There are several different ways of assessing stress, including traumatic events, life events, chronic role strain, and daily stressors or hassles. In the last decade, it has rapidly become apparent that both type and frequency of stressors change with age. While early studies suggested that the number of stressful life
Assessment of Mental Health in Older Adults events decrease with age, perusal of the types of events typically found on early life event scales reveal that many are far more relevant to younger populations than to older ones (e.g., marriage, divorce, changing jobs, imprisonment). Several instruments are now available that assess life events that are more relevant to older populations such as caretaking for spouse and parents, institutionalization of parent or spouse, death of a child, child's divorce, problems with grandchildren, and the like. These instruments are less likely to show a decrease in stressful life events with age.
However, the number of daily stressors does decrease with age, most probably due to the decline in the number of social roles. For example, most older adults have relinquished active parenting and work roles, the source of the majority of hassles in mid-life. While there is a concomitant increase in the number of hassles associated with both health problems and avocations in retirement, for most older adults, these typically do not generate as many hassles as do work and childrearing roles.
In part, this may be due to changes in the nature of stress in late life. Stress in earlier life is more likely to be episodic in nature, such as children's crises or problems at work, whereas stressors in late life may be more likely to be chronic, for example, managing chronic illnesses or caregiving for an ill spouse. If chronic problems are successfully managed, they may not be perceived as "problems" per se. An 80-year-old with multiple health problems may well assert that he or she has had no problems in the past week, despite obvious impairments requiring careful management. Thus, among the old-old, interviews may be better assessments of stress than self-report instruments.
However, the decrease in stress reporting may also be due to age-related changes in the way individuals cope. In some ways, older people are better copers, in that they are less likely to use escapist strategies such as alcohol, drugs, or wishful thinking — or perhaps individuals who survive until late life are less likely to use escapist strategies. However, the old-old may be more likely to use denial as a coping strategy. Denial of the severity of health problems, for example, may be a palliative strategy, as long as appropriate instrumental actions are taken, such as adhering to a medical regimen. However, the old-old are often reluctant to admit problems for fear that they will be institutionalized, with all that entails, including separation from spouse and loved ones and the loss of control. Thus, they may deny and/or hide problems, even those which could be adequately treated in the home, which can lead to worse problems, greatly increasing the risk of institutionalization. Thus, accurate assessment of problems in the elderly are crucial to both their treatment and may permit successful home treatment and forestall institutionalization. [See Coping with Stress.]
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