Journal of Cross-Cultural Gerontology 15: 331–347, 2000.

331
© 2000 Kluwer Academic Publishers. Printed in the Netherlands.

Social support exchange and quality of life

among the Korean elderly

HYE-KYUNG KIM1 , MITSURU HISATA2, ICHIRO KAI3 &

SUNG-KOOK LEE4
1 Department of Health Sociology, Tokyo Metropolitan Institute of Gerontology, Japan;
2 Department of Psychology, School of Nursing, Tokyo Women’s Medical University, Japan;
3 Department of Social Gerontology, School of Health Sciences & Nursing, University of
Tokyo, Japan; 4 Department of Preventive Medicine & Public Health, School of Medicine,
Kyungpook National University, Korea

Abstract. This study examined the impact of providing and receiving support on the quality
of life (QOL) of the elderly. Trained interviewers conducted face-to-face interviews with
714 rural community residents aged 60 and over in Korea. Subjects were asked a series
of structured questions including age, sex, living arrangement, physical functions, and the
frequency of providing and receiving support in their network (spouse, children, and friends).
The Philadelphia Geriatric Center Morale Scale was used to measure degree of QOL. Results
indicated that respondents had family-centered support networks. We found a significant
correlation between support and physical functions and, less strongly, between support and
age. When physical function was controlled, ANOVAs (Analyses of Variance) showed that
providing support to their children and friends was more strongly related to QOL score than
receiving support from the in both males and females. Overall, the elderly who exchanged
support frequently, both providing and receiving support, showed the highest QOL in most
situations. Researchers and policy makers should explore the potential benefits of providing
support as well as receiving support.

Keywords: Korean elderly, Providing support, Quality of Life (QOL), Receiving support,
Rural area

Introduction

Traditionally, the health status of a population has been measured by

mortality, such as crude death rate, infant mortality rate, and life expect-
ancy. However, those indices based upon mortality are no longer sufficient
for assessment of health status, especially in an aging society characterized
by a high prevalence of chronic and incurable diseases. Under these circum-
stances, a number of researchers have emphasized the importance of quality
of life (QOL) as a health index as well as indices based upon mortality (e.g.,
Bowling 1991). Numerous studies focusing on QOL have been conducted,
332 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

especially in western countries, and QOL has been defined from various
perspectives through various disciplines (De Haes & Van Knippenberg 1985;
Van Dam, Somers & Van Beek-Couzijn 1981). Factors such as morale, life
satisfaction and happiness are considered to be important in determining
subjective well-being in the elderly (e.g., Kai, Ohi, Kobayashi, Ishizaki,
Hisata & Kiuchi 1991; McDowell & Newell 1996). Therefore, in this study,
we focused on the morale of the elderly as the core factor of QOL.
In the field of gerontology, increasing attention has been paid to social
support as one of the most influential determinants of QOL (Antonucci &
Akiyama 1987; Krause 1986). Previous studies indicated that elderly who
received more support showed higher morale and life satisfaction than those
who received less (Krause 1986, 1990; Sugisawa 1993). Although there is no
consensus on the concept of social support (Antonucci 1990), House (1981)
identified four types of supportive behavior: (1) emotional support which
involves caring, trust, and empathy, (2) instrumental support which includes
helping others with their work, loaning money, and going out with others
who have difficulty in moving, (3) informational support which means giving
information or teaching skills which can provide a solution to a problem, and
(4) appraisal support which involves information that helps one in evaluating
personal performance, as when a work supervisor tells an underling that a job
was well done (Leavy 1983). However, some researchers hold the opinion
that social support may be actually covered by only two types: emotional and
instrumental support (Ingersoll-Dayton & Antonucci 1988; Lin 1986).
The majority of studies, however, have focused on the effect of receiving
support among elderly people. The elderly are regarded as being weak and
in need of help from others in society. Sanders (1988) pointed out that there
has been little focus on what they contribute to their families, nevertheless
the majority of the elderly, especially the young old, are relatively healthy
and active. It may be assumed that not only receiving, but providing support
leads to a positive psychological outcome among the elderly. In fact, in a
recent study using an American representative sample, providing support had
a positive effect on the psychological well-being of the aged 60 and over
through bolstering the feeling of personal control within informal networks
(Krause, Herzog & Baker 1992).
Furthermore, several researchers has stressed the importance of balance
between giving and receiving, namely, reciprocal support exchange (Anto-
nucci & Akiyama 1987; Ingersoll-Dayton & Antonucci 1988; Maton 1988;
Rook 1987; Stoller 1985). In their studies, people who had reciprocal support
exchange showed better psychological outcomes than those with an exchange
imbalance. Walster, Walster and Bershied (1978) argued from the standpoint
of the equity theorist, that inequitable exchanges cause distress, and detract
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 333

from satisfaction with an individual’s relationship. In general, overbenefiting

causes a feeling of dependency or indebtedness, while underbenefiting makes
one feel burdened and frustrated in interpersonal relationships (Davey &
Eggebeen 1998; Lee & Ellithorpe 1982; Lu & Argyle 1992; McCulloch
1990; Rook 1987; Sprecher 1986). In an experimental study by Shumaker
and Jackson (1979), which focused on college students’ reciprocity of support
exchange, those students who could not exchange support reciprocally exper-
ienced negative feelings such as guilt and sadness. Brody and her colleagues
reported that elderly women were more likely to dislike receiving assistance
when they could not reciprocate than the younger generation (Brody, Johnsen,
Fulcomer & Lang 1983).
In Korea (Republic of Korea), the elderly population is growing rapidly.
The role of social support has recently come to be considered an important
issue among Korean gerontologists. However, few studies have examined the
effects of informal support in Korea. Especially, there are not many data
available, which examine the effect of support provided by the elderly to
the members of their network. The role of the elderly within their family or
community (cf. as a consultant when one needs to resolve an important thing)
has been weakened by the Korean society’s modernization which changed
the family structure from the extended family to the nuclear family type.
Under these circumstances, we assume that growing numbers of elderly do
not want to be just a receipt of support. Instead, they are willing to contribute
to their families or communities. There is an urgent necessity to clarify the
actual situation of social support exchange and its impact on QOL of the
elderly.
The objectives of our study were: (1) to examine the patterns of informal
support networks within family and friends among the Korean elderly,
including the aspects of providing and receiving support, and (2) to inves-
tigate the effect of providing support on the QOL of the elderly as well as
the effect of receiving support. We hypothesized that elderly who were both
providing and receiving support frequently would show a higher QOL.

Method

Sample

Subjects of this study were all community residents aged 60 and over living
in 14 small villages (called dongs) in Kyung-ju County, South Korea. This
county, now a part of Kyung-ju City, is located in the southeast part of
the Korean Peninsula. Recently, the population of this county has decreased
gradually due to the migration of young people to large cities. As a result,
334 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

in 1993 the proportion of elderly residents of this county aged 60 and over
was 20.8% (Annual Report of Kyung-ju County Health Center 1993). The
major industry of this county is agriculture and approximately 65% of the
population are engaged in it.
We tried to interview all of the elderly people identified as residents of
this county on the basis of resident registration forms, but some elderly
people who happened to be living in these villages during the survey period,
despite the fact that their resident registration had been made where their
children lived, were also included to ensure sufficient sample size. Thus, due
to inaccurate sample size, we could not calculate a response rate. While a
small number of elderly residents of this county could not participate in the
survey, mainly due to absence during the survey period or to certain health
problems, more than 90% of the elderly residents were willing to cooperate as
subjects of our study. We were able to collect data from 714 subjects, with the
participation of 24 interviewers recommended by the local health center. They
were intensively trained before the survey. A face-to-face interview survey
was carried out by these interviewers using a structured questionnaire in July
1994.

Measurement

The questionnaire included demographic items such as age, sex, living

arrangement, and marital status. Also, QOL, social support, and instrumental
activities of daily living (IADL) scales were included.

QOL. To measure QOL, we employed the Korean version of the Philadelphia

Geriatric Center Morale Scale (Lawton 1975) because of its two properties:
applicability to the elderly, and optimal length allowing reliability without
respondent’s fatigue (Bowling 1991). The reliability of this scale was deter-
mined in a previous study (Lee & Kai 1995). It includes 17 items, and we
coded them dichotomously. Range of the score is therefore 0 to 17, with a
higher score indicating higher morale. The internal consistency of this scale
was shown to be satisfactory in the case of the present sample (α = 0.79).

Social support. Social support was assessed on the basis of the frequency of
providing and receiving support to and from the spouse, children, and friends
based upon our original social support scale developed in a previous pilot
study (Kim, Lee, Hisata & Kai 1996). Although the scale demonstrated good
reliability and validity, we revised it to enhance the quality of the scale in this
study.
Emotional support was measured using two items: “Talking about worries
concerning personal problems” and “encouragement when depressed.”
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 335

Instrumental support was measured with the following two items: “Helping
with tasks” and “care when ill.”
To measure providing support, we questioned subjects about the frequency
of providing each kind of support: “How frequently to you give assistance
to your spouse, children, or friends respectively?” Subjects were asked to
choose one from the following: “Never (zero points),” “once in a while (one
point),” and “often (two points).” As for receiving support, we questioned
the subjects as follows: “How frequently do you receive assistance from
your spouse, children, or friends respectively?” We measured frequency of
receiving support in the same way as in the case of providing support.

IADL. We assessed physical function of the elderly using an IADL scale

developed by the Tokyo Metropolitan Institute of Gerontology, which
measures higher functional activities by five items: “Going out,” “shopping,”
“preparing meals,” “paying bills,” and “managing bank accounts” (Koyano,
Shibata, Nakazato, Haga & Suyama 1987). The scale was coded dichotom-
ously, and a higher score indicated better physical function. Our preliminary
study demonstrated the reliability of the scale in Korea: Test-retest coeffi-
cient was 0.86, and the internal reliability coefficient (α) was 0.88 (Lee, Kai,
Chun & Yeh, paper presented at the 5th Asia/Oceania Regional Congress of
Gerontology, 1994).

Data analysis

The pattern of social support exchange. A series of t-tests was used to

compare support scores by sex and living arrangement. Pearson’s correla-
tion coefficients were calculated to examine the relationship between social
support exchange and age and physical function.

The impact of social support exchange on QOL. Analyses of Variance

(ANOVAs) were used to examine the effect of social support on the QOL
of the elderly. We divided the subjects into high- and low-providing groups
on the basis of the median scores for providing support to each of the support
network members (i.e., spouse, children, friends). Similarly, subjects were
divided into high- and low-receiving groups on the basis of the median
scores for receiving support. In the analyses, providing support and receiving
support were treated as independent variables, while QOL score was treated
as a dependent variable. Since physical functioning of the elderly is an
important determinant of social support exchange (Kim, Lee, Hisata & Kai,
paper presented at the Annual Meeting of the Japanese Society for Hygiene,
1995), we treated it as a covariate. Analyses were conducted separately by
sex and support exchange partners (i.e., spouse, children, and friends). The
336 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

elderly who had no available partners, such as those who lost his/her spouse,
were deleted from the analysis.

Results

Demographic characteristics

Table 1 shows the demographic characteristics of the subjects. The majority

were in their 60s, and 59.8% were female. As for marital status, 59.5% were
married. 13.9% lived alone, and 32.6% lived only with their spouses. IADL
score distribution skewed to a high score: 75.8% of the subjects accomplished
independently all five items.
Table 1. Demographic characteristics

N (%)

Age 60–69 397 (55.6)

70–79 230 (32.2)
80–89 77 (10.8)
90 and over 10 (1.4)
Mean ± SD 69.7 (±7.6)

Sex Male 287 (40.2)

Female 427 (59.8)

Marital status Married 425 (59.5)

Widowed/never married 289 (40.5)

Living arrangement Alone 99 (13.9)

With spouse only 233 (32.6)
With unmarried child(ren) 101 (14.1)
With married child(ren) 87 (12.2)
With child(ren) and grandchild(ren) 158 (22.2)
Other 36 (5.0)

IADLa score 5 541 (75.8)

4 41 (5.7)
3 26 (3.6)
2 20 (2.8)
1 33 (4.6)
0 53 (7.4)
Mean ± SD 4.23 (±1.6)

Total 714 (100)

a IADL: instrumental ADL.
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 337

Social support scale

Table 2 shows the results of factor analysis with a varimax rotation of our new
social support items for providing support (accounting for 77.9% of the total
variance). Providing support was composed of three factors, i.e., the three
support partners, not the type of support.
The factor analysis of receiving support was performed in the same
manner as providing support. As shown in Table 3, receiving support consists
of three factors, i.e., the three support partners, and 77.8% of the total variance
was explained by these three factors.
Consequently, we measured social support by six scales: spouse providing
support, child providing support, friend providing support, spouse receiving
support, child receiving support, and friend receiving support. The alpha
coefficients of these scales were satisfactory (α = 0.89 ∼ 0.92).
Table 2. Factor analysis of providing support

Factor 1 Factor 2 Factor 3

Spouse Helping with tasks 0.89 0.12 0.17

Care when ill 0.89 0.06 0.11
Talking about worries 0.88 0.04 0.11
Encouragement 0.84 0.10 0.14

Child Helping with tasks 0.17 0.31 0.83

Care when ill 0.19 0.28 0.80
Talking about worries 0.21 0.29 0.75
Encouragement 0.07 0.32 0.81

Friend Helping with tasks 0.08 0.81 0.36

Care when ill 0.11 0.80 0.23
Talking about worries 0.12 0.83 0.23
Encouragement 0.02 0.79 0.35

PCT of var 48.1 21.3 8.5

Cum PCT 48.1 69.4 77.9

Social support score by sex

A average scores of social support according to sex are shown in Table 4.

As for providing support, it is apparent that the elderly provided support
most frequently to their spouses, followed by children and friends. When we
338 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

Table 3. Factor analysis of receiving support

Factor 1 Factor 2 Factor 3

Spouse Helping with tasks 0.91 0.06 0.06

Care when ill 0.90 0.02 0.17
Talking about worries 0.86 0.00 0.11
Encouragement 0.86 0.02 0.10

Child Helping with tasks 0.10 0.21 0.85

Care when ill 0.17 0.21 0.85
Talking about worries 0.20 0.20 0.77
Encouragement 0.00 0.24 0.83

Friend Helping with tasks 0.00 0.86 0.27

Care when ill 0.07 0.83 0.17
Talking about worries 0.10 0.83 0.17
Encouragement −0.06 0.85 0.23

PCT of var 41.1 24.6 12.2

Cum PCT 41.1 65.6 77.8

Table 4. Social support score by gender

Male Female Difference

N Mean ± SD N Mean ± SD t-value

Providing support
Spouse 251 6.0 ± 2.3 174 6.9 ± 1.8 4.73***
Child 283 4.0 ± 2.6 422 4.8 ± 2.6 3.97***
Friend 287 2.5 ± 2.1 426 2.8 ± 2.2 1.71

Receiving support
Spouse 251 6.8 ± 1.8 174 6.3 ± 2.3 2.29*
Child 283 5.3 ± 2.3 422 5.6 ± 2.2 2.12*
Friend 287 2.8 ± 2.2 426 3.1 ± 2.2 2.19*

*p < 0.05, ***p < 0.001.

 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 339

examined gender differences, females tended to provide more support to their

spouses and children than males.
In terms of receiving support, we found tendencies similar to those
observed for providing support. Examination of the frequency of receiving
support showed that the elderly received support most frequently from their
spouses, followed by children and friends. Concerning gender differences,
males scored higher in receiving support from their spouses, but the scores
were reversed for child and friend support.
To sum up, women received assistance more frequently from children and
friends, but they were not compensated by support from their husbands in
terms of support exchange.

Social support score by living arrangement

We show the average score of social support by the pattern of living arrange-
ment in Table 5. As for providing support, the elderly living with their
child(ren) provided support more frequently than those living alone or living
only with their spouses. However, there was no difference among spouse or
friend support in the providing aspect.
Table 5. Social support score by living arrangement

Alone With spouse only With child(ren) Other Difference

(N = 99) (N = 233) (N = 346) (N = 36) F-value

Providing support
Spouse – 6.5 ± 2.2 6.2 ± 2.3 6.5 ± 2.1 0.68
Child 4.0 ± 2.3 4.0 ± 2.6 5.1 ± 2.7 4.9 ± 2.9 10.99***
Friend 2.9 ± 2.2 2.5 ± 2.1 2.7 ± 2.2 3.3 ± 2.5 1.59

Receiving support
Spouse – 6.8 ± 1.9 6.3 ± 2.4 6.8 ± 2.0 2.79*
Child 4.5 ± 2.2 4.6 ± 2.3 6.3 ± 2.0 5.4 ± 2.4 38.85***
Friend 3.3 ± 2.2 2.7 ± 2.2 3.2 ± 2.3 3.5 ± 2.5 3.40*

*p < 0.05, ***p < 0.001.

On the other hand, receiving support score was different according to

living arrangement in all partners. More specifically, in spouse support, the
score was lowest among people living with child(ren). Child support was
highest among people living together with their child(ren). The elderly living
with their spouse received friend support least frequently.
Our results illustrate that the elderly living with their child(ren) had
higher child support both in providing and receiving, and less spouse support
340 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

compared with other people. On the other hand, receiving support from
friends was lowest among people living with their spouse only.

Correlation of social support with age and IADL

As shown in Table 6, providing support was significantly related to age and

IADL, except for spouse support and age. As the elderly became older and
weaker, they were less likely to give assistance to their family and friends
regardless of gender. IADL showed a stronger relationship with providing
support than with age. On the other hand, receiving support showed a weaker
correlation with age and IADL. A significant negative correlation between
the amount of support received from children and IADL score in both males
and females was evident. These results indicated that the elderly who had lost
physical functions received more help from their children.
Table 6. Correlations of social support score with age and IADL

Male Female
Age IADLa Age IADLa

Providing support
Spouse −0.04 0.32*** −0.09 0.21**
Child −0.27*** 0.32*** −0.21*** 0.31***
Friend −0.27*** 0.32*** −0.14** 0.23***

Receiving support
Spouse 0.02 0.08 −0.11 −0.03
Child 0.11 −0.18** 0.07 −0.18***
Friend −0.10 0.10 −0.05 0.04
a IADL: Instrumental ADL. **p < 0.01, ***p < 0.001.

The impacts of social support exchange on QOL

Concerning the impact of spouse support on QOL, there was no significant

main effect or interaction in the case of either men or women. This finding
suggests support provided to and received from the spouse has neither a
positive nor a negative effect on the QOL of the elderly.
The relationship between child support and QOL is shown in Figure 1.
We found a main effect of providing support (F = 10.40, p < 0.01) and an
interaction (F = 6.40, p < 0.05) in males. Providing support to their children
was positively related to a high QOL score. The men who belonged to the
high-providing/low-receiving support group showed the highest QOL score
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 341

Figure 1. Child support and QOL (Male; N = 283, Female; N = 422).

among all of the groups. On the other hand, main effects of providing and
receiving support were evident in females (F = 8.87, p < 0.01; F = 6.27,
p < 0.05, respectively). Both providing and receiving support in the case of
women showed a positive relation to QOL score.
With regard to the relationship between support exchange with friends and
QOL, we found a main effect of providing support (F = 7.49, p < 0.05) and an
interaction between providing and receiving support (F = 6.01, p < 0.05) in
men (Figure 2). In other words, the high-providing group showed higher QOL
scores than the low-providing group. The elderly men who provided more
support to their friends and received more support at the same time showed
the highest QOL scores. There was also a significant interaction between
providing and receiving support (F = 5.85, p < 0.05) in females. Women who
342 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

Figure 2. Friend support and QOL (Male; N = 287, Female; N = 426).

provided and received more support within their network of friends showed
the highest QOL scores.
The above results were almost identical when we analyzed the impact of
social support exchange on QOL of both married and unmarried elderly. To
summarize, the elderly who had frequent support exchange in both providing
and receiving support showed better QOL scores in most support exchange
situations.

Discussion

The results of this study suggest that the providing of support by the elderly
to their children or friends showed stronger positive effects on their QOL
than receiving support. Krause and his colleagues explained why providing
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 343

support could contribute to an individual’s subjective well-being on the

following grounds (Krause, Herzog & Baker 1992: 300). First, the realization
that one has helped another individual in need is a fulfilling and self-
validating experience that can enhance feelings of psychological well-being.
Second, giving aid to others fosters intimacy and trust, thereby strengthening
existing social bonds. Third, giving support to significant others increases
the probability of assistance when one needs it in the future. It seems that the
experience of such feelings as helping someone in need and being appreciated
for the support he or she gives to others is important to maintain social roles
of the elderly who are likely to lose these roles with aging.
We examined the impact of providing support and receiving support
among three support exchange partners, that is, spouse, children, and friends,
and found that there were remarkable differences depending on those rela-
tionships. The results of our analysis indicated that the frequency of support
exchange with wife or husband had no significant impact on QOL among the
Korean elderly. It is possible that spouse support is so frequently exchanged
that it is difficult for spouses to appreciate such supportive behavior. In Korea,
it is sometimes said that the existence of a spouse is like ‘oxygen in the
air,’ which means it is too natural for one to recognize the importance of
its existence until one loses it. Thus, support exchange with their spouses did
not show any clear effect on the QOL of the Korean elderly.
Concerning child support, men who provided more support to their
children had higher QOL than the low-providing group. It was also revealed
that in women, both providing and receiving support was positively related
to their QOL. Despite the fact that there is a general belief in Korea that
only people are always in need to some kind of assistance from the younger
generation, our data demonstrated that the elderly who provided more support
to their child(ren) showed a better QOL. The concept of Antonucci’s (1985)
‘support bank’ might party explain the gender difference regarding child
support. According to her, women generally have an investment of support
with their children as a result of rearing and caring for them when their
children are young, and they feel less of a psychological burden when they
need to receive help from their children. Thus, the strong and more intimate
relationship of a mother and her child(ren) may lead to a positive correlation
between frequent support exchange and QOL in women.
In the case of support exchange with friends, the elderly who received
more support from friends but who provided less support in turn had the worst
QOL in both men and women. In addition, the high-providing group showed
better QOL than the low-providing group in men. It is said that elderly people
tend to be more satisfied when they are underbenefited than overbenefited in
friend relationships (Roberto & Scott 1986). Our results might be explained
344 H-K. KIM, M. HISATA, I. KAI & S-K. LEE

by the fact that friendship was less intimate than the family relationship, so
the elderly might hesitate to receive support from friends without reciprocal
compensation. In this context, receiving assistance from friends might cause a
feeling of emotional burden, whereas providing support could maintain a high
QOL of the elderly by enhancing the feeling of attainment and self-esteem.
From our findings, the hypothesis that frequent support exchange in both
providing and receiving support would enhance the QOL of the elderly was
partly substantiated. The elderly who exchanged support frequently with
members of their network showed the highest QOL scores in the majority of
support exchange situations. Regarding this, the discussion in Maton (1988)
is highly suggestive. He used three concepts in his interpretation. The first
concept is ‘additive benefits’. Definitely providing and receiving support lead
to psychological benefits. Therefore, individuals who have both will obtain
more benefits. The Second concept is ‘balance theory’. There are psycholog-
ical costs in receiving and providing support, but the individuals do not feel
such costs if the costs are balanced. The third concept is ‘need and resource’.
The individuals who have frequent support exchange are emotionally and
socially competent, so that they are able simultaneously to provide support to
others and to receive support from others. The results of our study confirmed
the importance of reciprocity of support exchange among the support network
members.
The results of this study also indicated that the Korean elderly had family-
centered support networks in both providing and receiving support. These
results are consistent with previous studies which revealed that the elderly
have family focused informal support systems (Koyano, Hashimoto, Fukawa,
Shibata & Gunji 1994; Penning 1990; Sung 1991). We found gender differ-
ences in support exchange patterns. Women provided more support to their
husbands, yet they were not reciprocally rewarded with support from their
husbands. However, women received frequent support from their children
and friends. As noted by Antonucci (1990), in general, women tend to have a
more extended support network and more frequent contact with their network
members. Furthermore, traditionally women have more important roles than
men in the family networks (Shenk 1991).
The picture of social support exchange differed by living arrangement.
Overall, elderly people who live together with their child(ren) exchanged
support more frequently with child(ren) than people who have other types
of living arrangement. We understand that this tendency arose from the fact
of accessibility to the support exchange partner.
Our data also revealed that there is a stronger relation between IADL and
support providing and receiving than between IADL and age. Elderly subjects
were able to provide less support to their family and friends as their physical
 SOCIAL SUPPORT EXCHANGE AND QUALITY OF LIFE 345

functions declined, whereas they received more support from their children.
Our results confirmed the findings of previous studies by Morgan, Schuster
and Butler (1991) and Antonucci and Akiyama (1987), which showed that
there was a decrease in the amount of support provided as people age among
American elderly. It seems that the decrease in providing support was attrib-
utable to an inability to assist others. The idea of filial piety is still important,
although weakening, in Korean society. Children, especcially the eldest son,
have a responsibility to take care of their parents. Under these circumstances,
receiving support from children is likely to increase as the elderly get weaker.
Several limitations in our study should be mentioned. First, the sample
of this study was drawn from a rural community, and the results obtained are
not necessarily applicable to the urban elderly. Second, our study respondents
were limited to community residents who could live independently. Thus,
it is necessary to investigate the impact of social support on the subjective
well-being of elderly people with diminished physical functions. Third, the
design of this study is cross-sectional, so we cannot infer a causal relationship
between social support and QOL.
In conclusion, the results of our present study indicate that together with
receiving support, providing support is also important for the maintenance
of QOL of the elderly. Furthermore, data from our research suggest the
possibility that the effects of support vary according to the relationship of
the elderly individual to other members of their social network, specifically
their spouse, children, and friends. Future research should further explore the
potential benefits of providing support. It may contribute to the empowerment
of elderly people, and thus, enhance their QOL in the coming super-aging
society.

Acknowledgments

This research was funded by a grant from the Sasakawa Health Science
Foundation, a grant from the Universe Foundation, and a JSPS (Japan Society
for the Promotion of Science) Research Fellow grant. We thank the respond-
ents and interviewers for their participation and Kyung-ju County Health
Center for cooperation.

References
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Address for correspondence: Hye-kyung Kim, PhD, Department of Health Sociology, Tokyo
Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
Phone: +81 3 3964 3241, ext 3116; Fax: +81 3 3579 4776; E-mail: kyung@tmig.or.jp