Social Support From Family and Friends,Educational Attainment,and Cognitive Function

Abstract

This study assessed the extent to which associations between perceived and received social support from family and friends and changes in older adults’ cognitive function were moderated by educational attainment. Sibling pairs in the Wisconsin Longitudinal Study (WLS) (N = 4,297) completed a survey about social support in 2011 and a cognitive battery in 2011 and 2020. Participants’ mean age in 2020 was 80.2 years old. Multilevel linear regressions indicated that perceived, but not received, support from friends was associated with better cognitive function 9 years later. Perceived family support was cognitively advantageous for older adults at most levels of educational attainment. However, among postgraduates, perceived family support was unrelated to cognitive function. That the association between perceived support and cognitive function differs based on educational attainment gives interventionists additional information needed to identify groups of older adults most susceptible to cognitive impairment.

Keywords

socialsupport education cognitive function family

What this paper adds

• Greater levels of perceived support from friends were related to better cognitive function among a sample of white adults (mean age 80).

• Greater levels of perceived support from family were related to better cognitive function, though the effect decreased as educational attainment increased.

Applications of study findings

• Perceived support may be an important cognitive health resource for less well-educated older adults.

Introduction

Social support is “the positive, potentially health-promoting or stress-buffering, aspects of relationships such as instrumental aid, emotional caring or concern, and information” (House et al., 1988, p. 302). Cognition is among the domains of health that benefits from social support: Older adults with more support report better cognitive function, deferred onset of cognitive impairment, and reduced risk of dementia relative to peers with less support (Costa-Cordella et al., 2021). Several mechanisms link social support to cognitive health; we focus on its role in moderating adverse physiological and psychological reactions to stress (Costa-Cordella et al., 2021; Peng et al., 2022).

While everyone experiences stress, socioeconomic position profoundly affects the type, duration, and intensity of stress exposures (Thoits, 2010). Therefore, if social support promotes cognitive health by buffering stress, then the returns of social support to cognitive health may vary by educational attainment, which is perhaps the aspect of socioeconomic position that is most strongly correlated with cognitive health (Lövdén et al., 2020). Education widens social networks and provides the resources to preserve social relationships (Fischer & Beresford, 2015). Educated older adults also may need less instrumental assistance, which may mean less conflict within social networks, reducing stress. Given that they may have amassed fewer socioeconomic resources, the less well-educated may depend more on support for their health (Ross & Mirowsky, 2006). Empirical evidence supports this hypothesis, but the direction of the effect has varied. In a sample of Black adults, Byrd et al. (2022) found that received support had the strongest positive cognitive effects for people with less education. Conversely, in a Swiss sample, Sauter et al. (2021) found that received support slowed cognitive decline, but only among highly educated individuals.

We contribute to this literature by focusing attention on two elements of social support that are important to cognitive health but have not yet been included in studies of an interaction between social support and educational attainment. First, we distinguish between support from family and friends. Family relationships, and thus support, may be of longer duration, but also more obligatory, than friendships (Blieszner et al., 2019). While studies have observed that support from both kin and non-kin protects against cognitive decline (Béland et al., 2005), others have found the effects of friend support to be stronger (Sharifian et al., 2020).

Second, we distinguish between received support, which is situational and often does not indicate either current or future need, and perceived support, or latent sources of potential support (Melrose et al., 2015). Because it is more consistent over time, perceived support may be the better predictor of chronic disease (Uchino, 2009). It also protects older adults from chronic stress (Kraus, 1986), and is associated with better coping mechanisms (Uchino, 2009), which can protect cognitive function over time. Despite some research finding protective effects of received support against stress among older adults (Krause, 1986), received support is also linked with reduced sense of self-efficacy and self-worth (Fischer & Boer, 2011) and increased depression (Ang & Malhotra, 2016), which can culminate in cognitive distress.

The present study assessed (1) the associations between perceived and received social support from family and friends and changes in older adults’ cognitive function; and (2) the extent to which (1) is moderated by educational attainment.

Methods

Data

The Wisconsin Longitudinal Study (WLS) is a random sample of one-third of the cohort of people who graduated from Wisconsin high schools in 1957 (N = 10,317). In 1975, the WLS sample nearly doubled with the addition of randomly-selected siblings of graduates (N = 9571). The present analytic sample is comprised of the 2948 graduates and 1349 siblings (from 3420 families) who completed a mail-back survey about social support in 2011, and cognitive screening in 2020. Participants consented to the survey in writing and the screening verbally. Appendix Table 1A includes details on response rates.

Cognitive Function

In 2011 and again in 2020, participants completed (a) immediate and (b) delayed 10-word recall and (c) digit ordering (Wechsler, 1997). Each of the three was rescaled to percent correct (i.e., 0–100), and then the scales were averaged.

Social Support

In 2011, participants completed a module on social support. Perceived support items began, “If you needed,” and addressed three potential needs: (1) to borrow US$250 for a few weeks because of an emergency; (2) care if sick and unable to take care of yourself for a week or more; (3) to talk to someone about a personal problem. Participants reported whether they could ask an adult child, sibling, other relative, or friend. We summed the number of needs that participants could ask one or more family members to help with, creating a measure that ranged from 0 (no family member available to help with any need) to 3 (at least one family member available to help with each of the 3 needs). Likewise, we summed the number of needs that participants could ask one or more friends to help with (range: 0–3).

Received support items were phrased “In the past month, did a [adult child/sibling/other relative/friend] help you with…” There were three queries: (1) transportation, errands, or shopping; (2) housework, yard work, repairs, or other work around the home; (3) advice, encouragement, moral or emotional support. We created 0–3 sum scores for friends and family. Table 2A presents a correlation matrix of the support measures.

Educational Attainment

We created four categories: high school diploma or less education; some college; 4-year college degree; postgraduate education. All graduates had at least a high school diploma, but some siblings had not completed high school.

Covariates

Our models included several covariates measured in 2011 in addition to cognitive function: provided social support, depressive symptoms, self-reported health, number of cardiometabolic conditions, sex, marital status, and income. Table 3A includes further detail on these measures.

Analytic Strategy

After computing descriptive statistics, we estimated multivariate regressions. The regressions were multilevel to account for shared variance within sibling pairs. Compound symmetry was the error covariance structure. The first regression estimated the main effects of education, social support, and all covariates on cognitive status (a continuous outcome) in 2020. We next added all two-way multiplicative interactions between education and support to the model. The final model includes only significant interaction terms. Sensitivity analyses confirmed that the results were robust across males and females, and to alternative specifications of education (e.g., years vs. categories).

We handled missing data by estimating regressions across 25 multiple imputations. A large majority of cases (82%) had no missing values on study variables. Cognitive function in 2011 was the measure with the most missing data (405 observations, or 9% of cases). Results estimated using listwise deletion were substantively similar (Table 4A). There has been some selective attrition based on cognitive function over time (Tables 5A–7A).

Results

Table 1 reports descriptive statistics. On average, cognitive function declined, from 52% of answers correct in 2011 to 36% in 2020. The results of the multilevel regression models appear in Table 2. Controlling for cognitive function in 2011, each additional dimension of perceived support from friends in 2011 was associated with an increment of .85 percentage points (p < .001). The second model showed one significant interaction, between education and perceived family support. Please see Figure 1. Although the slope for perceived family support among postgraduates appears negative, simple slopes tests showed that it was not statistically significant. The coefficient in the interaction term shown in Table 2 is negative and significant because the difference in slopes between high school graduates and those with postgraduate education was negative and significantly different from zero.

Table 1.

Descriptive Statistics for All Measures (N = 4,297).

	Mean (SD) or percent
Cognitive Functioning
2011 (range: 0–100)	51.56 (12.91)
2020 (range: 0–100)	36.25 (15.88)
Social Support (2011)
Perceived from family (range: 0–3)	2.42 (.86)
Perceived from friends (range: 0–3)	1.14 (1.11)
Received from family (range: 0–3)	.60 (.82)
Received from friends (range: 0–3)	.37 (.64)
Provided to family (range: 0–3)	1.20 (.99)
Provided to friends (range: 0–3)	.79 (.89)
Educational Attainment (2011)
High school diploma or less education	48.82%
Some college	16.71%
Four-year college degree	16.05%
Postgraduate education	18.42%
Health Conditions (2011)
Depressive symptoms (range: 0–140)^a	14.38 (13.55)
Self-reported health (1 = good, fair, or poor; 0 = excellent or very good)	33.47%
Cardiometabolic diagnoses (sum of: diabetes, heart disease, hypertension, high cholesterol, stroke)	1.39 (1.02)
Sociodemographic Characteristics (2011)
Female	56.48%
Currently married	75.44%
Divorced	9.38%
Widowed	11.89%
Never married	3.28%
Income (US dollars)^a	33,089.75 (46,138.24)

Note. Statistics reported prior to multiple imputation.

^aReported prior to transformation for regression.

*p < .05, **p < .01, ***p < .001.

Table 2.

Multilevel Regression of Cognitive Function on Social Support, Wisconsin Longitudinal Study, 2020.

	Main effects model	Interaction model
	Unstandardized coefficient (SE)	Unstandardized coefficient (SE)
Social Support (2011)
Perceived from family (range: 0–3)	.47 (.27)	1.03 (.39)**
Perceived from friends (range: 0–3)	.85 (.23)***	.86 (.23)***
Received from family (range: 0–3)	−.18 (.31)	−.17 (.31)
Received from friends (range: 0–3)	−.22 (.41)	−.22 (.41)
Provided to family (range: 0–3)	.30 (.24)	.29 (.24)
Provided to friends (range: 0–3)	−.13 (.28)	−.09 (.28)
Educational Attainment (2011)
Some college (reference: high school or less)	2.01 (.63)**	1.51 (1.84)
Four-year college degree (reference: high school or less)	3.06 (.65)***	4.92 (1.98)*
Postgraduate education (reference: high school or less)	4.55 (.66)***	9.95 (1.76)***
Interaction Terms: Social Support by Education
Perceived from family by some college	—	.21 (.72)
Perceived from family by 4-year degree	—	−.76 (.76)
Perceived from family by postgraduate	—	−2.27 (1.26)**
Health Conditions (2011)
Cognitive function (range: 0–100)	.41 (.02)***	.40 (.02)***
Depressive symptoms (standard deviations)	−.62 (.23)**	−.63 (.23)**
Self-reported health (1 = good, fair, or poor; 0 = excellent or very good)	−1.63 (.51)**	−1.64 (.51)**
Cardiometabolic diagnoses (sum of: diabetes, heart disease, hypertension, high cholesterol, stroke)	−.37 (.22)	−.36 (.22)
Sociodemographic Characteristics (2011)
Female	4.78 (.52)***	4.77 (.52)***
Divorced (reference: currently married)	−.18 (.77)	−.19 (.77)
Widowed (reference: currently married)	−.93 (.71)	−.96 (.71)
Never married (reference: currently married)	.07 (1.25)	−.42 (1.26)
Income (quartiles)	.99 (.22)***	1.02 (.22)***
N (individuals; families)	4,297; 3,420	4,297; 3,420
Fixed intercept	8.39 (1.20)	7.14 (1.37)
Random Components
Family-level intercept (τ²)	3.15 (1.14)	3.27 (1.09)
Person-level intercept (σ²)	13.77 (.29)	13.72 (.29)

*p < .05, **p < .01, ***p < .001.

Figure 1.

Interaction of Perceived Social Support by Categories of Educational Attainment. Note. Cognitive function scores range from 0–100.

Discussion

The present study found perceived—but not received—support from friends to be associated with higher cognitive function 9 years later. That perceived support is consequential for cognitive function mirrors findings in previous studies (Costa-Cordella et al., 2021). Additionally, we found perceived family support to be cognitively advantageous for older adults at most levels of educational attainment. However, for postgraduates, perceived family support was unrelated to cognitive function.

The perception of support availability when in need may be more cognitively meaningful for the less educated given that education typically is positive correlated with psychological resources such as self-efficacy and self-esteem that are needed to respond to acute or chronic stressors (Mirowsky & Ross, 2003). The null effect of perceived family support on cognitive function among postgraduates may be because highly educated individuals may move away for the purposes of work, which could alter family interactions and limit the ability to provide support (Choi et al., 2020). The perception of continued support from family, therefore, may trigger guilt, and the perceived unevenness of support exchange may counteract any potential cognitive health benefits attached to perceived family support.

Our study has several limitations. First, the sample includes only white older adults, as reflective of Wisconsin’s population when the study began: In 1960, 97% of Wisconsinites were non-Hispanic white (Wisconsin Legislative Reference Bureau, 2015). This fact precludes us from staking any predictive claims about the broader population. Second, WLS did not measure social support in 2020, and the measurement of it in 2011 excludes structural dimensions, such as the composition, size, density, and stability of social networks. Examining how social network gains and losses modify the perception of support for individuals with varying levels of education may prove useful in building interventions directed at improving cognitive function. Third, despite considering several covariates, residual confounding from unmeasured variables may still be an issue.

Notwithstanding these limitations, this study advances our knowledge of the link between social support and cognitive function and the moderating influence of education. That perceived, but not received, support matters for cognitive function suggests that interventions to nurture the perception of existing support may be just as important as those typically focused on building new networks of support (Brand et al., 1995). Moreover, our findings indicate that for older adults with less than postgraduate education, the perception of support availability from family may be a substitutable resource that is consequential for their cognitive health.

Supplemental Material

Supplemental Material - Social Support From Family and Friends, Educational Attainment, and Cognitive Function

Social Support From Family and Friends, Educational Attainment, and Cognitive Function by Sara M. Moorman and Manacy Pai in Journal of Applied Gerontology

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Research Ethics

Anonymized data are publicly available at ; therefore, this project did not require approval from an Institutional Review Board (IRB).

ORCID iD

Sara M. Moorman

Supplemental Material

Supplemental material for this article is available online.

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