The Role of Social Capital in Psychological Well-Being and Health Care Utilization among Older Adults in Indonesia

Background and purpose: Older adults risk experiencing a shrinkage of support, a declining network, social isolation, and feeling lonely, which could negatively affect health and well-being. Nevertheless, the relationship of social capital with health and well-being as well as healthcare utilization is inconsistent. Furthermore, most prior research used a cross-sectional design. Social capital is quite emphasized in the society of Indonesia, especially for older people. Thus, this study aimed to explore the effects of social capital on emotional well-being (happiness and depressive symptoms) and healthcare utilization among older people in Indonesia by longitudinal data.

Method: The study utilized the data from the Indonesian Family Life Survey (IFLS) in the set period of 2007 (wave 4) and 2014 (wave 5). IFLS was a panel survey conducted since 1993, representing 83% of the Indonesian population. The data collection was performed by trained field researchers. This survey measured the aspect of economic, health, and well-being issues. We included participants aged 60 years and above who were followed in Wave 4 and Wave 5 (n = 1374). In study one, social capital, demography, well-being, and health factors predicted the depressive symptoms and happiness determinants. Meanwhile, we used the predictors of social capital and three factors related to Andersen's healthcare utilization model and the utilization of healthcare (healthcare admission/inpatient, outpatient, medical checkup, and posyandu). Generalized estimating equation models were performed in the two studies.

Results: In the first study, older adults participating in arisan (B = -0.63, p < 0.05) and religious programs (B = -0.59, p < 0.01) were significantly related to the scores of depressive symptoms reduction. The effect of religious activities on depressive symptoms would be offset over time. Meanwhile, a higher score of neighborhood trust could increase the possibility of a “very happy” feeling at the intercept (OR = 1.52, p < 0.01). Furthermore, when social participation was defined as none, low or high, low, and high social participation compared to no participation showed protective effects on depressive symptoms at the intercept and at the time slope.
In the second study, social capital was a significant predictor of healthcare utilization. High participation (joining two programs or more) was contributing an essential determinant for access to posyandu (OR = 5.84, p < 0.001) and health checkup services (OR = 1.62, p < 0.05). The higher neighborhood trust was significant with hospital admission (OR = 1.25, p < 0.05).

Conclusion: Social capital significantly predicted positive and negative emotional well-being and healthcare access among older adults. Providing and supporting the program using social capital approaches (such as promoting social activity and neighborhood trust) might be a fundamental choice to enhance older adults’ well-being and health. Social capital support for older adults can be achieved through realizing an age-friendly city or community, advocacy for budget support at national and local levels, and providing public access to enhance interactions among older adults.