The Social-Medical Network: Using a Network Approach to Explore the Integration of Informal and Formal Care Networks of Older Adults
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PROJECT SUMMARY Due to factors such as multimorbidity and access to Medicare health insurance, older adults are often frequent users of the formal health care system. Their formal health providers may range from primary care providers to specialists (e.g., cardiologist) and direct care workers. The various formal health care providers of an older adult form a social network of care. Thus, the connections that exist between the older adult and their formal health care professionals act as a formal care network, centered on the older adult. In addition to formal health care providers, older adults may have informal caregivers, defined as family, friends, and neighbors who provide care to older adults or individuals with disability, illness, or other debilitating conditions. There is a lack of research about the number of informal caregivers, the type and amount of care and support provided, and the quality of the relationship between the patient and caregiver. There is also a gap in examining how informal caregivers of an older adult form a social network of care, or an informal care network centered on an older adult. Literature has suggested that these two networks (i.e., formal and informal) do not operate separately but instead are dynamically integrated. The interaction between the two networks forms a larger network: The social-medical network. The social-medical network represents the larger network comprised of the two subnetworks and their integration (density) across. To our knowledge, no studies have proposed nor been conducted on the social-medical network. There is also little understanding on how the informal and formal care networks operate together to improve health outcomes for older adults. Using social network methods and analysis, this study aims to measure the social-medical networks of older adults and explore its association with escalating acute service utilization (e.g., urgent care, emergency department, and unplanned hospitalization). This study will examine the social-medical network among a population of older adults with Type 2 diabetes. The specific aims of this study are (SA1) To characterize the structure, function, and quality of the informal care, formal care, and social-medical networks; (SA2) To compare escalating acute service utilization by the characteristics of the informal and formal care subnetworks; and (SA3) To examine the association between density of the social-medical network and escalated use of acute health services. This study will measure an unexplored network that may be associated with utilization outcomes of older adults, laying the foundation for improving the human healthspan, improving lives of informal caregivers, lowering health care costs, and strengthening care communities. This research also aligns with the NIA’s mission and research strategies to promote innovative work in areas and disease domains with established health disparities among older adults, such as Type 2 diabetes. Findings will contribute a new concept to the literature, a novel application of existing methods, and additional mechanisms that may influence the health outcomes of an older adult.
