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Major Health Issue Paper

Stress is an issue for the elderly, in part because of other health problems and their reaction to them, and in part because of their loss of identity and a role in society. Various aspects of life can lessen the impact of stress. A review of research is conducted, leading to a proposal for an empirical study. Introduction Stress is a major health issue that is not always seen as the cause of the many health problems with which it is associated. Stress is associated with certain particular life events, such as a financial crisis or overwork, though stress can be caused by a number of different factors.

Stress has been associated with age in various ways, showing some of the stressors that face the elderly and some of the health problems that result. Some of the research shows the course of stress over a lifetime, meaning how stress may increase during one’s working life and then continue for different reasons in old age. Old age has particular stressors deriving from financial need, health problems, the health problems of loved ones, and problems with children and grandchildren. Stress is associated with old age because of some of the changes involved in that time of life. Lieberman and Tobin (1988) point this out when they write,’

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Because of the increasing likelihood that valued extensions of self will be lost with advancing age, threat and loss models are prevalent for explaining wellbeing and adjustment among the elderly. Although loss has at one time or another throughout history been associated with the vast diversity of the physical as well as psychological ills that befall mankind, loss models are particularly relevant to the second half of life. Death of others becomes ubiquitous among the elderly; decreasing physical capacities and chronic impairments must be confronted; and loss of work and family functions results in the roleless role of the elderly (p.

67). The role people play in their working life is often the cause of stress, but for the elderly, having that role removed can be a cause of stress. The elderly have identified themselves by certain roles, be they father, other, or professional. When those roles no longer apply, the individual may experience stress. This can be seen among certain retired persons, and while some may believe that stress derives from overwork and not from having nothing to do, this is not the case. Stress is an internal response and may result from being roleless after a lifetime of having a clear identity.

Review of Literature Other types of loss also contribute to the degree of stress experienced by the elderly. Psychosocial variables affect stress levels, and among these, some that have a documented effect upon health status have been addressed in the literature, these being the number of symptoms and other measures of poor health status experienced by the individual, the loss of an external locus of control, and the size of (and degree of support from) the informal network of family and friends.

These variables have been found to be associated with health even after controlling for income, gender, and age. Two of these variables, social support and stressful life changes, are often studied together to test the buffering hypothesis, holding that the adverse effects of high stress upon health are reduced by the presence of supportive associations, such as friends and family.

The effect of locus of control upon health has been studied most often independently of the other two effects, but more and more the direction of research has been to look upon an internal locus of control as an additional buffer moderating the effect of stress on health and on life satisfaction Acredolo, Montgomery, Parks, and Pilisuk (1993) note that the three variables together had not previously been included in a single study of physical health outcomes, though the authors saw good reasons for doing so. They also point out the importance of changes in life in developing stress:

A popular measure of individual differences in stress is a simple count of the number of significant life changes one has experienced in the recent past. While it is clear that some individuals are overwhelmed and others challenged by the same circumstance . . . a preponderance of life changes is almost always stressful, and it is for this reason that measures of significant life changes have so frequently been associated with illness. Bereavement, divorce, residential mobility, retirement, and combined cumulative scores of life change events have all been linked to breakdowns ranging from cardiac to psychological problems .

. . In fact, the buffering hypothesis posits that the beneficial effects of supportive social networks in reducing rates of illness are discernible only in the presence of high levels of stress (p. 147). In their own study, the authors show the particular importance of locus of control either alone or in association with the social support network. Some research suggests gender differences in stress in old age as at other times of life, with the number and quality of social relations being an important factor cited.

Antonucci, Lansford, Akiyama, and Dartigues (2002) consider the issue with reference to populations in different countries to see if there is a cultural distinction to be made, noting that they “focus on gender differences in both quantitative (as indicated by network size) and qualitative (as measured by positive and negative assessments of social relations) aspects of close social relations. Most research on gender differences in social relations has focused on one cultural group at a time.

It is unclear to what extent gender differences in social relations are related to norms in a particular country versus more broadly found across cultures and countries. The present study addresses this limitation by examining differences between older men and women in four countries: France, Germany, Japan, and the United States” (p. 767). The results showed that resource deficits were associated with increased depressive symptomatology in all four countries, a logical finding given that widowhood, illness, and financial strain are all likely to be stressful experiences compromising a person’s well-being.

They also found that the quality of social relations, specifically negative social relations, was associated with depressive symptomatology. They also noted, however, that the lack of longitudinal data made it impossible to ascertain the direction of effects, thoh they believed that they could make a compelling case for the bi-directionality of this relationship. A problem noted for many elderly is alcoholism, and it is believed that stress plays a role on the onset of alcoholism among the elderly. To examine this question, Adams and Waskel (1993) studied 60 men (M age = 63.

6 years) from six midwest treatment centers to determine whether stress resulting from loss of social-psychological structures was greater for later onset alcoholics. Data was gathered as each subject completed a modified Veteran’s Alcoholism Screening Test and the Drinking Practices Survey. Respondents were then identified as early onset (problem drinking before age 40) and later onset (problem drinking after age 40), with cross tabulations made using the chi-square statistic to show that more early onset alcoholics were married than later onset alcoholics.

In terms of the social-psychological structures, only marital status showed a significant relationship with alcoholism, which seemed to confirm the idea that the onset of problem drinking has less to do with stress than with the loss of a spouse who might serve to regulate the older man’s drinking habits, though it is not clear that the loss itself might be a stressor contributing to the onset of alcoholism.

Wilensky (2004) makes recommendations on how to guide the older person in order to reduce the harmful effects of stress, stating, “For too many Americans, old age is a roleless phase of existence, a time of heightened risk of social isolation. The development of interventions to promote social integration is essential to the quality of life of older persons” (p. 6). The role of peer support is discussed, noting research showing who will accept such aid and who will not:

The researchers found that caregivers in high-stress situations were more likely to accept the intervention, indicating that interventions can be targeted to those who most need them. Persons who were caring for spouses were much less likely to agree to participate. Length of illness also was important–the more recent the onset of the family member’s symptoms, the more likely was participation in the support program. Competing demands on the caregiver’s time, excessive caregiving responsibilities, and the presence of sufficient perceived social support were found to be important predictors of refusal (p.

6). For the elderly, the need to care for a loved one who is ill ads to levels of stress but may also mitigate against accepting help to reduce that stress. Some research suggests that there may be a cultural element in stress, though one reason for this can be informative for other cultures as well. Mazumdar and Treas (2004) consider the role of the e3lderly in immigrant families and find ways in which the role identity for these older persons might be maintained as they are given a clear role in life as caregivers and teachers for the younger members of the family, reducing levels of stress.

In many immigrant families, they find, “Older parents’ kin-keeping and caregiving make possible their children’s participation in the American economy and society” (p. 105). This contrasts with the lack of a role for the elderly in many American families, which have long been marked by a separation between generations that might contribute to the stress felt by the elderly and might add to stress for the middle levels as well as parents must give aid and care to their children, aid and care that the grandparents might take off their hands if the family was closer.

Shmotkin and Eyal (2003) consider counseling for the elderly and note the impact of psychological time on the perceptions of the older person, noting the effect that such perceptions may have on how the older persons views his or her role in life, the passage of time, the naure of illness, and so on. Whether the older person is able to construct a scenario of future events and planning depends on his or her sense of control: In later life, there are fewer life roles that require obligatory investment in external systems, along with fewer of the energy resources needed for self-improvement.

The directedness and intentionality that characterize purpose in life are on the decline in old age . . . Thus, purposeless time naturally comes to fill a larger share of the older person’s life. (p. 259) research has also shown that optimism has a good effect on physical and mental health throughout the life span (Reker & Wong, 1985; Scheier & Carver, 1992), while a lack of optimism, such as often develops in old age, can have the opposite effect and can damage health and increase stress. The perceptions of the elderly can be as important as the reality of their social situation.

Schultz and Heckhausen (1996) offer a model of aging over a lifetime in order to reduce the likelihood of such a rise in stress in old age. They note first that the usual way of viewing aging is not sufficient and fails to take certain elements into account: Investigators interested in aging have long recognized the importance of distinguishing between pathologic as opposed to normal aging. Thus, researchers interested in normative physiologic or cognitive age changes have been careful to exclude persons suffering from illnesses that might adversely affect performance and thus give a distorted picture of age-related declines.

Although the distinction between aging as a disease and aging as a normative process is both important and useful, several researchers have recently argued that it does not go far enough (p. 702). The authors note, then, that “this simple bifurcation of the population into diseased and normal fails to recognize the large heterogeneity within the normal category. Moreover, what is observed to be normal does not necessarily tell us what is possible” (p. 702). Recognizing the variety of experience among the elderly can help show how some avoid the problems of stress while others suffer from them and the health problems they bring.

Clarke (2001) notes one gender issue that affects how women experience more stress when they get older, referring to “the uneasy and often conflicted relationship between an older woman’s sense of self and her aging body” (p. 441). The researchers use data from semi-structured interviews with 22 female participants aged 61 to 92 years to examine the influence of the loss of perceived physical attractiveness and the deterioration of health and functional abilities on an older woman’s sense of identity.

Males tend to lose their identity when they are no longer working, while women are clearly affected by body changes that make them reconsider their roles in society and in the family. The researchers note that women experience the body as both mask and prison of the self, finding stress in the challenge faced based on the reflected image for a woman’s sense of being youthful on the “inside. ” Proposal A survey can be conducted to suggest differences between age groups in a population otherwise3 similar. Select a profession in the area, one with an organization to which practitioners belong.

The membership list is to be divided among those still working and those who have retired. The survey instrument will include questions concerning health problems, perceived degrees of stress, and accompanying factors such as marital status, children, and financial status. The survey is to be given to a group of working individuals who remain on the job, and to a second group of retired individuals who are no longer working. The intent is to see differences in perceptions of stress between the two groups and among members of each group on the basis of the other factors noted, such as marital status, family situation, activities, and the like.

It is hypothesized that stress in the retired population will be related most to family situation and to health problems in old age, while for the working group, stress is most associated with hours of work and life crises. Change in life situation is assumed to be a major source of stress for both groups. Bibliography : Acredolo, C. , Montgomery, M. B. , Parks, S. H. , & Pilisuk, M. (1993). Locus of Control, Life Stress, and Social Networks: Gender Differences in the Health Status of the Elderly. Sex Roles: A Journal of Research, Volume 28, Issue 3-4, 147. Adams, S. L. & Waskel, S. A. (1993).

Late Onset Alcoholism: Stress or Structure. Journal of Psychology, Volume 127, Issue 3, 329-334. Akiyama, H. , Antonucci, T. C. , Baltes, M. M. , Dartigues, J. F. , Fuhrer, R. , Lansford, J. E. , Smith, J. , & Takahashi, K. (2002). Differences between Men and Women in Social Relations, Resource Deficits and Depressive Symptomatology during Later Life in Four Nations. Journal of Social Issues, Volume 58, Issue 4, 767. Clarke, C. (2001). Older Women’s Bodies and the Self: The Construction of Identity in Later Life. The Canadian Review of Sociology and Anthropology, Volume 38, Issue 4, 441.

Lieberman, M. A. & Tobin, S. S. (1988). The Experience of Old Age: Stress, Coping, and Survival. New York: Basic Books. Mazumdar, S. & Treas, J. (2004). Kinkeeping and Caregiving: Contributions of Older People in Immigrant Families. Journal of Comparative Family Studies, Volume 35, Issue 1, 105. Reker, G. T. , & Wong, T. P. (1985). Personal optimism, physical and mental health: The triumph of successful aging. In J. B. Birren & J. Livingston (Eds. ), Cognition, stress, and aging (pp. 134-173). Englewood Cliffs, NJ: Prentice-Hall. Scheier, M. E, & Carver, C.

S. (1992). Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cognitive Therapy and Research, 16, 201-228. Schulz, R. & Heckhausen, J. (1996). A Life Span Model of Successful Aging. American Psychologist, Volume 51, Issue 7, 702-714. Shmotkin, D. & Eyal, N. (2003). Psychological Time in Later Life: Implications for Counseling. Journal of Counseling and Development, Volume 81, Issue 3, 259. Wilnesky, J. (2004). Helping Older Individuals Age Successfully. Human Ecology, Volume 31, Issue 3, 6.

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