Stress and Coping

Stressors refer to hardships, challenges, threats, and other circumstances that have the potential to adversely affect well-being. Stressors are broadly categorized into two types: life events and chronic strains. Life events are discrete stressors that have a relatively clear onset, an example being the death of a spouse. In contrast, chronic strains are continuing and enduring problems or threats, such as chronic disease and disability, or caregiving for a disabled family member. These two types of stressors are viewed by researchers as important risk factors that can threaten physical and psychological well-being. Some researchers have focused on the stressfulness of daily hassles—relatively minor daily events such as arguments or inconveniences. While life events, chronic strains, and daily hassles are conceptually distinct, in reality their effects may be difficult to disentangle. For example, the death of a spouse may follow years of caregiving strain; it may coexist with a chronic health problem; and it may lead to a variety of daily hassles, such as managing financial matters or the complexities of Medicare reimbursement.

Contrary to the widespread belief that old age is a highly stressful period of life, it has been found that older persons generally have a reduction in many kinds of stressful experiences, including family conflict and job stress. However, older adults are more likely to encounter some stressful situations, including health deterioration, reduced income, and the death of friends or a spouse. Some theorists believe that even though older adults experience fewer negative life events, once they occur, their adverse impacts are greater because aging may lead to declines in some coping resources. However, it is important not to assume that older persons are highly vulnerable. Many studies have found that common stressors in old age (such as health problems and the death of a spouse) may be stressful but are expected and normative experiences in late life, and that these events have less of an impact in older adults because older people are psychologically prepared to cope with them. Presumed stressors such as retirement are often found to have no ill effects among healthy persons retiring voluntarily.

Studies assessing exposure to stressful life events using checklists of life events have been utilized with older adults with mixed success. While greater numbers of negative life events have been found in a number of studies to predict depression in older adults, results have not been consistent and the magnitude of the life events–depression relationship is generally small. Because these instruments generally require individuals to report on events that have occurred in the past (such as the previous six months or year), retrospective reporting biases can occur. In addition, life events scales can confound stressors with outcomes. For example, life events such as family problems may be a result and not a cause of depression, and health problems may be included both as stressors and dependent variables. Special concerns have been raised about the use of life-events questionnaires in studies of older adults. Scales initially designed for younger adults include inappropriate items and exclude common events faced by older persons. The Louisville Older Persons Events Scale (LOPES) is an exception in that it was specifically designed for older adults on the basis of extensive pretesting with older populations.

Another tactic in studying the impact of life events is to identify individuals who have faced a particular type of life event, such as retirement, natural disasters, or the death of a spouse, and then to assess the impact of this particular event on well-being. Cross-sectional studies may compare individuals who have experienced a life event (such as the death of a spouse), with controls who have not experienced the event. Prospective longitudinal projects have assessed large populations at an initial point in time (perhaps with a life-events checklist), and then identified individuals who subsequently experience onset of a major life event, allowing for a prospective study of the consequences of a stressor. This strategy avoids the problems faced when assessing life events via checklists, but requires large samples and longitudinal research projects. Research utilizing prospective methods has demonstrated that stressors, including the trauma of a major flood, and spousal bereavement, increase the risk of depression in older adults.

Compared to the voluminous literature on life events, chronic strains have been understudied. Chronic strains are the enduring problems, conflicts, and threats that people face in their daily lives. The extended duration of chronic strains may deplete an individual’s resources and eventually have adverse physical and psychological effects. A number of different chronic strains have been identified that are both common in older adults and are risk factors for declining mental and/or physical health. These include chronic health problems, physical disability, and family caregiving for relatives with dementia. Chronic strains have been consistently shown to be risk factors for depression in older adults.

There has been considerable debate on whether life events or chronic strains are greater risks to well-being. However, studies have consistently shown that chronic strains have a greater negative impact than life events. Chronic strains are continuing and unresolved demands, and they therefore have more power to undermine equilibrium.

Regarding the interaction of life events and chronic strains, some researchers have suggested that chronic strains have the power to amplify the impact of life events. For example, individuals with chronic illness may be more susceptible to the effects of other stressful events. A combination of chronic strains and life events may therefore cause more adverse outcomes. In contrast, other researchers suggest that experience with chronic strains might actually mute the impact of minor stressful events, because those minor stressful events pale in comparison to the more chronic stressors. In sum, chronic strains and discrete life events may shade into one another and interact in a variety of ways, and both should be taken into consideration in models of the stress and coping process.