Chapter 13: Coping and Stress

Since stressors are cumulative, individual perception significantly influences what constitutes a stressor. The body’s predictable physiological response to stress is governed by Dr. Hans Selye’s General Adaptation Syndrome (GAS), which progresses through the stages of alarm (the fight-or-flight reaction), resistance, and potentially exhaustion. High levels of stress result in physical manifestations such as elevated pulse and blood pressure, hyperventilation, muscle tension (headaches/backaches), and various gastrointestinal and urinary issues. Cognitively, severe stress can impair problem-solving, induce tunnel vision, and affect memory, while emotionally, it presents as anxiety, irritability, and feelings of worthlessness. For older adults, stress is often precipitated by multiple, overlapping losses, including the loss of loved ones, home, physical abilities, or financial security. Depression is discussed as a whole-body syndrome requiring diagnosis, noting that it is common but not a normal part of aging, and its symptoms often tragically mimic typical age-related changes, leading to missed diagnoses. Maladaptive coping can include self-medication, with alcohol being the most commonly abused substance among older adults, often initiated late in life in response to stressful events. Coping strategies fall into two categories: problem-focused (eliminating the threat) or emotion-focused (changing the response), with proactive coping providing a greater sense of control. Nursing interventions emphasize reducing stressors, ensuring basic needs (nutrition, rest, pain relief) are met, promoting continuity of care to foster trust, and teaching stress reduction techniques such as meditation, imaging, and progressive relaxation. The chapter highlights that managing disrupted living situations (relocation stress) requires active inclusion of the older adult in decision-making and encouraging the use of familiar possessions to minimize feelings of powerlessness.