Volume 12, Issue 3 (May & Jun 2022)                   J Research Health 2022, 12(3): 151-158 | Back to browse issues page


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Hosseini S S. The Mediating Role of Relationship Quality in the Relation Between Desire for Relationship and Job Stability With Loneliness in the Elderly. J Research Health 2022; 12 (3) :151-158
URL: http://jrh.gmu.ac.ir/article-1-1830-en.html
Department of Social Science, School of Humanities, Gonabad Branch, Islamic Azad University, Gonabad, Iran. , sshoseini62@gmail.com
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1. Introduction
According to the World Health Organization (WHO), the elderly population is growing as a result of increased life expectancy and health issues. In Iran, the elderly population reaches about 10 million by 2020 and more than 26 million by 2050. However, no measures have been taken regarding the needs of this population; therefore, given the increase in the elderly population, it is important to consider this issue [1]. Deprivation from social activities predisposes the elderly to depression and increases their sense of loneliness [2, 3]. Evidence also shows that 20% to 40% of the elderly report feeling lonely; a total of 5% to 7% also reported feeling permanent or severe loneliness. Loneliness is the inability to establish and maintain satisfactory relationships with others, which is likely to cause feelings of deprivation, among many other problems in the elderly [4, 5, 6, 7, 8]. Exploratory studies among the elderly show that most elderly believe they are marginalized in the family [9, 10], while people belonging to the family-centered networks had the lowest scores [11, 12, 13]. Therefore, the situation of the elderly relationships in the family networks, and especially the study of the quantity and quality of ongoing relationships with elderly parents should still be researched in Iran. More interestingly, the size of social networks is not as important as the stability of different networks. Here, both the number and the frequency of communication, along with its quality and desirability are important because continuous communication between children and parents is a type of communication that is of great value and has favorable effects on both sides, especially parents [7, 14, 15]. We can discuss the quality of a relationship when it is stable; therefore, the stability of a relationship is considered a predictor variable, and loneliness is considered a dependent variable, while the quality of the relationship acts as a mediating variable between the two.
According to various studies [5, 10], examining the type of relationships in social networks is done because the type of social network that describes the interpersonal environment can be used to purposefully assess the health status of the population. Some researchers [16] have found evidence that people are more knowledgeable and selective in their social relationships during the final years of their lives. This selectivity may not only lead to more stability but also leads to more confidence in relationships. According to network theories [17], the stability of a person’s social relationships throughout their life is an important area for study. Much of the information about stability comes from research on instability. However, an increasing number of these studies address the stability of relationships. Having a weak or small social network can be useful for people [18]. More interestingly, there is evidence to suggest that people with multiple social networks are more likely to report network changes [19]; however, shrinkage in smaller networks has more health implications than instability in larger networks. This means that the size of the elderly network does not always need to be large to have a better mental state, rather continuity and quality of communication in a small group, especially the family network, is much more effective and stable in their mental health and happiness.
In the field of gerontology, there are two important theories, namely activity theory, and freedom theory, which indicate the initial focus on the role of social relations on health. Although these theories did not address relationships per se, they instead focused on different levels of relationships in social activity. The activity theory as described by Hvughrst showed that at every stage of life (especially in the final stages), energetic people express greater life satisfaction [20]. Thus, a set of stable social relationships at higher levels is considered a privilege. Also, changes in the direction of more social relationships may be helpful.
According to Kaming & Henri [21], the theory of freedom is based on the assumption that individuals make more decisions about their levels of activity during the later stages of their lives. In the theory of freedom, the focus has not only been on the level of activity but also the status of the activity: a) whether the individual is inclined to do more or less activity; b) whether the society pushes people to be more or less active. For example, consider a worker approaching retirement in their final years. By applying this theory, one could ask: does the worker want to stay in their desired job or do they want to retire? And, does the employer want to keep this worker or they are willing to declare him retired? According to these observations, the implication of stability in social relations is based on the question of whether the individual or the society wants stability or it is willing to make changes.
The lesson to be learned from such early studies is that stability and instability, based on personal circumstances and inclinations, have different meanings. For example, the desired and anticipated loss of a particular job (and the relationship with co-workers) as a result of retirement is completely different from when it is the result of job loss, and the relative loss because of dismissal or retirement as a result of the health of an endangered person. Changes in relationships resulting from an empty middle-aged nest alteration are not only a hallmark of lower levels of interrelationships but also indicate a constant closeness. Such changes are often welcomed by parents calmly and without any disappointment [18]. Conversely, the death of a close friend or a family member is often mourned by the whole world.
Even before questioning the importance of social stability, it is useful to examine the importance of social relationships. The practical mechanisms by which social relationships affect health are numerous but less known [18]. They have reached similar conclusions and state that our sense of dependence is because of our need for social change. Dependence is a small set of minute psychological processes that lead to health issues, depending on how well it is expressed. Thus, instability in relationships may pose a threat to these types of dependencies. Therefore, considering the high population of the elderly in Gonabad Town with 9.97%, it seems necessary to pay attention to this type of study; therefore, the present research aims to investigate the mediating role of relationship quality in the family network in the relationship between the desire for stability of the relationship with the feeling of loneliness in the elderly. The research model is demonstrated in Figure 1.

2. Method
This research is a descriptive correlational study. The statistical population includes all men and women aged 60 or above, living at home in Gonabad Town, Iran in 2017. The population of this group based on the statistical yearbook of 2016 has been announced as 5076 people. The statistical sample of this study consists of 350 people using the Cochran formula. A total of 178 men and 172 women were selected by the stratified sampling method. These strata were from the four main parts of Gonabad Town, namely Qasbeh, Sartraz, Jumand, and Noghab areas, which were identified using the matching method according to the inclusion criteria (age over 60, widowed and having a spouse, retired, having a single and married child, no medical record related to cognitive impairment, and willingness to participate in the study). The data were collected using a questionnaire. Accordingly, after selecting the statistical sample, the purpose and the method of the research were explained to the elderly and they were assured of the confidentiality of their information. The personal consent letter of the elderly was obtained from them. Then, the relationship quality questionnaire was completed along with some background questions by the researcher.

Research tools
Quality of Relationship Inventory

The Quality of Relationship Inventory (QRI) is one of the best tools to measure the quality of relationships developed in 1991 by Pierce et al. This questionnaire has 25 items and its scoring method is the 4-point Likert scale, including zero, low, medium, and high. The questionnaire has three subscales: perceived social support (7 items), interpersonal conflicts (12 items), and depth of relationships (6 items). Also, in each of the 25 items, the quality of the elderly’s relationship with their spouse, married children, and single children are evaluated. To score the relationship quality questionnaire, one should give a score of 1 to “No,” the score of 2 to “Low,” the score of 3 to “Medium,” and the score of 4 to “High.” The subscales are then obtained. Regarding inverted articles, questions 8 to 19 are scored in reverse. The content validity has been verified by several psychologists [22]. The reliability was obtained at 83% for the whole questionnaire and over 77% for subscales [23, 24]. The reliability of the instrument in the present study was obtained at over 65% for all subscales by the Cronbach α.

Loneliness Questionnaire
The loneliness questionnaire was created in 1980 and consists of 20 questions in the form of 4 options, 10 negative sentences, and 10 positive sentences. In this questionnaire, scores are given as follows: “Never”=1, “Rarely”=2, “Sometimes”=3, and “Always”=4. However, the score of questions 1, 5, 6, 9, 10, 15, 16, 19, 20 is inverted: “Never”=4, “Rarely”=3, “Sometimes”=2, and “Always”=1. The Scores range from 20 (minimum) to 80 (maximum); thus, the average score is 50. A score higher than the average indicates greater intensity of loneliness. The reliability of this test in the new revised version was reported as 0.78. Meanwhile, the reliability of the test was reported at 0.89 by the retest method. This scale was translated and used after preliminary implementation and corrections [2]. The collected data were analyzed using the SPSS software, version 23, with multiple regression and path analysis techniques.

3. Results
A total of 38% of men and around 44% of women feel very lonely. The highest rate of loneliness (68%) is related to people who have a high desire to return to work. More than 50% of the elderly who had children felt “very lonely” and “very, very lonely.” More than 40% of the elderly who attend large family gatherings feel “very lonely,” and over 60% of those who do not attend the gatherings have a high sense of loneliness. About 47% feel “very lonely” and “very, very lonely,” and 20% feel lonely “very little” and “very, very little.” Table 1 provides the statistical indices of the variables.

Path analysis results
Path analysis is a statistical method based on multivariate regression analysis, used to measure the relationships of variables in a causal model. In this method, the standard beta coefficient of regression is used to determine the direction and intensity of relationships between variables. The value of the t-statistic also shows the significance of the relationships. The analysis shows the direction and the intensity of the relationships between the research variables. The values that indicate the direction and magnitude of the effect between the variables are called the path coefficient and are conventionally represented by β. Path coefficients are the same as the standardized regression coefficient; therefore, simple linear regression should be used to analyze the path.
In this study, the two independent variables are the desire for job stability and the desire to register a relationship with married children. The dependent variable is the loneliness of the elderly, while the mediating variable is the quality of relationships. Therefore, according to the path analysis technique, feeling lonely is the final dependent variable and the quality of the relationship is the intermediate dependent variable. Depending on the number of variables, a linear regression test is applied to first measure the effect of independent variables on relationship quality and then determine the effect of relationship quality on loneliness. That is, this relationship is measured in three stages. Here, the tables are not presented because of the large volume of calculations.
Step 1: The separate measurements of two variables of the tendency toward job stability and the stability of relationship with family members with the dependent variable of feeling lonely were performed to obtain the direct effect of each. At this stage, the tendency toward job stability on the feeling of loneliness was equal to 0.47 and the direct effect of the tendency toward stability of relationships with family members was -0.73.
Step 2: Involved measuring the relationship between the two independent variables with the quality of relationships (intermediate dependent variable).
Step 3: In this step, the relationship between the intermediate dependent variable and the final dependent variable (the loneliness of the elderly) was measured.
Step 4: The direct, indirect, and the total effect of each of the two variables were identified.
According to figure 2, the following measures are obtained:

= -0.73 The direct effect of the desire to stabilize the relationship
-0.44=-0.717 * 0.487 Indirect effect=
-1.17=-0.44+Total effect= -0.73
The direct effect of the desire for job stability =0.47
-0.31=-0.717 *0.43 Indirect effect=
-0.78=-0.31+Total effect=0.47

4. Discussion
As mentioned earlier, according to some studies, the elderly has expressed some frustration with their families in terms of their social, economic, and physical status, and few have placed themselves at the center of the family. Most believed that they did not have the respect they deserved and that they had a marginal position in the family [9, 10]. Therefore, the importance of family relationships can be understood. The communications and social support of the family could be a cheap source regarded as social capital to dynamize and improve the quality of life and the morale of the elderly. This type of relationship is commonly studied in terms of structural patterns in social networks. This pattern shapes the quality of network relationships that are affected over time and in old age [10, 11]. The type of social network describes the interpersonal environment and is used in the health status of populations [12, 25]. Researchers have shown that people who are in the final years of their lives are more knowledgeable and selective in their social relationships. This selectivity not only leads to greater relationship stability, but also greater confidence in relationships [22, 23, 24, 25, 26].
Network analysis is based on the idea that one should not use internal stimuli or abstract external forces to explain the social organization, but rather study the structure of relationships that are limiting or empowering [12]. On the other hand, the status of relationships in the social networks of the elderly in the field of care, nursing, and social work provides a good assessment framework to assess their health status (physical and mental). One of the manifestations of elderly care is the support of network members for the elderly in the family and is one of the mechanisms by which the health of the elderly is increased. Therefore, it is obvious that the relationship between children and parents is a type of communication that is of great value and has favorable effects on both parties, especially parents [15].
Moreover, the results of the present study showed that the desire for continuous communication with family network members also explained more than 60% of changes in the quality of relationships [22, 23, 24, 25, 26]. This effect is crucial in a way that shows itself well in the tests. In the analysis of two-variable relations between contextual variables and the quality of relations, there is only one significant relationship between employment and unemployment and the quality of relations. In other words, it is the job that determines the quality of the relationship. But when the context variables along with other independent variables entered the regression equation to measure their effect on the dependent variable (quality of relationships in general) in interaction with other variables, none of the context variables remained in the equation. Meanwhile, the variable of the tendency to continuously communicate with children alone explains about 37% of the changes in the dependent variable (relationship quality), the intensity of which (according to the beta) is 60.2%.
Research shows that families provide much of the social support for older people. Contrary to popular belief, many older people establish a permanent connection with their families and provide the minimum support they need [14]. Interestingly, minority groups have certain benefits in the support area. Family support systems are often more prevalent among Hispanic or African American people and other individuals or groups may also play an important role [19]. Researchers have always described the concept of social support in terms of behavior that provides the individual with emotional support, benefits, self-confidence, or information [19]. The actual and perceptual adequacy of the support system is also important, even if it is independent of the fact that this support system consists of only one person or the whole social network. These results indicate that support does not always mean care and nursing, but only regular greetings from family members, especially married children who have been separated from their parents, giving them the necessary confidence and not making them feel marginalized, but sensing their importance and respect in the eyes of their children. This feeling causes them to avoid isolation, depression, and loneliness. The elderly at this age need more attention and respect from the members of their family network because they feel they are the closest to them; therefore, they expect more responses from them.
There is evidence that the importance of social relationships among the elderly is emphasized [27]. The reasons for this fundamental importance may be as follows: as people get older, the amount of their care resources decrease, largely because of declining performance, income, and the number of social networks (which in turn results from an increase in mortality or relocation). Along with the reduction in the care resources of these people, their support system is considered one of the main factors in coping with the difficulties, albeit these systems may face many problems and are declining [26, 28]. Among the elderly, relative network stability may be a key factor in stabilizing their physical and mental health.
According to the research findings, the most important suggestion for reducing the feeling of loneliness in the elderly is informing their needs for stronger emotional ties to families and other people involved in their personal social network. This is done to create self-worth and interest in them and reduce their feeling of loneliness, which in turn makes the community aware of the need to form associations and family organizations that can meet the emotional along with other needs of the elderly. Some of these cases are informing the institutions in charge of the elderly to pay more attention to the social needs of the elderly to empower them to have a fruitful and positive old age and raise the awareness of research institutions to conduct studies in the fields of aging and limited social relationship while assessing the degree of loneliness in the elderly.

5. Conclusion
Not only is the study of social relationships inherently valuable, but it is also important considering the practical logic that such relationships are frequently associated with better moods, life satisfaction, fewer symptoms of depression, and even lower risk of death. The expression of interest in the study of social relations and health is rooted in Emile Durkheim’s classic essays on the relationship between social cohesion and suicide and anomie. Today, there is a general understanding that social relationships have profound and complex implications. 
Having a strong and consistent social network can prevent performance decline in the elderly. From a social relations perspective, supportive research can be informative and useful, as it can provide us with information on how and when social relationships are useful or harmful to all of us. Care-related research can be even more focused. Such research focuses primarily on relationships that involve the continual provision of care for the person who is unable to respond to this assistance while emphasizing primarily the caregiver rather than the recipient. There is a general agreement that care is a sign of a multidimensional structure that includes factors, such as the amount of support required, the sex of the caregiver and the person under care, the caregiver’s previous relationship with the recipient, and even the personality of the individuals. The stability of the caregiving relationship has not yet been systematically evaluated, but it can be assumed that the instability in the caregiving relationship may have clear and sometimes relatively expensive themes for the health of both the caregiver and the recipient. 
The caregiving relationship changes over time according to the changes of the dependencies, in proportion to the promotion of the caregiver and the recipient. Based on the results of the present study, it is clear that paying attention to the problems of caregivers during the experience of the care process of the family’s elderly members can provide us with materials for future research like facilitators and deterrents such as knowledge of care, personal characteristics of caregivers and the elderly, care experience, an effective link between caregiver and the elderly, family support network, family partnership, formal support system, home care context, and formal health and care systems for the elderly. Therefore, the need for interventions to reduce the pressure of care and also provide appropriate education about the disease to caregivers is recommended.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles were considered in this article. 

Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.

Conflict of interest
The authors declared no conflict of interests.

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Type of Study: Orginal Article |
Received: 2020/11/8 | Accepted: 2022/04/17 | Published: 2022/05/1

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