Social Support Attainment of Older Adults Living in a Flood-Prone Community

Introduction: A flood, a catastrophic phenomenon often experienced by many, brings destruction to property and livelihood. This kind of event renders access to basic services difficult. During times of floods, older adults need additional social support, from family, friends, relatives, or significant others. The aim of this study was to investigate the level of attainment of social support of older adults during periods of floods and periods without floods. Methods: A descriptive quantitative research design was used. Purposive sampling was utilized to reach the population sample of 126 elderly respondents. They were interviewed face-to-face in their homes using a modified questionnaire. To analyze the data, descriptive statistics and mean scores were used. Results: 126 older adults participated in the research study. Most older adults strongly agreed that they received social support during periods of floods (with a mean score of 4.40) and without floods (with a mean score of 4.39). Discussion: Social support was extended to older adults both during times of floods and without floods. The support they received from people who were special to them maintained their health and well-being. ARTICLE HISTORY Received: October 9, 2020 Accepted: November 11, 2020


INTRODUCTION
Social support is a fundamental and substantial need for every person. With the attainment of this need, people can live well. At the community level, for instance, older adults are one of the groups of people who need social support because they have a higher prevalence of chronic diseases, physical disabilities, and other co-morbidities (Benson, 2013). Due to the predicted physical changes related to aging, they are a vulnerable age group (Orimo et al., 2006). Wu et al. (2015) concluded that the emergence of natural catastrophic calamities such as floods further hampers the attainment of social support among older adults.
Globally, older adults in both developed and underdeveloped countries have been affected by the effects of natural catastrophes with regard to attaining social support (WHO, 2008). Abraham (2016) reported that older adults were seriously affected by the 2013 and 2014 severe flooding in northern England and northwest Europe. Similarly, older adults were significantly affected by the severe flooding in the southeastern United States due to Hurricane Katrina (Dyer, 2006). Moreover, Wu et al., (2006) indicated that flooding is considered one of the most severe forms of natural disasters affecting various age populations, including older adults.
The Philippines has recorded debilitating effects of natural catastrophes due to various tropical storms affecting the country (Cadag et al., 2017). The tropical storms Haiyan (Yolanda), Bopha (Pablo), Nesat (Pedring), Washi (Sendong), Ketsana (Ondoy), and Parma (Pepeng) caused severe flooding in the lower regions of the urban and rural areas of the country in 2013, 2012, 2011, and 2010(Gilbuena, Kawamura, Medina, Amaguchi, & Nakagawa, 2013. In 2014, the Intergovernmental Panel on Climate Change (IPCC) forecasted that coastal regions and disaster-prone areas were likely to experience intense flooding due to typhoons and tropical storms. Fernandez, Stoeckl, and Weltres (2019) emphasized that the possible severe impact of these events could be devastating to the lives of the Filipinos residing in those areas. The social support that people may receive during these debilitating times has been hampered by some destruction in the national and provincial roads.
The Biliran Province, an island community situated in the Philippines, is considered a very highrisk place for climate and weather-related threats (Santos, 2016). Empirical study results showed that the four typhoons, namely Urduja in 2017, Yolanda in 2013, Pablo in 2012, and Ruby in 2004, hit the province and caused serious flooding in some areas and municipalities. Local reports indicated that injuries occurred, but there were undocumented cases of injuries for elders. Among the areas of Biliran, Barangay Poblacion in the municipality of Almeria was identified as one of the flood-prone places. It has been noted in the historical accounts of flooding in the Poblacion, which started in the year 1961 when Typhoon Bebing caused heavy flooding in the area.
However, the effects of the naturally-occurring phenomenon on older adults in Biliran Province, specifically in Almeria, remained uninvestigated. There has been a dearth of research studies elucidating the extent of older adults' attainment of social support, both in periods of floods and periods without floods, especially considering that older adults are a vulnerable population. Meeting their social support needs will foster their increased health, enabling them to live longer. The aim of the study was to investigate the level of the attainment of the social support of older adults living in the floodprone community of the Biliran Province during a flood and when no flooding was present.

Study Design
A descriptive quantitative study design was conducted through a cross-sectional approach.

Respondents
The respondents of the study were 126 older adults age 65 years old and above. The inclusion criteria included elders who were willing to participate in the study, who were ambulatory and able to talk, communicate, and express their thoughts. The exclusion criteria included those elders who could not talk, were bed-ridden, stuporous, or comatose.
A purposive sampling design was utilized in the study. The Senior Citizen Organization located in one of the district in Philippines, provided a list of 186 senior residents in the locality, and out of that number, 126 seniors consented to participate.

Instruments
The instrument utilized in the study was derived from the studies of Zimet, Dahlem, Zimet, and Farley (1988). The modified questionnaire was composed of two parts. Part I included the determination of the respondents' demographic profile in terms of age, gender, marital status, common illnesses, presence of chronic disease, and living style. Part II included data on the scoring of how the participant felt about five (5) statements of social support. These items were categorized according to the following sources of social support: acquaintances, relatives, and other important persons related to the care of the elderly. This part covers two periods: when there is no flood and when there is a flood. Each period has a scale to assess the social support acquired by the older adult. Responses were scaled with a five-point Likert-scale. Numbers 5, 4, 3, 2, and 1 represented strongly agree, agree, neutral, disagree, and strongly disagree. The scoring and quantification were designated as follows: 4.21-5.00 indicated strongly agree, 3.41-4.20 indicated agree, 2.61-3.40 indicated neutral, 1.81-2.60 indicated disagree, and 1.00-1.80 indicated strongly disagree. The semi-structured questionnaire was scrutinized by an external panel to improve certain items in order to ensure reliability and validity.

Data Collection
The researchers interviewed the respondents using the modified questionnaire. Before the actual interview, informed consent was secured. An explanation of the study's intent was conducted, and the study's duration was explained. Those who could not read and write were assisted by their caregivers or the researchers to complete the questionnaire.

Data Analysis
The data gathered was tallied using Microsoft Excel. In analyzing the data, the study utilized the following statistical techniques: Descriptive statistics were used to describe the population studied. Simple frequency and percentage were utilized to determine sample characteristics in terms of age, gender, marital status, common illness, presence of chronic disease, and living style. Mean scores were used to determine the level of attainment of social support of the older adults.

Ethical Consideration
Before embarking on the study, the researchers sought ethics approval from the internal review panel. Once the study was approved, the older adults Strongly Agree were given informed consent forms to read and sign. Then, a thorough explanation of the purpose of the study took place prior to the actual interview. Signing the informed consent form indicated that the participant wanted to join the study. However, the participants were reminded that they could withdraw at any time. The consent process was also used to determine willingness for continued participation in the research endeavor. Issues of anonymity and confidentiality of data were also addressed throughout the study using the following measures: (1) replacement of names with pseudonyms and other identifying information to conceal the identity of the interviewee; (2) data was stored in a locked cabinet inside a secure room; (3) data in computers were secured with a password that only the researchers could access; and (4) files will be destroyed five years after the study.

RESULTS
The findings of the study revealed that during floods, most older adults had people who provided them with comfort, with a mean score of 4.47. Similarly, the older adults answered that these people were the ones with whom they shared their joys and sorrows, garnering a score of 4.46, and were around them especially in times of need (with a mean score of 4.44). Also, findings showed that there were special people in the older adults' lives who cared about their feelings, with a mean score of 4.39. Last, older adults responded very strongly that their friends were the ones they could talk to when they had problems, with 4.26 as the mean score. The answers of the older adults referring to times when there is no flood showed a slim variance with their answers when there is a flood. First, older adults responded that there were special people with whom they shared their joys and sorrows (mean score of 4.48). Second, older adults considered these special people as the group of people who were around with them whenever they needed help (mean score of 4.46). Third, older adults answered that they had special people who provided them with the comfort they needed (mean score of 4.44), and the same people were recognized by them as the ones who truly cared about their feelings (mean score of 4.37). Last, older adults shared that they had friends to whom they could talk whenever they need good conversation (mean score of 4.22). Generally, the overall findings of the study revealed a slight difference of the results on the level of attainment of social support for older adults both during floods (mean score of 4.40) and without floods (mean score of 4.39).
Generally, the findings of the study revealed a slight difference in the results on the level of attainment of the social support for older adults both during a flood (mean score of 4.40) and when there was no flood (mean score of 4.39). The above findings are presented in Table 1.

DISCUSSION
126 older adults participated in the research study. Most of them were 65-74 years old, female (61.9%), widowed (47.62%), had chronic diseases (60.32%) such as hypertension and diabetes mellitus, and had common issues such as coughs and colds (63.49%). Also, they tended to live with their spouses and offspring (41.27%).
Older adults in the study were surrounded by significant people who journeyed with them during the flooding in Barangay Poblacion, Almeria, Biliran. These people were their children, partners, family, and significant others who had been with them through ups and downs. The older adults considered these people as special people who were readily available for them (with a mean score of 4.44 with flood and 4.46 without flood). These individuals were those to whom the elderly could turn in times of flooding. According to Hays (2015), Filipinos deeply value their family and culture. They are very sociable and love to have good conversations with family and friends.
The older adults genuinely felt they had someone who could share their joys and sorrows (with a mean score of 4.46 with flood and 4.48 without flood). This someone was a loved one, friend, relative, or significant other. They shared their happiness and sadness. Filipinos are people who enjoy fun and still maintain good attitudes in the face of adversity. According to Global Affairs Canada (2019), Filipinos are sociable, friendly, good-natured, and hospitable. These traits are shown whenever they are at home or in their work environment. Therefore, sharing joys and sorrows with friends is very common. They live in the present moment, rather than dwell on the past, and think of what might be in the future (Hays, 2015).
In addition, the majority of older adults strongly agreed that they had a special someone to give them comfort and ease (with a mean score of 4.47 with flood and 4.44 without flood). This same person tried to help them in times of need, especially during flooding. When facing the ultimate unknown, older adults also had another source of solace: religion and spirituality. According to Llaneta (2018), there is a clear correlation between religion, spirituality, and health in the elderly. The anxiety faced by the elderly dissipates when they have faith to hold on to, to give them a sense of fulfillment and positive well-being. Spirituality and religious involvement have been strongly associated with healthy productive aging, nutrition, fitness, mental stimulation, selfeffectiveness, and communal interaction.
Older adults also mentioned that these special persons truly cared about their emotions and feelings (with a mean score of 4.39 and with flood and 4.37). This finding shows an obvious increase in support received by older adults during flooding periods. This support will lessen the possible apprehension and depression that would be felt by elders who are more susceptible to the dangers caused by isolation.
Depression and suicidal tendencies are common among older adults (Pejner et al., 2012). Knowing that someone cares about their feelings relieves some of their emotional baggage. Spouses, children, or friends are significant persons that help the elderly feel cared for and loved. That is why it is not uncommon to find older adults living with their children and families.
Last, older adults had trustworthy friends with whom they shared their problems (with a mean score of 4.26 with flood and 4.22). It was noticeably apparent that there was an increase of support received by the older adults whenever they needed someone to support them. Their friends always lent a helping hand when things went wrong. They valued friendships and being useful. This means that in times of trouble or calamity, older adults can rely on their friends. According to Global Affairs Canada (2019), Filipinos are sociable in nature, which allows them to befriend almost anyone they meet. They are able to form groups that will back them up when faced with uncertainties. Interim HealthCare (2015) presents an important link between social interaction and senior individuals' health. Filipinos believe that to feeling loved and needed or to have someone to speak to each day are crucial elements in living a healthy life.

CONCLUSION
There is a noticeable slight increase in social support extended to older adults during a flood compared to when there is no flood. The special persons were untiring in providing physical, emotional, psychological, and spiritual support to older adults during this time. These forms of support were beneficial to maintaining the health and well-being of the older adults whether or not there was flooding. The policymakers should craft a plan of action to maintain social support for older adults, especially during flooding.