STRESSORS AND THEIR IMPACT ON COPING AND OUTCOME WITHIN THE OLDER ADULT POPULATION
Adjustment to stressors in one’s life depends on multiple variables. Naturally, relevant examples of stressors in the rehabilitation population include illnesses, injuries, and changes to functional status. Given the increased incidence of diseases in older adults, there is an associated increase in the number and frequency of stressors as the individual ages. For the older adult, this can include a combination of chronic and acute stressors, all playing a role in the individual’s response to illness, treatment adherence, and clinical course.
There are certain common stressors in the older adult population that should be considered, given their impact on physical and emotional functioning as well as adherence and health-related behaviors. Examples of these common stressors include changes in social roles and relationships, changes in family structure, loss within the support system, caregiving roles, retirement, financial changes, decreased level of functioning, decreased independence, changes in social opportunities, social isolation, etc. Frequently, these factors contribute to existential issues regarding the meaning of one’s life, their mortality, and the role of illness in their lives. Subsequently, the individual might engage in revisions of their self-definition, life goals, and values. With loss within the support system and/or changes in the nature of social relationships, there is often less support available to assist the older adult with the process of coping and adjusting to stressors. This can become problematic, particularly given research findings that indicate that social support serves as a strong external coping resource. The role of social support is discussed further in this chapter.
Within the acute rehabilitation setting, an additional layer of stressors can become apparent. Not only is the individual adjusting to an acute medical issue, but they are also adjusting to changes in functional status, independence, identity, and goals for the future. These can be further compounded by pain, poor sleep, and decreased energy. In addition, the individual is in an unfamiliar environment away from home and may have less access to their usual social supports while in the hospital. They may also be experiencing distress related to medical procedures and events that occurred earlier in their hospital stay. Individuals within the acute rehabilitation setting also face the additional stressor of discharge planning and decision-making surrounding this important step in the recovery process.
After discharge from the acute rehabilitation setting, the individual often continues to experience the impact of stressors that were first encountered during their rehabilitation stay. They also face the additional adjustment to the transition back home, moving in with a family member or friend, or transferring to a subacute rehabilitation setting. There is also an adjustment to changes in the social environment and social roles upon transition to the community. Changes in level of functioning can impact the nature of social roles (e.g., social supports taking on responsibilities that the individual used to have and/or providing additional assistance for the individual). In addition, those in the social support system may have different levels of understanding or expectations of the individual’s level of functioning.
When returning to the community from acute or subacute rehabilitation, there is a decrease in the level of medical supervision and decreased frequency of restorative therapies. Without the high level of structure inherent in one’s daily schedule during acute rehabilitation, there is the potential for decreased involvement in restorative therapies, thereby impacting functional improvement and recovery. Medication adherence is another potential factor that becomes highlighted for community-dwelling older adults. Falls are also common in older adults, with prevalence increasing with age.31 Falls can result in declines in health status, in the ability to undertake activities of living, and in lifestyle and quality of life, contributing to additional stressors.
If the older adult lives alone, there are fewer external resources available to help motivate them to participate in restorative therapies and to adhere to treatment recommendations. Thus, this motivation must arise internally. The presence of psychosocial factors and stressors may impact this internal motivation. When the older adult lives alone, there is also the potential for increased social isolation, as they may not be able to drive, may have fewer visitors, and no longer have the daily interactions with the acute rehabilitation treatment team. As discussed below, social isolation is a risk factor for declines in physical and emotional status.