Stress among the aged and

coping strategiesPresented by : Sunita Sijwali

Dept of Extension and Communication Management

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“Everyman desires to live long, but

no man would be old.”

Johnathan Swift, 1667-1745

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Aging

• Aging is a process of general, irreversible,and progressive physical deteriorationthat occurs over time.

• This process usually occurs after sexualmaturation and continues up to the timeof maximum longevity (life span) formembers of a species.

• Death is the final event.

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What is “Normal Aging”?

• Two groups:

▫ Those with disease

▫ Those with “normal” health

• Society has a widespread belief, however, that physical and mental declines are inevitable as we age.

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Stress, Anxiety and Depression

• Stress is an everyday part of our lives and a normal reaction to a situation where you feel under pressure. It’s part of our primal “fight or flight” response and is intended to keep us safe and alive

• Stress causes your body to release stress hormones, which stimulate your brain and body. Over time, that type of stimulation can take a negative toll on an older person.

• Anxiety, however, is still having those feelings of stress long after the actual offending event has passed. This constant feeling of being stressed, even though there no longer exists an imminent stressful situation you have to deal with, is what is classed as anxiety.

• Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness and poor concentration.

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Stress, Anxiety, and Depression –

• Stress is usually a precursor to anxiety, and anxiety is usually a precursor to depression.

stress anxiety depression

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• Stressful life events often precede anxiety disorders (Faravelli & Pallanti 1989, Finlay-Jones & Brown 1981).

• Interestingly, long-term follow-up studies have shown that anxiety occurs more commonly before depression (Angst &Vollrath 1991, Breslau et al. 1995).

• In fact, in prospective studies, patients with anxiety are most likely to develop major depression after stressful life events occur (Brown et al. 1986).

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SAD among the aged

• In older persons, stress is thought to play a bigger role in triggering depression than in other groups.

• Like childhood, old age brings special pressure, unique upsets, and key biological changes

• The stresses of elderly people need not result in psychological disorders, if treated early.

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Who is at riskElderly

Live alone

Are economically disadvantaged

no relatives or friends

experienced recent losses

Have been ill or have a progressive orchronic illness

experienced a head injury

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Leading Causes of Stress

• Disintegrating family bond and relationship

• Work Pressure and Financial Insecurity

• Health Hazards

• Poor Nutrition

• Lack of Rest

• Personal Relationship

• Social Environment and Panic of Terror

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Loss and Grief

Role Loss ( spouse , friends, work) and Acquisition

(Grandparenthood and great-grandparenthood) provide

both new demands and opportunities.

Social Status

Changes in social identity: due to role loss in retirement

Losses in physical capacity and reserve

Functional losses may place older persons in help-seeking

rather than help-providing roles

Examples OF STRESSORS2/2/2015

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How stress affects older adults

• Studies show that long-term stress can damage brain cells, leading to depression. Depression is one of the most dangerous effects of stress in older people.

• Fatigue• Loss of memory and concentration• Inability to fight off or recover from illness• Increased risk of chronic diseases such as heart disease

and cancer• Irritability or moodiness• Consuming too much alcohol• Symptoms of stress may include anxiety, sadness,

trouble eating and sleeping, aches and pains, and weight loss.

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Anxiety Disorders in Later Life• Anxiety is also common among the elderly

• At any given time, around 6% of elderly men and 11% of elderly women in the U.S. experience at least one of the anxiety disorders

▫ GAD is particularly common, experienced by up to 7% of all elderly persons

▫ Anxiety in the elderly may be underreported

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Anxiety Disorders in Later Life• There are many things about aging that may

heighten anxiety levels, including declining health▫ Researchers have not, however, systematically tied

anxiety disorders among the elderly to specific events or losses

• Older adults with anxiety disorders are often treated with psychotherapy of various kinds, particularly cognitive therapies▫ Many also receive antianxiety medications

Again, all such drugs must be used cautiously with older people

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▫ Excess or undue worry or fear

▫ Fatigue

▫ Disturbed sleep

▫ Jumpiness, jitteriness, trembling

▫ Muscle aches, tension

▫ Dizziness, lightheadedness

symptoms

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AnxietyHow it works… Our rest system shuts down

and stress response kicks on.

We are too relaxed even tiered.

Our minds go blank and we feel helpless.

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Depression in Later Life

• Depression is one of the most common mental health problems of older adults

• The features of depression are the same for elderly people as for younger people▫ As many as 20% of people experience this disorder at

some point during old age The rate is highest in older women

• Several studies suggest that depression among older people raises their chances of developing significant medical problems

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Depression in Later Life• Like younger adults, older people who are

depressed may be helped by cognitive therapy, interpersonal therapy, antidepressant medications, or a combination of these approaches

▫ More than half of older patients with depression improve with these treatments

▫ It is sometimes difficult for elderly people to use antidepressant drugs effectively and safely because the body’s metabolism works differently in later life

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Depression Symptoms:

• Poor appetite or weight Loss

• Insomnia or hypersomnia

• Loss of energy or tiredness

• Psychomotor agitation or slowing

• Loss of pleasure in usual activities or decrease in sexual drive

• Feelings of self-reproach or excessive guilt

• Diminished ability to concentrate

• Suicidal ideas, wishes or attempts.

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Cellular clock theory

Stress, aging and telomeres• Researchers recently confirmed that people subjected to

chronic stress tended to have shorter telomeres. • Cells with long telomeres live longer. Short telomeres

have been linked to a wide range of human diseases, including coronary heart disease, osteoporosis and HIV infection. Shortening of telomeres is prevented or reduced by telomerase, which has been shown to keep immune cells young by preserving their length and ability to continue to divide and reproduce accurate replicas.

• Chronic stress results in increased secretion of cortisolthat causes a rise in blood sugar and blood pressure and reduces inflammation and immune system resistance to infection.

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• The stress theory of aging emphasizes that stressful environments cause cellular damages, disruption of cellular functions, and eventual organismal aging.

• Loneliness and Shortened Telomeres

• An April 2014 study by scientists at the Vetmeduni Vienna in Austria examined the telomere length of isolated “lonely” African grey parrots compared to parrots with a partner. The researchers found that the telomere lengths of single parrots were shorter than those housed with a companion parrot. African grey parrots are highly social birds, but unfortunately in captivity they are often kept in isolation from other parrots.

• Phobic Anxiety and Shortened Telomeres

• A July 2012 study from Brigham and Women’s Hospital (BWH) found that chronic phobic anxiety shortened telomere length in middle-aged and older women. The study suggests that untreated chronic phobic anxiety is a possible risk factor for accelerated aging.

• Untreated Depression and Shortened TelomeresThe scientists discovered that within the cells of the immune system, activity of telomerase is generally greater in individuals with untreated major depression. Over time, untreated depression can shorten telomeres and make people prone to diseases typically associated with advanced age such as heart disease, diabetes, osteoporosis, and stroke.

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Hormonal stress theory

• Hormonal stress theory is aging in body hormonal system can lower resistance to stress and increase risks of diseases.

• Hormonal stress theory is a theory that attributes stress responses to stressors (internal or external stimuli) that cause a cascade of hormonal reactions involving multiple hormones, especially the hypothalamic, pituitary, adrenal axis, cortisol, and eventually norepinephrine and serotonin as well as peptide y which is involved in resilience.

• In the long run, elevates blood glucose and lipids (cholesterol) in the blood can lead to chronic illnesses such as diabetes and cardiovascular disease, and the immune system can become suppressed. This is why chronic stress may contribute more to the development of chronic illnesses

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Erikson's Integrity vs. Despair

• Integrity versus despair is the eighth and final stage of Erik Erikson's theory of psychosocial development. This stage occurs during late adulthood from age 65 through the end of life.

• During this period of time, people reflect back on the life they have lived and come away with either a sense of fulfillment from a life well lived or a sense of regret and despair over a life misspent.

• A person caught up in old sadness, unable to forgive themselves or others for perceived wrongs, and dissatisfied with the life they've led, will easily drift into depression and despair.

• The ego quality that emerges from a positive resolution is wisdom.Conversely, despair is the result of the negative resolution or lack of resolution of the final life crisis. This negative resolution manifests itself as a fear of death, a sense that life is too short, and depression. Despair is the last dystonic element in Erikson's (1959, 1982) theory.

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Activity theory

The activity theory suggests that aging people should remain as active as possible, expand their activities beyond their daily routine, and to develop friends their own age.

The act of staying social and seeking a particular role in society during old age has proven to dramatically decrease the likelihood of depression and solitude.

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stress theory of aging

• stress theory of aging, a stochastic theory of aging that hypothesizes that aging and death result from the effects of environmental stressors that cause wear and tear on cells and disrupt their function.

• The generation of free radicals during oxidative cell processes is sometimes cited as a specific stressor that disrupts DNA and protein function and so causes aging.

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Coping with stress

• The first step to coping with stress is learning to recognize it. If you have suffered a loss, are struggling with an illness or disability, or are having trouble dealing with a major change in your life, know that symptoms of stress are normal and not a sign of weakness.

• But prolonged sadness, anxiety, loss of interest in life, and giving up activities you once enjoyed are not a normal part of getting older. They could be signs of depression. If you are struggling to deal with stress or depression, you need to ask for help from your doctor or another member of your medical team.

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• Long term stress increases the risk for heart disease, high blood pressure, stroke, digestive problems, and sleep disorders. An older person is already at greater risk for these conditons.

• People respond to stress in different ways. These may include crying, withdrawal, and depression. It is important to allow an elderly person to maintain as much independence as possible. However, if stress interferes with a person's eating, health, or normal daily activity, he or she should be referred to an appropriate mental health provider.

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Strategies for coping with stress:• Take care of yourself. When dealing with stress, it's important to

get plenty of sleep and maintain a healthy diet. Avoid caffeine and alcohol.

• Get regular exercise. Exercise releases hormones that help you fight off stress and depression. Exercise can improve your sense of well-being.

• Participate in social activities. Find activities you enjoy that will give you more social interaction. You could try to learn a new language, mentor a child, or take up dancing.

• Talk about your feelings. Sharing your feelings with friends and loved ones is the best way to get these emotions out in the open, where you can start to deal with them.

• Learn relaxation techniques. Mind-body techniques such as deep breathing, meditation, and yoga can be helpful. You might also relax by listening to music, reading, or participating in low-stress activities that you enjoy, such as a walk around your neighborhood.

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Contd..

• Put things in perspective. Accept that there are some things you just can't control—try to see the positive aspects of change. Solve whatever problems you can and let go of the rest. Also, don't forget the value of humor.

• Get professional help. If you are still struggling with stress or depression, talk with your health care provider. Sometimes treatment with counseling or medication is needed to help you get back on track. Treatment is nothing to be ashamed of, and it usually does work.

• Research has shown that having a pet can reduce blood pressure and stress in the elderly. Many nursing homes now allow pets to visit.

• Maintain sleep hygiene

• Other treatments effective for some people include meditation biofeedback massage acupuncture

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Other Coping Techniques2/2/2015

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Cognitive Behavioral – Triad

Thoughts, Feelings and Behaviors.

Thoughts

Cognitions, Ideas, Beliefs, Values

Feelings, Emotions

(Happy, Sad, Fear, Anger, Disgust, Surprise)

Behaviors

Actions or anything observable from

the outside

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Negative Thought CycleThought

“Something Bad Might Happen.”

Feeling“Worried or Anxious.”

Behavior“Avoid trying new things.”

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Information Seeking

• Lack of information and fear of the unknown can lead to stress

• To conquer fear of the unknown, gather information about a specific circumstance

• Collecting and processing facts can solve the problem and regain emotional stability

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Social Support Groups

• Friends, family are essential to help buffer the effects of crisis

• Support groups enhance feelings of acceptance

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Hobbies

• Hobbies serve as a good mental escape

• Hobbies help make order out of chaos (gardening)

• Organizational skills can transfer to other aspects of life

• Cautionary note: Hobbies can produce stress at times

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Forgiveness• Forgiveness is considered an antidote

for anger• Forgiveness is done for you, not the

person who wronged you• Forgiveness is a means of letting go so

you can move on with your life• Forgiveness doesn’t mean restitution,

don’t wait for an apology• Forgiveness also involves the aspect

of acceptance

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Dream Therapy

• Freud called dreams the royal road to the unconscious

• Freud said dreams conceal the truth

• Jung said dreams reveal the truth

• Dreams can offer insight to resolve personal issues

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Prayer and Faith

• Prayer is considered to be one of the oldest coping techniques

• Prayer is one of the top coping skills for older adults• There are several different methods of prayers• Prayer: building a bond with a higher power• Prayer is not the same thing as meditationWays to Pray

1. Send a clear transmission2. Communicate in the present tense3. Express your thoughts in a positive mind frame

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Exercise, Yoga, and Meditation

• The use of these therapies is increasing.Several studies of exercise and yoga have demonstrated therapeutic effectiveness superior to no-activity controls and comparable with established depression and anxiety treatments.

• Mindful meditation andexercise have positive effects asadjunctive treatments fordepressive disorders,

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Ineffective Coping Strategies

• All coping techniques that avoid stress rather than confront it are ineffective

• Our worst health concerns are examples of poor coping techniques

• Drinking that leads to alcoholism

• Fighting that leads to spousal abuse

• Drug experimentation that leads to addiction

• Avoidance of any kind that perpetuates stress

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Research studies:

• Lack of Sleep, Stress Leads to Inflammation in Older AdultsBy Traci Pedersen Associate News Editor on March 2, 2012

• The immune system of an older adult who doesn’t get enough sleep responds to stress with inflammation, increasing the risk for mental and physical health problems, according to researchers at the University of Rochester Medical Center.

• “This study offers more evidence that better sleep not only can improve overall well-being but also may help prevent poor physiological and psychological outcomes associated with inflammation,” said Kathi L. Heffner, Ph.D., assistant professor of psychiatry at the Medical Center.

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STRESS AND EXERCISE AMONG THE JAPANESE ELDERLY

NEAL KRAUSE, LINDA GOLDENHAR, JERSEY LIANC,GINA JAY and DAISAKU

MAEDA’

• The findings reveal that more frequent physical exercise is associated with less psychological distress.

• Most important the results reveal that social support tends to promote more frequent exercise.more emotional support was related to better exercise habits.

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Stress and Depression Among the Oldest-Old: A

Longitudinal Analysis

Hae-Sook Jeon1 and Ruth E. Dunkle2

• Using multilevel modeling analyses, longitudinal results showed that changes in positive life events, daily hassles (worries), and mastery were significantly associated with changes in late-life depression among the oldest-old.

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• Elders aged 85 and older are more vulnerable to stress and depression than other age due to increasing stressors with age resulting from declining health and dwindling social relationships (Borson et al. 2001).

• Diminishing psychosocial resources with increasing age further contribute to increasing depression This is an important consideration as psychological and social resources act as protective factors to depression by contributing to decreasing depression directly or mediating the impact of stress on depression (Hobfoll et al. 2003; Holahan et al. 1999; Lazarus and Folkman1984; Pearlin 1989).

• Researchers suggest that there are significant individual differences in available psychosocial resources that influence the relationship between stress and depression.

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References:

• http://www.stress.org/seniors/#• http://www.medicineonline.com/articles/s/2/Stress-and-

the-Elderly/Stress-and-Seniors.html• http://www.goodtherapy.org/blog/vicious-cycle-of-anxiety-

depression-and-negative-life-events-0411131• http://www.newstrackindia.com/health/stressmanagement/

8-leading-causes-of-stress.html• http://www.psychologytoday.com/blog/the-athletes-

way/201404/emotional-distress-can-speed-cellular-aging• http://www.ellisonfoundation.org/content/roles-stress-

response-aging-and-age-related-diseases-humans• https://www.healthtap.com/topics/hormonal-stress-theory-

of-aging

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Conclusion:

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Thankyou

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