GERIA CHAPTER 13

• Stress is usually a precursor to anxiety, and anxiety is usually a precursor to depression.
• Fight-or-flight response- the general alarm reaction, occurs first.
• Fight-or-flight response- the general alarm reaction, occurs first.
• PHYSICAL SIGNS OF STRESS:

  Gastrointestinal - Decreased production of digestive enzymes. Loss of appetite, nausea, abdominal distention, vomiting, and heartburn. May contribute to development of gastric or duodenal ulcers. Decreased peristalsis resulting in excess intestinal gas and constipation, but diarrhea is also quite common.

  Urinary - Decreased urine production but increased urinary frequency.
• PHYSICAL SIGNS OF STRESS:

  Cardiovascular - Sensation of racing or pounding heart. Elevated pulse rate. Increased BP. Cold, clammy hands and feet. Increased blood glucose level.

  Respiratory - Increased respiratory rate and depth. Possible hyperventilation with a tingling sensation in the extremities, faintness, dizziness, and even seizures if the acid-base balance is seriously altered. 

  Musculoskeletal - Increased blood glucose level to provide energy for muscles. Increased muscle tension in the back, neck, and head. Complaint of tension headaches, teeth grinding, and backaches.
• COGNITIVE SIGNS OF STRESS

  In addition to physiologic changes, stress affects the way we think, feel, and act. Although some stress is normal and necessary, even beneficial, high stress levels can be physically and mentally exhausting.
• Mild stress - results in an increased state of alertness. Individuals experiencing mild stress are be able to pay attention to details, to learn, and to solve problems. With increased stress levels, these abilities decrease rapidly.
• Emotional Signs

  ❑People experiencing high levels of stress are likely to complain of fatigue, tension, and anxiety. They often report a feeling that something is wrong.

  ❑They may appear distracted, irritable, short-tempered, even angry. People living with high-level stress often verbalize feelings of poor self-worth or low self-esteem.
• Depression

  ❑ Is not easily identified or diagnosed.

  ❑ Is often missed because it occurs in conjunction with the numerous physical and social changes that occur with aging.

  ❑ Is more than the down moods that everyone temporarily experiences. For depression to be diagnosed, the symptoms must occur most of the day, nearly every day, for at least 2 weeks.
• Depression

  ❑ Is a whole-body syndrome that causes physiologic, emotional, and cognitive changes in older adults. The notion of mental illness is unsettling to many older people, who feel that seeking help for mental problems is a sign of a weakness that they should be able to overcome alone.
• Depression

  Symptoms such as chronic pain, appetite loss, sleeplessness, loss of interest, and even dementia-like behavior are often attributed to other problems, and the underlying depression is missed. This is unfortunate, because 80% to 90% of the identified cases of depression are treatable (National Alliance on Mental Illness [NAMI], 2014).
• Behavioral Signs

  ❑ People attempt to cope with stress in different ways. Some avoid all interactions or tasks that might increase their stress level, whereas others take on additional duties to block out the source of their distress. In either case, performance is likely to suffer.

  ❑ People under stress tend to be disorganized, make more errors, and leave tasks incomplete. They may appear and even sound muddled.
• Self-medicating

  ➢ is one response to dealing with depression and other situational problems. It is certainly not a recommended method, but one that is all too common among all age groups, including older adults
• Self-medicating

  ➢ The substances most abused include tobacco, alcohol, and prescription drugs. Some older adults also abuse illicit street drugs (a number expected to climb as Baby Boomers get older). Many older adults are aware that tobacco has harmful effects and continue to use the substance despite warnings. Although it is physically damaging, tobacco does not have the same effects on the mind and behavior, as do alcohol and drugs.
• STRESS AND ILLNESS

  ❑Stress and illness are closely linked. Research has shown that both mental and physical illness results in stress and that stress increases the risk for both mental and physical illness.
• STRESS AND ILLNESS

  ❑A physically ill person is less able to cope with additional physical or psychological stressors, which take energy away from the already depleted reserves and decrease the ability to cope. Stress can interfere with the ability to learn, function, and follow through with the plan of care. Decreasing the number of stressors or the level of stress can prevent illness or improve a person’s ability to cope with existing illnesses.
• STRESS AND LIFE EVENTS

  ❑Although stress can cause physical illness, physical illness also increases stress. An older adult suffering from numerous chronic and acute conditions is under greater stress than one who is healthier. Stress can increase as a result of loss; the loss of friends, family members, and, particularly, a spouse can be highly stressful. Other life events, such as a change in residence or financial worries, can also cause stress.
• Symptoms of Depression

  • Persistent sad, anxious, or "empty" feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
• 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.
• STRESS-REDUCTION AND COPING STRATEGIES

  ❑There are two basic categories of coping style: problem-focused strategies and emotion-focused strategies.
• ❖Problem-focused coping strategies - attempt to change or eliminate the stressful event or threat.
• ❖Emotion focused strategies - attempt to change the person’s response to the stressful event or threat. The type of strategy used depends on the personal significance of the event and the perceived ability to alter the outcomes.
• Relaxation techniques

  ➢ can be used to help people cope with stress. The most common forms of relaxation techniques include progressive relaxation, meditation, imaging, biofeedback, and self-hypnosis. In addition to these techniques, the support of friends and family benefits most people. Talking through problems and stresses can facilitate problem solving.
• The most common forms of relaxation techniques include progressive relaxation, meditation, imaging, biofeedback, and self-hypnosis.
• 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
• STRESS RELATED THEORIES

  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 cortisol that causes a rise in blood sugar and blood pressure and reduces inflammation and immune system resistance to infection.
• Telomeres are structures made from DNA sequences and proteins found at the ends of chromosomes.
• 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.
• Hormonal stress theory

  • 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
• 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, people reflect 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.
• 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
• 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.
• 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.
• Coping with stress:

  • 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.