Mohammed T. Abou-Saleh

84 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRY2. The locally integrated support network includes close relationshipswith local family, friends and neighbours. Many friendsare also neighbours. It is usually based on long-term residenceand active community involvement in church and voluntaryorganizations in the present or recent past. Networks tend tobe larger on average than others.3. The local self-contained support network typically has arm’slengthrelationships or infrequent contact with at least onerelative living in the same or adjacent community, usually asibling, niece or nephew. Childlessness is common. Reliance isfocused on neighbours but respondents with this type ofnetwork adopt a household-focused life style and communityinvolvement, if any, tends to be low key. Networks tend to besmaller than average.4. The wider community-focused support network is typified byactive relationships with distant relatives, usually children, andhigh salience of friends and neighbours. The distinctionbetween friends and neighbours is maintained. Respondentswith this type of network are generally involved in communityor voluntary organizations. This type of network is frequentlyassociated with retirement migration and is commonly amiddle-class or skilled working-class adaptation. Networks arelarger than average. Absence of local kin is typical.5. The private restricted support network is typically associatedwith absence of local kin, other than in some cases a spouse,although a high proportion are married. Contact withneighbours is minimal; there are few nearby friends and alow level of community contacts or involvements. The typesubsumes two sub-types: independent married couples anddependent elderly persons who have withdrawn or becomeisolated from local involvement. Networks are smaller thanaverage.As a result of different network configurations and differingnormative expectations for members, some networks are morerobust in terms of the provision of the informal support they canprovide. Different types of networks react in different ways to thecommon problems of old age 22,23 . Different network types havedifferent strengths and weaknesses and nature of the risk is relatedto the type of network 24 . Network types have also beendemonstrated to relate to levels of use of domiciliary servicesand to types of presenting problems 25,26 . Knowledge of networktype can, therefore, be a useful tool in planning therapeuticinterventions and a measurement instrument for use by practitionershas been developed 22,24 . This makes it possible to identifysupport network type on the basis of eight questions.Recent research has paid increasing attention to the significanceof network type for professional practice. It has been suggestedthat to achieve ‘‘real improvements in the quality of life’’, therelationship environment of people with severe, long-term mentalhealth problems needs to be explicitly addressed by practitioners27 . Other authors 28 make the same point in the context ofbereavement. Network type has been shown to be stronglyassociated with depression but not anxiety 29 .High needs for intervention have been identified in the contextof a firm diagnosis of dementia associated with networks thatreflect low levels of social support 30 . Admission to long-term careof older people with dementia occurs sooner in all network typesother than the family-dependent network. In network typeswithout local kin, the network tends to become private, restrictedin the face of dementia 31 .The distribution of network types has been shown to be relatedto neighbourhood or community. Typically, where populationstability is high, those types of networks based on local kin andproviding high levels of informal support are found. Wherepopulation movement is high, for example in areas whereretirement migration is common, the proportion of morevulnerable network types is greater 13,15 . Because of the relationshipwith coping strategies, knowledge of the distribution ofnetwork types can be an important indicator for planning the mixof service provision, in the same way that the identification of thenetwork of an individual can indicate the appropriate type ofintervention and potential future outcomes.REFERENCES1. Corin E. Elderly people’s social strategies for survival: a dynamic useof social networks analysis. Can Ment Health 1982; 30(3): 7–12.2. Sinclair I, Crosbie D, O’Connor P et al. Networks Project: A Study ofInformal Care, Services and Social Work for Elderly Clients LivingAlone. London: National Institute for Social Work, 1984.3. Kendig HL (ed.). Aging and Families: A Social Networks Perspective.Sydney, Australia: Allen and Unwin, 1986.4. Wenger GC. The Supportive Network: Coping with Old Age. London:Allen and Unwin, 1984.5. Wenger GC. A longitudinal study of changes and adaptations in thesupport networks of Welsh elderly over 75. J Cross-cultural Gerontol1986; 1(3): 277–304.6. Wenger GC. Support networks in old age: constructing a typology. InJefferys M, ed. Growing Old in the Twentieth Century. London:Routledge, 1989, 166–85.7. Stephens RC, Blau Z, Oscar G, Millar M. Ageing, social supportsystems and social policy. J Gerontol Soc Work 1978; 1(4): 33–45.8. Mugford S, Kendig H. Social relations: networks and ties. In KendigH, ed. Ageing and Families: a Social Networks Perspective. Sydney,Australia: Allen and Unwin, 1986, 38–59.9. Wenger GC. Social network research in gerontology: how did we gethere and where do we go next? In Minicheillo V, Chappell N, WalkerA, Kendig H, eds. The Sociology of Ageing: International Perspectives.Melbourne, Australia: International Sociological Association, 1996.10. Thompson JV. The elderly and their informal social networks. Can JAging 1989; 8(4): 319–32.11. Walsh J, Connelly PR. Supportive behaviours in natural supportnetworks of people with serious mental illness. Health Soc Work 1996;21(4): 296–303.12. Veiel HOF. Detrimental effects of kin support networks on the courseof depression. J Abnorm Psychol 1993; 102(3): 419–29.13. Wenger GC. A network typology: from theory to practice. J AgingStud 1991; 5(2): 147–62.14. Wenger GC, Shahtahmasebi S. Variations in support networks: somesocial policy implications. In Mogey J, ed., Aiding and Aging: TheComing Crisis in Support for the Elderly by Kin and State. New York:Greenwood, 1990, 255–77.15. Harper, S. The kinship network of the rural aged: a comparison of theindigenous elderly and the retired immigrant. Ageing Soc 1987; 7:303–27.16. Wenger GC. 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