Stress Management for Older Adults Prepared by: Carmen Morano, PhD, LCSW-C University of Maryland School of Social Wo

1. Stress Management for Older AdultsPrepared by:Carmen Morano, PhD, LCSW-CUniversity of Maryland School of Social Work

2. Understanding the life course of older adults is critical to developing appropriate stress management strategies. The cumulative effects of changing rolls within the family and society, combined with the normative changes in the physical and cognitive functioning, will all have implications both on the way stress is experienced, as well as treatment strategies. Understanding the life course of older adults is critical to developing appropriate stress management strategies. The cumulative effects of changing rolls within the family and society, combined with the normative changes in the physical and cognitive functioning, will all have implications both on the way stress is experienced, as well as treatment strategies.

3. Double Jeopardy Ageism Gender and Minority Status Barriers to help Structural Social Political Environmental Ageism, sexism and racism result in a blinding of society to the numerous structural, political, social, and environmental barriers that can impede older adults from seeking help. Ageism also promotes the idea that functional decline and impairment is irreversible, therefore little attention is placed on how to best help older adults adapt or cope with stress. Sexism and Racism result in making a vulnerable population face even greater difficulties as they age. A lifetime of lower wages, limited opportunities, and stereotyped expectations place older women and minorities in even greater jeopardy to increased levels of stress. Physical and financial access to services can be barriers that decrease help-seeking behavior. Federal, state, local, and service provider policies have demonstrated a limited awareness of the special needs of older adults in general, however this is even more true for older women and minorities.Ageism, sexism and racism result in a blinding of society to the numerous structural, political, social, and environmental barriers that can impede older adults from seeking help. Ageism also promotes the idea that functional decline and impairment is irreversible, therefore little attention is placed on how to best help older adults adapt or cope with stress. Sexism and Racism result in making a vulnerable population face even greater difficulties as they age. A lifetime of lower wages, limited opportunities, and stereotyped expectations place older women and minorities in even greater jeopardy to increased levels of stress. Physical and financial access to services can be barriers that decrease help-seeking behavior. Federal, state, local, and service provider policies have demonstrated a limited awareness of the special needs of older adults in general, however this is even more true for older women and minorities.

4. Familial Role Changes “Head of the Family” shifts from parent to Adult Child, and not always by choice Impairment and frailty further limit the older adults role in the family could result in dependence on family members Demands of adult children for parental support is just as common as parents being dependent on their children Myths about aging foster the belief that impairment is to be expected and older parents are or will become a burden to their adult children. Many children assume caregiving roles, or become self appointed heads of the family with little understanding of how this can add to the “normal” stressors of life. Interestingly, while it does not receive much attention in the literature, it is estimated that 60% of older adults provide some form of financial or caregiving assistance to their adult children and grandchildren. Being aware of previous roles within the family and how they changed can help in developing more effective interventions. Myths about aging foster the belief that impairment is to be expected and older parents are or will become a burden to their adult children. Many children assume caregiving roles, or become self appointed heads of the family with little understanding of how this can add to the “normal” stressors of life. Interestingly, while it does not receive much attention in the literature, it is estimated that 60% of older adults provide some form of financial or caregiving assistance to their adult children and grandchildren. Being aware of previous roles within the family and how they changed can help in developing more effective interventions.

5. Social Roles Ageism promotes the perception that older adults are inflexible and incapable of change Older adults are perceived as taking from society, without the ability to contribute Ageism promotes the perception that with aging comes a decline in the individuals ability to participate in society. The needs of older adults are frequently pitted against the needs of society at large. Social isolation is just another source of stress.Ageism promotes the perception that with aging comes a decline in the individuals ability to participate in society. The needs of older adults are frequently pitted against the needs of society at large. Social isolation is just another source of stress.

6. Environmental The ability to maintain independence in one’s own home is threatened by Expensive repairs Taxes Poor design Changing neighborhoods Limited access to transportation Limited access to supportive services The older adult is faced with structural and environmental barriers to maintaining their most valued possession, their home. Although the home is typically the largest single asset of older adults, limited income and increased home maintenance costs frequently result in older adults being unable to maintain their home. Unfortunately the current solution is to move older adults out of their environment and into “senior” living facilities, and not look at how older adults can be assisted to remain in their home.The older adult is faced with structural and environmental barriers to maintaining their most valued possession, their home. Although the home is typically the largest single asset of older adults, limited income and increased home maintenance costs frequently result in older adults being unable to maintain their home. Unfortunately the current solution is to move older adults out of their environment and into “senior” living facilities, and not look at how older adults can be assisted to remain in their home.

7. Communal Segregation Personalized Homes are replaced with “Segregated” Institutionalized “Facilities” “Rules of the House” are established by facility staff and corporate policy Forced Socialization “Bingo at 3” and “Dinner at 4” When older adults do move they are relocated into elder residences, where they are faced with having to make new friends, adopt to others’ time schedules, taste in food, and activities. Although moving has always been recognized as one of the leading causes of stress, little attention is given to stress encountered by those older adults who “choose” to relocate. To ease the transition they are flooded with messages about how wonderful this new lifestyle is going to be, with little attention to the pain of leaving a home that they might have lived in for the majority of their life, let alone the anxiety of having to meet and make an entirely new set of acquaintances. When older adults do move they are relocated into elder residences, where they are faced with having to make new friends, adopt to others’ time schedules, taste in food, and activities. Although moving has always been recognized as one of the leading causes of stress, little attention is given to stress encountered by those older adults who “choose” to relocate. To ease the transition they are flooded with messages about how wonderful this new lifestyle is going to be, with little attention to the pain of leaving a home that they might have lived in for the majority of their life, let alone the anxiety of having to meet and make an entirely new set of acquaintances.

8. Loss of Occupational Roles Chronological markers that dictate when a person can “Do the Job” Policy provides the “Golden Watch” Financial incentives for replacing older workers with younger workers Occupational Ageism – “older workers CAN’T change or get along with younger workers Mandatory retirement, the cost of employee medical insurance, and a lack of understanding has contributed to the myth that older workers represent too much “risk” for the potential reward. The myth that the older worker is too set in their ways and cannot learn new skills, further contribute to the belief that older workers present little upside. Employers fearing loss of productivity, increased cost for insurance, and perceptions of “younger” workers result in the “Golden Watch” retirement of what could otherwise be productive workers.Mandatory retirement, the cost of employee medical insurance, and a lack of understanding has contributed to the myth that older workers represent too much “risk” for the potential reward. The myth that the older worker is too set in their ways and cannot learn new skills, further contribute to the belief that older workers present little upside. Employers fearing loss of productivity, increased cost for insurance, and perceptions of “younger” workers result in the “Golden Watch” retirement of what could otherwise be productive workers.

9. Reactions to Stress Older adults react to stress, in much of the same ways of younger adults. Physical reactions Increased heart rates and blood pressure Increased rate of breathing Muscle Tension The stress response of older adults is similar to that of younger adults. Unfortunately, older adults do not have the benefit of youth to help in their recovery from a stressful event. The stress reaction can be exacerbated by the presence of other physical ailments which might restrict the “recovery” from stress.The stress response of older adults is similar to that of younger adults. Unfortunately, older adults do not have the benefit of youth to help in their recovery from a stressful event. The stress reaction can be exacerbated by the presence of other physical ailments which might restrict the “recovery” from stress.

10. Reactions to Stress Psychological Reactions Loss of self esteem and self efficacy Withdrawal and Disengagement Hopelessness and Helplessness Emotional Reactions Depression Anxiety Grief The reactions of older adults to “distress” are similar to that of younger adults, however, the older adult will frequently have limited coping resources available. The coping skills that might have worked to defend against situational stress might no longer be as effective. As a result of the loss of roles, diminished capacity, and the previously mentioned changes that accompany aging, the older adult is at greater risk for physical and emotional symptoms. Unfortunately, given the societal, political, and environmental barriers, they are less likely to seek or find appropriate assistance.The reactions of older adults to “distress” are similar to that of younger adults, however, the older adult will frequently have limited coping resources available. The coping skills that might have worked to defend against situational stress might no longer be as effective. As a result of the loss of roles, diminished capacity, and the previously mentioned changes that accompany aging, the older adult is at greater risk for physical and emotional symptoms. Unfortunately, given the societal, political, and environmental barriers, they are less likely to seek or find appropriate assistance.

11. Stress, Appraisal, and Coping What is stressful to one person is challenging or exciting to another Lazarus and Folkman (1984) present a model that identifies those factors that mediate stress. Person Factors – Values and Beliefs Environmental Factors – Situations and Resources Appraisal – Perception of the situation Understanding those factors that mediate stress is the first step in providing appropriate interventions to help reduce the negative outcomes associated with stress. Lazarus and Folkman’s Stress, Appraisal and Coping model provides a framework for understanding and ultimately developing effective interventions.Understanding those factors that mediate stress is the first step in providing appropriate interventions to help reduce the negative outcomes associated with stress. Lazarus and Folkman’s Stress, Appraisal and Coping model provides a framework for understanding and ultimately developing effective interventions.

12. Person Factors A threat, real or perceived, to the values of the individual is Stressful A threat, real or perceived, to the beliefs of the individual is Stressful During times of stress the value and belief system of the individual is either threatened or challenged. How they react and why they react in the way they do is a reflection of the perception of a given situation as being a threat or a challenge. A perceived threat initiates defensive reaction, while a perceived challenge becomes an opportunity for proactive growth. As individuals have different value and belief systems so do they perceive and ultimately react differently to stress. The individual’s beliefs, what does “this” (situation) mean to me, does it confirm or contradict my existing belief system, and does my response alter, challenge, or threaten the belief system will mediate or magnify the perception and feeling of “stress”. A life review is important to understand the value and belief system of the older adult.During times of stress the value and belief system of the individual is either threatened or challenged. How they react and why they react in the way they do is a reflection of the perception of a given situation as being a threat or a challenge. A perceived threat initiates defensive reaction, while a perceived challenge becomes an opportunity for proactive growth. As individuals have different value and belief systems so do they perceive and ultimately react differently to stress. The individual’s beliefs, what does “this” (situation) mean to me, does it confirm or contradict my existing belief system, and does my response alter, challenge, or threaten the belief system will mediate or magnify the perception and feeling of “stress”. A life review is important to understand the value and belief system of the older adult.

13. Environmental Factors Changing conditions result in an uncertainty about one’s environment Structural and Cultural Barriers limit access to environmental supports It is easier to remove the person from the environment than alter the environment “Not in MY Neighborhood” The ecological perspective or person-in-environment model recognizes the importance of comfort and knowledge with familiar supports. The individual can better withstand the onslaught of stress with the presence of known, proven, and available supports. The ever changing environment and the loss of familial, social and environmental supports, are all sources of stress instead of being mediators of stress.The ecological perspective or person-in-environment model recognizes the importance of comfort and knowledge with familiar supports. The individual can better withstand the onslaught of stress with the presence of known, proven, and available supports. The ever changing environment and the loss of familial, social and environmental supports, are all sources of stress instead of being mediators of stress.

14. Locus of Control Research has shown that when the locus of control shifts from being internal to external, perceived stress increases Individuals with External Locus of Control are found to report with greater: Depression Anxiety Somatic Complaints Faced with repeated situations of losing control, there is repeated reinforcement of the belief that the individual has no ability to control things around him or her. Older adults are faced with this reminder in a multitude of ways. The Familial, Social, Occupational, and Environmental examples of change provided here are but just a few which magnify any stressful situation. Faced with repeated situations of losing control, there is repeated reinforcement of the belief that the individual has no ability to control things around him or her. Older adults are faced with this reminder in a multitude of ways. The Familial, Social, Occupational, and Environmental examples of change provided here are but just a few which magnify any stressful situation.

15. Ways to Reduce Stress Acknowledge the reality of what is happening Validate the feelings associated with what is happening Review the attempts that have been made to cope with the stress Help to generate different ways of coping Acknowledging the life experience of older adults is critical to engaging them in any form of stress management treatment. Provide an opportunity to identify all the potential sources of stress. Validate the emotional reactions in an effort to help normalize the feelings that an individual might be experiencing. Pointing out that it is normal to feel a certain way can help to reduce the shame and guilt that will limit seeking help. Once a clear understanding of what the older adult has attempted to do to manage their stress, proceed to generating new or alternative techniques.Acknowledging the life experience of older adults is critical to engaging them in any form of stress management treatment. Provide an opportunity to identify all the potential sources of stress. Validate the emotional reactions in an effort to help normalize the feelings that an individual might be experiencing. Pointing out that it is normal to feel a certain way can help to reduce the shame and guilt that will limit seeking help. Once a clear understanding of what the older adult has attempted to do to manage their stress, proceed to generating new or alternative techniques.

16. Reframing Thoughts Thoughts contribute to how a person feels and then ultimately how they behave Irrational thoughts are a source of distressed feelings Once identified, irrational thoughts can be changed Reframing irrational thoughts with rational thoughts will change how a person feels Exploring what a person thinks is happening, is an important part of being able to identify any irrational thoughts that might be resulting to added stress. Irrational thoughts are reinforced over time and if left unattended could result in resistance to assistance. Once a person understands that they have been taught to think in certain ways, they will be more receptive to learning new ways to think. Once irrational thoughts can be reframed into more rational thoughts the willingness to accept alternatives significantly improves.Exploring what a person thinks is happening, is an important part of being able to identify any irrational thoughts that might be resulting to added stress. Irrational thoughts are reinforced over time and if left unattended could result in resistance to assistance. Once a person understands that they have been taught to think in certain ways, they will be more receptive to learning new ways to think. Once irrational thoughts can be reframed into more rational thoughts the willingness to accept alternatives significantly improves.

17. Ecological Perspective Awareness of how the environment either contributes to, or provides relief from stress is especially important with older adults Does the environment help or hinder access to assistance Does the environment promote inclusion or exclusion Does the environment respond to the changing needs of older adults, or demand that they adjust to inflexible and intolerable structural barriers The ecological perspective or person-in-environment model recognizes the importance of comfort and knowledge with familiar supports. The individual can better withstand the onslaught of stress with the presence of known, proven, and available supports. Effective intervention will require empowering older adults to take some control over their environment.The ecological perspective or person-in-environment model recognizes the importance of comfort and knowledge with familiar supports. The individual can better withstand the onslaught of stress with the presence of known, proven, and available supports. Effective intervention will require empowering older adults to take some control over their environment.

18. Taking Back Control Mobilize older adults to take back some of the control, and instill a sense of hope Lifestyle changes Senior Advocacy Groups Neighborhood Coalitions Resident Councils Help the older adult to recognize that sometimes a simple change in their lifestyle can help them to better manage their stress. Proper nutrition, sleep, and exercise are some ways to initiate the process of change. In addition to reframing thoughts, relaxation techniques can be effective for achieving internal control. Mobilizing older adults to participate more actively in their community can also provide a sense of taking back control over their external environment. Joining senior advocacy groups, neighborhood coalitions, and resident councils are other ways to help older adults to achieve a sense of control. Empower them to find the right forum for initiating change and provide guidance when it is needed.Help the older adult to recognize that sometimes a simple change in their lifestyle can help them to better manage their stress. Proper nutrition, sleep, and exercise are some ways to initiate the process of change. In addition to reframing thoughts, relaxation techniques can be effective for achieving internal control. Mobilizing older adults to participate more actively in their community can also provide a sense of taking back control over their external environment. Joining senior advocacy groups, neighborhood coalitions, and resident councils are other ways to help older adults to achieve a sense of control. Empower them to find the right forum for initiating change and provide guidance when it is needed.