Coping and Stress



Coping and Stress


Objectives



Key Terms


coping (p. 227)


distress (p. 224)


imaging (ĬM-image-jimageng) (p. 228)


mantra (MĂN-tră) (p. 230)


meditation (p. 228)


relaxation (p. 228)


self-hypnosis (p. 228)


imagehttp://evolve.elsevier.com/Wold/geriatric


Normal stress and coping


Stress is a normal part of life. No one lives without it. Stress occurs when a person is faced with a real or perceived threat or experiences a significant or life-altering change. Stressors include external physical threats such as extreme heat or cold, noise, or physical trauma; internal or psychological threats such as thoughts and feelings; and external social threats such as job pressures or changeable social relationships. Stress often results from a combination of these factors. The more stressors a person faces, the greater the level of stress will be. Stress occurs whether the threat or change is positive or negative.


Each of us faces a steady stream of life events with which we must cope. Some are temporary or minor events, such as taking a test or giving a speech, which may cause mild distress for a short period. Major life events such as the death of a spouse, serious injury, birth of a child, or marriage are likely to cause significant stress that lasts for a longer period. People experiencing high levels of stress feel exhausted, anxious, and vulnerable.


Different experiences are stressful to different people. Individual perceptions play an important role in determining what constitutes a stressor. For example, muscle pain is a stressor to most people but not to an athlete who views it as a measure of training. Public speaking is highly stressful to most people, but not to a politician who does it every day.


Various rating scales have been developed to quantify the amount of stress caused by common social and psychological occurrences in the lives of older people (Table 13-1). In these rating scales, various events are based on the proportional amount of distress involved. These scales are useful general guides when one attempts to measure the amount of stress caused by a particular event. Stress is cumulative, and a combination of several smaller stressors can have the same effects as a major stressor. The more stressors a person faces at a time, the greater the likelihood will be of physical, cognitive, and behavioral changes.



Table 13-1


Stokes/Gordon Stress Scale: Selected Items
















































































































































































Rank Event or Situation Weight
1 Death of a son or daughter (unexpected) 100
2 Decreasing eyesight 99
2 Death of a grandchild 99
3 Death of spouse (unexpected) 97
4 Loss of ability to get around 96
4 Death of a son or daughter (expected, anticipated) 96
5 Fear of your home being invaded or robbed 93
5 Constant or recurring pain or discomfort 93
6 Illness or injury of close relative 92
7 Death of spouse (expected, anticipated) 90
7 Moving in with children or other family 90
7 Moving to an institution 90
8 Minor or major car accident 89
8 Needing to rely on cane, wheelchair, walker, or hearing aid 89
8 Change in ability to perform personal care 89
10 Loneliness or aloneness 87
11 Having an unexpected debt 86
11 Your own hospitalization (unplanned) 86
12 Decreasing hearing 85
13 Fear of abuse from others 84
13 Being judged legally incompetent 84
13 Not feeling needed or having a purpose in life 84
14 Decreasing mental abilities 84
15 Giving up long-cherished possessions 82
15 Wishing parts of your life had been different 82
16 Using your savings for living expenses 80
17 Change in behavior of a family member 79
18 Taking a relative or friend into your home to live 78
19 Concern about elimination 77
19 Illness in public places 77
20 Feeling of remaining time being short 76
20 Giving up or losing driver’s license 76
20 Change in sleeping habits 76
21 Difficulty using public transportation 75
23 Uncertainty about the future 73
25 Fear of your own or your spouse’s driving 71
27 Concern for completing required forms 69
27 Death of a loved pet 69
29 Reaching a milestone year 67
32 Outstanding personal achievement 64
33 Retirement 63
35 Change in your sexual activity 59

Modified from Stokes SA, Gordon SE: User’s manual, SGSS, Pleasantville, NY, 1988, Pace University.


When confronted with stressful events, the body undergoes predictable physiologic responses that prepare it to withstand the threat and to maintain homeostasis. The general adaptation syndrome, described by Dr. Hans Selye, describes the collective responses of the body to stress. According to this theory, stress activates both the sympathetic and parasympathetic components of the autonomic nervous system, initiating a series of physiologic responses.


The general alarm reaction, often called the fight-or-flight response, occurs first. In this stage, the body undergoes a predictable range of responses or physiologic changes that are designed to overcome the threat. If these physiologic responses are effective, the body enters a stage of resistance during which it returns to normal functioning. If the responses are not effective, the body depletes its energy reserves and enters the stage of exhaustion. In the most severe cases, this exhaustion can result in death.


Physical Signs of Stress


Physical signs of stress are similar in both the young and older adults. These are summarized in Table 13-2.



Cognitive Signs of Stress


In addition to physiologic changes, stress affects the way we think, feel, and act. Although some stress is normal and necessary, high stress levels can be physically and mentally exhausting.


Mild stress results in an increased state of alertness. Individuals experiencing mild stress are able to pay attention to details, to learn, and to solve problems. With increased stress levels, these abilities decrease rapidly.


Persons experiencing severe stress are likely to miss obvious details and might forget even the most basic information. Problem-solving ability is severely affected. Under stress, people are likely to develop tunnel vision, in which they become narrowly focused on one aspect of a problem and ignore other important facts. These individuals are likely to act irrationally or impulsively and make poor choices. Some become incapable of making any decisions at all. Some research even indicates that stress can cause physiologic changes in the brain that have an adverse effect on memory.


Emotional Signs


People experiencing high levels of stress are likely to complain of fatigue, tension, and anxiety. They often report a sense of foreboding or a feeling that something is wrong. They may appear distracted, irritable, short-tempered, or even angry. People living with high-level stress often verbalize feelings of poor self-worth or low self-esteem. They may appear to be so wrapped up in their own problems that they have little capability for or interest in interacting with others. When stress becomes severe, people may experience signs of clinical depression or even verbalize suicidal thoughts.


Depression, which is a major problem among older adults, is not easily identified or diagnosed. Depression is often missed because it occurs in conjunction with the numerous physical and social changes that occur with aging. Depression is more than the down moods that everyone experiences. Depression is a whole-body syndrome that causes physiologic, emotional, and cognitive changes in older adults. The notion of mental illness is unsettling to many older people, who feel that seeking help for mental problems is a sign of a weakness that they should be able to overcome alone. Older persons are more likely to seek attention for physical symptoms than they are for feeling depressed. Symptoms such as chronic pain, appetite loss, sleeplessness, loss of interest, and even dementia-like behavior are often attributed to other problems, and the underlying depression is missed. This is unfortunate, because 60% to 80% of the identified cases of depression can be treated using psychotherapy, medication, or a combination of both.


Depression, while common, is not a normal part of aging. In fact, studies have shown that most older people are satisfied with their lives. It appears that working through the stressors of a lifetime has enabled many older people to develop a high level of self-knowledge and strong coping skills. Depression appears to be most common when older adults are under physiologic stress. Depression is also likely to occur when older adults perceive that they have lost control of a situation, that they lack the support of significant others, or that their normal coping mechanisms have been overwhelmed by the number or severity of stressors (Boxes 13-1 and 13-2).




Behavioral Signs


People attempt to cope with stress in different ways. Some avoid all interactions or tasks that might increase their stress level, whereas others take on additional duties in an attempt to block out the source of their distress. In either case, performance is likely to suffer. People under stress tend to be disorganized, make more errors, and leave tasks incomplete. They may appear and even sound muddled.


The thoughts, statements, and actions of stressed people often jump around in a scattered or disconnected manner. They may pace, hum, or perform other ritualistic actions such as finger drumming, key jangling, or toe tapping. Temper tantrums, shouting, and other aggressive behaviors can occur without warning.


Self-medicating is one response to dealing with depression and other situational problems. It is certainly not a recommended method, but one that is all too common among all age groups, including the elderly. The substances most commonly abused include tobacco, alcohol, and prescription drugs. Some elderly also abuse illicit street drugs, and this number is expected to climb as Baby Boomers get older. Most older adults are aware that tobacco has harmful effects and continue to use the substance in spite of warnings. Although it is physically damaging, tobacco does not have the same effects on the mind and behavior as do alcohol and drugs.


While some people have abused substances from early in life onward, as many as one-third of addictions occur later in life. Drugs such as anxiolytics, tranquilizers, analgesics, and other mood-altering drugs are among the most common prescriptions given to elderly adults. Many times an older person receives prescriptions from several physicians, thus increasing the availability and potential for abuse. As discussed in Chapter 7, many older adults do not adhere to the directions given on a prescription. They alter doses and frequency to suit themselves, increasing their risk for tolerance and dependence. Because the use of alcohol is legal, socially acceptable, and readily available, it is most often an abused substance.


Alcohol tolerance changes as a result of altered physiology. Decreased lean muscle mass, changes in liver enzyme function, and increased nervous system sensitivity to alcohol decrease the safe level of intake for the elderly. Older adults who have abused alcohol for many years consume larger amounts and more often than those who start abusing alcohol later in life. Long-time abusers are more likely to have classic symptoms of alcoholism, experience disturbed family or social relationships, and experience withdrawal when alcohol consumption is stopped suddenly. Late-life abusers are more likely to drink in response to stressful events. They suffer fewer physical symptoms, are less likely to experience withdrawal, and are more likely to have intact relationships. Both groups are likely to drink alone, at home, and in response to stressful or negative emotional perceptions.


Most physicians and nurses overlook alcohol problems in the elderly. Signs of alcohol and drug abuse are sometimes missed because they mimic changes seen with aging such as bone density changes, urinary incontinence, altered sleep patterns, unsteadiness, hypertension, stomach complaints, falls, and so on. Substance abuse should be evaluated even though they seem unlikely. Although more men have substance abuse problems, elderly widows who live alone are also a high-risk group.


Mental health resources and support groups are available in many communities to help with substance abuse. Many are tailored to meet the specific needs of the elderly.


Stress and Illness


Stress and illness are closely linked. Research has shown that both mental and physical illness results in stress and that stress increases the risk for both mental and physical illness. A physically ill person is less able to cope with additional physical or psychological stressors, which take energy away from the already depleted reserves and decrease the ability to cope. Stress can interfere with the ability to learn, function, and follow through with the plan of care. Decreasing the number of stressors or the level of stress can prevent illness or improve a person’s ability to cope with existing illnesses.


Stress has been shown to have negative effects on many body systems. Because stress activates the sympathetic nervous system (fight-or-flight response), the older person under high levels of stress is at increased risk for angina, heart rhythm abnormalities, and even heart attack. Stress is associated with hypertension and may increase the risk for stroke. The immune system is affected, increasing susceptibility to infections and potentially impairing an older person’s response to immunizations such as the pneumonia vaccine. Gastrointestinal problems such as ulcer, GERD, and irritable bowel disease are more likely to occur or worsen when an older person is under stress. Stress can exacerbate sleep problems and often triggers painful headaches or muscle spasms.


People differ in their abilities to cope with stress. Those who do not learn to cope effectively with normal day-to-day stressors cannot function normally when the stress level is high and thus are at risk for becoming physically or mentally ill. Those who do learn good coping strategies can maintain their ability to function despite high-level stress. Many different coping or defense mechanisms are used as part of day-to-day living (Box 13-3). People who are able to cope effectively usually rely on several of these mechanisms. Coping mechanisms are neither good nor bad; they become dysfunctional only when used excessively or inappropriately as a way of avoiding dealing with the stressors.

Related posts:

  1. Theories of Aging
  2. Sleep and Rest
  3. Values and Beliefs
  4. Care of Aging Skin and Mucous Membranes

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Jul 11, 2016 | Posted by in NURSING | Comments Off on Coping and Stress

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