Diversity of social networks versus quality of social support: Which is more protective for health-related quality of life among older adults?

Both social networks and social support are important in addressing bio-psycho-social events in older adults. Their associations with health-related quality of life (HRQOL), however, are not well understood. This study aims to examine the associations of diversity of social networks and perceived quality of social support with HRQOL in older adults. We used data from 2012 to 2013 National Epidemiological Survey on Alcohol and Related Conditions Wave III (NESARC-III), and included respondents aged 65 or older (n = 5799 unweighted). We used the Social Network Index (SNI) to measure diversity of social connections and the Interpersonal Support Evaluation List (ISEL-12) to measure perceived quality of social support. We also constructed HRQOL (mental component summary (MCS) and physical component summary (PCS)) and quality-adjusted life years (QALYs). We characterized socio-demographic, behavioral, and clinical factors, and HRQOL and QALYs by type of social support. We also used multivariable-adjusted regression analyses to assess the associations of diversity of social networks and perceived quality of social support with HRQOL and QALYs, respectively. Older adults with greater diversity of social networks, regardless of perceived quality of social support, had higher mean scores in HRQOL domains, although effect sizes were small. In multivariable-adjusted analyses, diversity of social networks was positively associated with HRQOL-MCS (coefficient = 0.59; 95% confidence intervals [CI], 0.08-1.09), HRQOL-PCS (coefficient = 1.00; 95% CI, 0.38-1.61), and QALYs (coefficient = 0.01; 95% CI, 0.00-0.02). Perceived quality of social support was not associated with HRQOL. The diversity of social networks, more than perceived quality of social support, may be protective for HRQOL in older adults.