who live with their spouses, people who are more physically active, and wealthier people reported higher PSS scores. These findings suggest that demographic and socioeconomic factors play an important role in people’s perceptions of social support. The mean PSS score of the participants was 54.35 ± 20.68. Most of the elderly (44.9%) had a moderate PSS level, 36.6% had a high PSS level, and 18.5% had a low PSS level.

The variables that showed a statistically significant relationship with the dependent variable at the 95% confidence level in univariate analysis (Table 1) were entered as predictors in the multiple regression model. For further analysis, the variable of drug use with a significant level of 0.137 was also considered in the final model. The results of multiple linear regression analysis (Table 2) showed that while demographic variables such as gender, employment status, marital status, education level, medication use, living status, physical activity, and wealth index did not show a significant relationship with PSS scores, high levels of anxiety were significantly associated with lower PSS scores (B = -0.411, P < 0.001). Overall, for every unit increase in the anxiety score, the PSS score of the individuals decreased by an average of 0.41 points (Table 3).

Discussion

The aim of this study was to investigate the PSS and its related factors in the elderly. One of the important results of the present study was that most of the elderly (44.9%) had a moderate PSS level, and the mean PSS score was 54.35. In the study conducted by Ahmadi et al in 2019 (21), the mean score of PSS was reported to be 83.8354, which is in line with the findings of the present study. In the study conducted by Zolfaghari et al in 2024 (22), the mean score of PSS was reported to be 61.27, which is in line with the findings of the present study. Bakhtiari et al conducted a study in 2017 (9) and obtained a mean PSS score of 42.71, which is inconsistent with the results of the present study. Additionally, in a study conducted by Seifzadeh et al in 2020 (23), the mean score of social support was reported to be 46.95, which is not in line with the results of the present study. In the study performed by Sadegh Moghaddam et al (10) in 2016, the mean score of PSS was 27.47, which is inconsistent with the results of the present study. It seems that in the aforementioned studies, the sample size, sampling method, and characteristics of the elderly participants in the study in terms of inclusion and exclusion criteria account for the differences with the results of the present study. PSS is one of the most important forms of social relations and is influenced by the perception of the individual about it, as well as the need for it, which can vary according to age, gender, personality, and even culture. On the other hand, at every stage of human life, some aspects of support may become important and have more effects than other dimensions (24). Based on the findings of the present study, it can be concluded that PSS in the elderly should be considered an important issue and that health policymakers should consider this issue when examining, diagnosing, or improving the problems of the elderly. Additionally, the results of the present study indicated a relationship between PSS and physical activity in the elderly. In other words, for every hour of increased physical activity, the PSS score increased by an average of 0.3 points in the elderly. This is consistent with the findings reported by Soltani et al in 2015 (25), Borji and Motaghi in 2016 (26), and Huang et al in 2015 (27). The results of the study conducted by Seifzadeh et al in 2018 (23) are not in line with the results of the present study. It can be concluded that social support and physical activity somehow affect the quality of life of an individual; therefore, low physical activity and low social support in the elderly can result in failure in treatment and hospitalization. Another important result of the present study was that PSS in the elderly was associated with anxiety. In other words, higher levels of anxiety were significantly associated with lower PSS scores. This is consistent with the findings of the study conducted by Antonietti et al in 2020 (28), as well as Zolfaghari et al in 2024 (22), showing that PSS has a significant relationship with anxiety, depression, and self-esteem, which is in line with the outcome of the present study. Denche et al conducted a study in 2022 (29) and reported that high PSS was associated with less psychological distress in the elderly. In 2023, Hafeez and Hafeez (30) showed that PSS had an inverse effect on the level of anxiety in the elderly. Therefore, these findings suggest that anxiety among older adults should be prioritized and that health policymakers should take this issue seriously and continuously examine the support needs of older adults in terms of quality and quantity. They should take steps to improve the mental health of older adults by utilizing the support resources available in society and encouraging family support.

The present study had some limitations as well. First, this study was conducted based on information obtained from the elderly using a questionnaire. Second, the fatigue and low literacy of the elderly to complete the questionnaire may have affected their responses. Third, due to the nature of the present study, it is suggested that further studies should be conducted examining causal relationships. Since the present study is a cross-sectional study and only examines the relationship between variables, future studies should be conducted to detect and confirm the relationship between PSS and cultural and social factors related to social support for older people.

Conclusion

The findings of this study indicated that the PSS level of most of the elderly was moderate, and a low PSS level was significantly associated with a high level of anxiety. Therefore, it is recommended that policymakers and planners in the field of aging focus on physical and mental factors in the elderly and their families in order to make policies and provide better and more services in UCHSCs to improve their PSS.

Acknowledgments

The Student Research and Technology Committee of Neyshabur University of Medical Sciences, the staff of comprehensive health services centers, and all the elderly who participated and cooperated in this study are thanked and appreciated.

Competing Interests

The authors declare that they have no conflict of interests.

Ethical Approval

This study was approved by the Ethics Committee of Neyshabur University of Medical Sciences (IR.NUMS.REC.1402.003).

Funding

This study was financially supported by Neyshabur University of Medical Sciences.

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