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Kim and Shin: The Influence of Social Support among Community Dwelling Elderly and their Attitude towards the Withdrawal of Life-sustaining Treatment: A Mediating Effect of Self-esteem
Original Article

Korean J Adult Nurs 2017;29(4):373-381.

Published online: 9 August 2017

DOI: https://doi.org/10.7475/kjan.2017.29.4.373

The Influence of Social Support among Community Dwelling Elderly and their Attitude towards the Withdrawal of Life-sustaining Treatment: A Mediating Effect of Self-esteem

Hyun Sook Kim, MSN, APN, Sung Rae Shin, Ph.D., RN

Department of Nursing, Sahmyook University, Seoul, Korea

Corresponding author: Shin, Sung Rae Department of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 01795, Korea. Tel: +82-2-3399-1588, Fax: +82-2-3399-1594, E-mail: shinsr@syu.ac.kr

Received 14 April 201716 July 2017       Accepted 23 August 2017

Copyright © 2017 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to examine the mediation of Self-Esteem in the relationship between Social Support and attitude toward the Withdrawal of Life-Sustaining Treatment (WLST) for community dwelling elderly in order to provide a basis for planning nursing interventions to improve the attitude of elderly.

Methods

The participants were 252 elderly residing in Seoul. The data were collected through a questionnaire survey distributed in March, 2016. The survey included scales on Social Support, attitude towards WLST and measures of Self-esteem. Collected data were analyzed using SPSS/WIN 21.0 program.

Results

The mean score for the attitude towards WLST was 73.83. Self-Esteem was 29.44. Overall Social Support was 42.51. There were significant correlations among the three variables. Self-esteem was directly affected by the attitude (R2=24%). Attitude towards WLST was directly affected by Family Support. Family Support and Self-esteem affected by the attitude on WLST (R2=19%). Self-esteem had a partial mediating effect (β=.23, p<.001) in the relationship between Family Support and reported attitude from the WLST (Sobel test: Z=4.93, p<.001).

Conclusion

Based on the findings of this study, programs can be created focusing on Social Support and Self-Esteem improvement. The programs may positively change the elderly's attitude towards WLST.

Keywords: Social support, Self concept, Withholding treatment, Aged

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Figure 1.
Mediating effect of self-esteem in the relationship between social support, and attitude towards the withdrawal of life- sustaining treatment.
kjan-29-373f1.tif
Table 1.
Social Support, Self-esteem, and Attitude towards the Withdrawal of Life-sustaining Treatment according to Participants' Characteristics (N=252)
Characteristics Categories n (%) or M± SD Social support Self-esteem Attitude towards the WLST
M± SD t or F (p) Scheffé M± SD t or F (p) Scheffé M± SD t or F (p) Scheffé
Age (year) 65~69 50 (20.0) 3.53±0.99 0.26 2.99±0.46 0.46 3.84±0.67 1.11
70~79 157 (62.5) 3.59±0.95 (.769) 2.99±0.46 (.631) 3.89±0.54 (.330)
≥80 44 (17.5) 3.48±0.92 2.91±0.56 4.00±0.46
74.46±5.62
Gender Male 132 (52.4) 3.46±0.89 -1.73 2.92±0.49 -1.88 3.94±0.54 1.30
Female 120 (47.6) 3.67±1.01 (.085) 3.03±0.45 (.061) 3.85±0.57 (.195)
Education ≤ Elementary school 55 (21.8) 3.39±1.11 1.83 2.99±0.50 0.96 3.97±0.52 2.24
Middle school 85 (33.7) 3.58±1.03 (.146) 3.03±0.47 (.414) 3.98±0.56 (.085)
High school 73 (29.0) 3.73±0.80 2.94±0.44 3.89±0.48
≥ College 39 (15.5) 3.45±0.76 2.89±0.53 3.72±0.70
Martial status Unmarried a 5 (2.0) 2.60±0.45 7.40 2.68±0.13 4.91 4.22±0.45 1.34
Married b 167 (67.6) 3.71±0.88 (＜.001) 3.04±0.47 (.008) 3.88±0.56 (.263)
Divorce, bereavment c 75 (30.4) 3.32±1.03 a＜ c 2.86±0.46 a＜ b 3.96±0.55
Intimacy in family Moderate a 54 (21.6) 3.26±0.92 7.33 2.91±0.44 1.12 3.94±0.56 0.19
Closed b c 146 (58.4) 3.75±0.84 (＜.001) 3.01±0.49 (.329) 3.89±0.57 (.829)
Not closed c 50 (20.0) 3.33±1.17 a＜ b 2.95±0.49 3.93±0.53
Monthly spending money (100,000 won) ＜2.4 a 17 (6.8) 2.81±0.78 8.33 2.67±0.45 5.69 3.66±0.79 1.51
2.5~4.9 b 88 (35.1) 3.38±0.91 (＜.001) 2.88±0.45 (＜.001) 3.96±0.55 (.214)
5.0~9.9 c 83 (33.1) 3.63±0.92 a＜ b, c, d 3.08±0.45 a＜ c, d 3.93±0.49
≥10 d 63 (25.0) 3.91±0.93 3.05±0.51 3.88±0.58
Economic level Independent a 104 (41.6) 3.68±1.03 12.99 3.07±0.50 8.35 3.91±0.53 0.43
Child help b 95 (38.0) 3.75±0.74 (＜.001) 2.96±0.49 (＜.001) 3.88±0.61 (.651)
Government, real estate c 51 (20.4) 2.98±0.95 b＞ c 2.97±0.48 a＞ c 3.97±0.52
Education wish state for WLST Yes 150 (60.0) 3.60±0.94 0.67 3.05±0.46 3.08 3.96±0.55 1.94
No 100 (40.0) 3.52±0.96 (.506) 2.86±0.49 (.002) 3.83±0.56 (.045)

WLST=withdrawal of life-sustaining treatment.

Table 2.
Descriptive Statistics of Social Support, Self-Esteem, and Attitude towards the Withdrawal of Life-sustaining Treatment (N=252)
Variables Possible range Actual range Scale Subscale
M± SD M± SD
Social support 12~60 (1~5) 12~60 (1~5) 42.51±11.46 (3.56±0.96) 14.88±4.21 (3.74±1.04)
 Family support 4~20 (1~5) 4~20 (1~5) 13.53±4.49 (3.39±1.12)
 Friend support 4~20 (1~5) 4~20 (1~5) 14.09±4.30 (3.55±1.08)
 Significant other support 4~20 (1~5)4~20 (1~5) 4~20 (1~5)4~20 (1~5) 14.09 4.30 (3.55 1.08)
Self-esteem 10~40 (1~4) 13~40 (1~4) 29.44±5.06 (2.97±0.48)
Attitude towards the WLST 19~95 (1~5) 35~91 (1~5) 73.83±10.59 (3.90±0.56)

WLST=withdrawal of life-sustaining treatment.

Table 3.
Correlations among Social Support, Self-esteem, and Attitude towards the Withdrawal of Life-sustaining Treatment (N=252)
Variables Categories Social support Self-esteem Attitude on the WLST
Family support Friend support Significant other support
r (p) r (p) r (p) r (p) r (p)
Social support Family support 1 .63 (＜.001) .68 (＜.001) .47 (＜.001) .14 (.030)
Friend support 1 .70 (＜.001) .39 (＜.001) .03 (.049)
Significant other support 1 .50 (＜.001) .09 (.173)
Self-esteem 1 .16 (.011)
Attitude towards the WLST 1

WLST=withdrawal of life-sustaining treatment.

Table 4.
Mediating Effect of Self-esteem in the Relationship between Social Support, and Attitude towards the Withdrawal of Life-sustaining Treatment (N=252)
Variables B β t p Adj. R2 F p
Step 1. Family support → Self-esteem .23 .39 5.50 ＜.001 .24 9.21 ＜.001
Step 2. Family support → Attitude towards WLST .19 .27 3.48 ＜.001 .10 27.20 ＜.001
Step 3. Family support, self-esteem → Attitude towards WLST .19 47.82 ＜.001
  Family support → Attitude towards WLST .07 .09 5.101 ＜.001
  Self-esteem → Attitude towards WLST .39 .33 18.31 ＜.001
Sobel test: Z=4.93, p＜.001

WLST=withdrawal of life-sustaining treatment

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