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date: 16 August 2018

Stress and Coping Theory Across the Adult Lifespan

Summary and Keywords

Stress is a broad and complex phenomenon characterized by environmental demands, internal psychological processes, and physical outcomes. The study of stress is multifaceted and commonly divided into three theoretical perspectives: social, psychological, and biological. The social stress perspective emphasizes how stressful life experiences are embedded into social structures and hierarchies. The psychological stress perspective highlights internal processes that occur during stressful situations, such as individual appraisals of the threat and harm of the stressors and of the ways of coping with such stressors. Finally, the biological stress perspective focuses on the acute and long-term physiological changes that result from stressors and their associated psychological appraisals. Stress and coping are inherently intertwined with adult development.

Keywords: stress, social stress, psychological stress, coping, biological stress, trauma, life events, chronic stressors, daily stressors, nonevents

What Is Stress?

While stress is difficult to define (Contrada, 2011), stress researchers tend to share a common interest in a process by which external, environmental, or psychosocial demands surpass an individual’s adaptive capacity and result in biological and psychological changes that have the potential to jeopardize one’s health and well-being (Cohen, Kessler, & Gordon, 1997; Contrada, 2011). Stress can thus be viewed as a process delineated by three components (Almeida, Piazza, Stawski, & Klein, 2011; Cohen et al., 1997; Wheaton, 1994; Wheaton & Montazer, 2010): stressors (external or environmental demands), stress appraisals (the perceived severity of stressors), and distress (affective, behavioral, or biological responses to stressors).

Each of these components is emphasized in one of three theoretical stress perspectives: social, psychological, and biological (Cohen et al., 1997). The social stress perspective highlights the way that environmental or external demands precipitate individuals’ stress and how such demands are contingent upon contextual factors or social circumstances (Wheaton & Montazer, 2010). The psychological stress perspective focuses on individuals’ appraisals of stressors and the availability of coping resources to manage the overwhelming demands of such stressors (Cohen & Janicki-Deverts, 2012; Lazarus, 1999). Finally, the biological stress perspective highlights how and when physiological systems become activated by stress processes that may risk individuals’ physical health (Cohen et al., 1997). The purpose of this article is to describe each of these theoretical perspectives and their relevance to aging research.

Social Stress Perspective

The social stress perspective primarily focuses on the origins of stressful life experiences (Aneshensel, 1992; Pearlin, 2009). According to the social stress perspective, the experience of stressors is structurally constrained (Wheaton, 1999; Pearlin, 2009). Exposure to external demands is not random, but rather embedded in an individual’s position in society, social structure, social organizations, roles, and other social constructs (Aneshensel, 1992; Wheaton, 1999). Two central themes have emerged from the social stress perspective: (a) the differentiation of categories of stressor types and (b) the ways that social structures link to individuals’ experiences of stressors.

Categories of Stressors

Stressors are commonly divided into five categories: life events, chronic stressors, daily stressors, trauma, and nonevents (Wheaton, 1994, 1999; Wheaton & Montazer, 2010).

Life Events

Life events, also known as life change events or event stressors, are discrete, observable stressor events that have a clear onset and offset (Wheaton & Montazer, 2010). Some examples of life event stressors are the death of a spouse, divorce, and job loss. The modern study of social stress started with the analysis of life events, partly because the easily verifiable nature of these events make it possible to operationalize the concept of stress itself (Wheaton, 1994; Wheaton & Montazer, 2010). One challenge of this research is identifying a pool of all possible life events that an individual might experience (Aneshensel, 1992). For example, items in the stressful life event scales often mix life events with traumas and daily stressors (Aldwin & Yancura, 2011).

Life event representation is an important issue for aging researchers. For example, an early study found an inverse association between age and exposure to life events, with older individuals showing fewer life events than their younger counterparts (Rabkin & Struening, 1976). Such a result runs counter to the general assumption that late life is associated with higher stressors due to the development of chronic illnesses and higher levels of bereavement (Aldwin & Yancura, 2011). However, further analysis showed that the Social Readjustment Rating Scale (Holmes & Rahe, 1967) that was used by Rabkin and Struening in their study consisted of items that included life events pertaining to younger individuals, such as marriage, birth, divorce, graduation, and job loss (Aldwin & Yancura, 2011). Analysis of life events using items designed for older individuals showed that there was no association between age and exposure to life events (Aldwin, 1990). Another study of life events showed that different sociohistorical experiences (e.g., wars, terrorist attacks, and economic downturn) influenced different levels of reported life events, indicating significant period effects (Chukwourji, Nwoke, & Ebere, 2017; Elder & Shananhan, 2006; Pruchno, Heid, & Wilson-Genderson, 2017). More longitudinal studies are needed to disentangle the influence of age and sociohistorical experiences on the reporting of stressful life events.

Chronic Stressors

The concept of chronic stressors, from a social stress perspective, originated from a study of chronic role strain by Pearlin and Schooler (1978) that articulated the importance of chronic disruptions in important social roles (e.g., marriage, work, and parenting) for health and well-being. Additional work by Wheaton and Montazer (2010) refined these ideas by providing three defining characteristics of chronic stressors that set them apart from event stressors:

  1. 1. Chronic stressors develop slowly and insidiously as continuous problems related to social roles and the social environment. In addition, chronic stressors may or may not start out as events.

  2. 2. The duration of the stressors from onset to offset is usually longer than the duration of life events.

  3. 3. Chronic stressors include both regular problems and issues related to daily roles and more specific problems, making them less self-limiting than life events.

Although chronic stressors are often tied to social roles, they also can include ambient stressors, which are not role bound, such as time pressure, financial problems, or living in a noisy place (Kershaw et al., 2015; Henderson, Child, Moore, Moore, & Kaczynski, 2016; Wheaton & Montazer, 2010). Table 1 provides a description of seven types of problems that are considered chronic stressors (Wheaton, 1997).

Most studies of stress involving older adults focused on chronic stressors (Aldwin & Yancura, 2011; Grzywacz, Almeida, Neupert, & Ettner, 2004). However, more research is needed to investigate age differences across adulthood in the prevalence and duration of chronic stressors (Aldwin & Yancura, 2011). Different age groups might have different sources of chronic stressors, which might lead to a similar rate of prevalence and duration of chronic stress (e.g., chronic diseases among older adults, as opposed to economic hardships among younger individuals).

Table 1. Problems Considered as Chronic Stressors

Number

Type of Problem

Examples

1

Threats

Threat of regular physical abuse; threat of living in a high-crime area

2

Demands

Facing levels of expectation or duty that cannot be met with available resources, including overload caused by cross-role and within-role expectations.

3

Structural constraints

The lack of access to opportunity or the needed means to achieve goals or the structured reduction in available alternatives or choices.

4

Under-reward

Being paid less for a job than others with the same qualifications as a result of discrimination based on age, gender, race, or sexual orientation.

5

Complexity

Number of sources of demands, or direct conflict of responsibilities across roles, or constant contingency and instability in living arrangements, or complex content in role responsibilities.

6

Uncertainty

Unwanted waiting for an outcome.

7

Conflict

Regular reenacted (and thus institutionalized) conflict in relationships because of fundamental differences in goals or values, without apparent resolution.

Daily Stressors

Daily stressors, or daily hassles, are often mistaken as chronic stressors (Kanner, Coyne, Schaefer, & Lazarus, 1981). The defining characteristics of daily stressors, which separate them from chronic stressors, are their duration and magnitude of severity. DeLongis, Folkman, and Lazarus (1988) characterized a daily stressor or daily hassle as a short-duration experience of a stressor, such as having an argument with a partner or getting caught in a traffic jam. In addition, Almeida (2005) defined daily stressors as relatively minor events experienced in day-to-day living. Table 2 provides example questions from the Daily Inventory of Stressful Events (DISE), used by researchers to ascertain information about the frequency of people’s daily stressors.

Compared to life events, daily stressors tend to have a more proximal effect on well-being (Almeida, 2005; Almeida et al., 2011). Daily stressors produce spikes in psychological distress during a particular day, while life events create prolonged bouts of distress (Almeida, 2005; Almeida et al., 2011). Daily stress also may have prolonged health effects when piled up across days, which in turn creates persistent irritations, frustrations, and overloads, including chronic physical and psychological distress, chronic conditions and functional impairment, and mortality (Chiang, Turiano, Mroczek, & Miller, 2018; Lazarus, 1999; Leger, Charles, Ayanian, & Almeida, 2015; Pearlin, Menaghan, Lieberman, & Mullan, 1981; Piazza, Charles, Sliwinski, Mogle, & Almeida, 2013; Zautra, 2003).

Such a pileup of stressors (i.e., accumulation of stressor exposure or total number of stressors that an individual experiences) is more problematic if the stressors experienced are less diverse (i.e., low evenness of the type of daily stressors that an individual experiences). Higher levels of stressor exposure that are accompanied by lower levels of stressor diversity indicate a depletion of specific types of resources and may indicate the chronicity of the stressors (see Koffer, Ram, Conroy, Pincus, & Almeida, 2016, for an extensive discussion of stressor diversity).

The experience of daily stress differs across adulthood. Based on Midlife in the United States (MIDUS) data, a national longitudinal study of health and well-being (http://midus.wisc.edu), adults in the United States report at least one stressor on 40% of study days, and multiple stressors on 10% of study days (Almeida, Wethington, & Kessler, 2002). In general, studies show that the type and frequency of daily stressors differ by age (Aldwin, Sutton, Chiara, & Spiro, 1996; Almeida & Horn, 2004; Chiriboga, 1997). Mroczek and Almeida (2004) found that older adults reported fewer daily stressors, measured using DISE (see Table 2), and less stressor-related daily negative affect than younger individuals; however, older participants reported a higher level of severity in the reported stressors. Finally, Stawski, Sliwinski, Almeida, and Smyth (2008) found that there were no age differences in daily stressor-related negative affect.

Trauma

Stressors sometimes can be categorized as traumatic. Trauma is defined by the Diagnostic and Statistical Manual of Mental Disorders (4th edition) as “events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others . . . the person’s response [to the events] involved intense fear, helplessness, or horror” (APA, 1994, pp. 427–428). However, according to Wheaton and Montazer (2010), not all traumas happen as events. Physical abuse that happens one time during childhood might fit the definition of a traumatic event. On the other hand, repeated and regular experiences of physical abuse might be better categorized as a chronic traumatic experience. Another important defining characteristic of trauma is its greater severity compared to other types of stressors. As a consequence, traumas might have a greater impact on long-term health and well-being.

Table 2. Questions From the DISE

Number

Stem Questions

1

Did you have an argument or disagreement with anyone since this time yesterday?

Yes

No

2

Since (this time/we spoke) yesterday, did anything happen that you could have argued about but you decided to let pass in order to avoid a disagreement?

Yes

No

3

Since (this time/we spoke) yesterday, did anything happen at work or school (other than what you have already mentioned) that most people would consider stressful?

Yes

No

4

Since (this time/we spoke) yesterday, did anything happen at home (other than what you have already mentioned) that most people would consider stressful?

Yes

No

5

Many people experience discrimination on the basis of such things as race, sex, or age. Did anything like this happen to you since (this time/we spoke) yesterday?

Yes

No

6

Since (this time/we spoke) yesterday, did anything happen to a close friend or relative (other than what you have already mentioned) that turned out to be stressful for you?

Yes

No

7

Did anything else happen to you since (this time/we spoke) yesterday that most people would consider stressful?

Yes

No

Note: A “Yes” answer to each stem question is followed up with questions, including (a) a series of open-ended “probe” questions that ascertain a description of the stressful event, (b) a question regarding the perceived severity of the stressor, and (c) a list of structured primary appraisal questions inquiring about goals and values that were “at risk” because of the event (Almeida et al., 2002).

Source: Almeida et al. (2002)

According to Ozer, Best, Lipsey, and Weiss (2003), most people experience at least one violent or life-threatening situation during their lives. Among older adults, car accidents are the most common source of trauma (Weintraub & Ruskin, 1999). In addition, a study by Wheaton, Roszell, and Hall (1997) indicated that being sent away from home in childhood is the least common trauma (prevalence rate = 3.5%) and the death of a spouse, child, or other loved one is the most common traumatic experience (prevalence rate = 50%). Using the Traumatic Life Events Questionnaire (TLEQ) shown in Table 3, Ogle, Rubin, Berntsen, and Siegler (2013) found that nondisclosed childhood physical abuse is the least common trauma, and unexpected death, illness, or accident involving a loved one is the most common trauma.

Table 3. The TLEQ and Its Prevalence Among Adults in the United States

Number

Type of Trauma

Mean of Age at Exposure

Lifetime Prevalence (%)

1

Childhood physical abuse

9.51

5.46

2

Witnessed childhood family violence

10.60

10.91

3

Sexual assault

13.33

10.85

4

Warfare or combat exposure

25.49

9.23

5

Physical assault by stranger

26.87

5.95

6

Witnessed an attack or murder

27.34

4.30

7

Nondisclosed

28.01

3.87

8

Non–live birth pregnancy

30.39

31.51

9

Motor vehicle accident

30.67

20.20

10

Other life-threatening accident

31.43

8.82

11

Other life-threatening event

31.82

18.55

12

Death threat

34.55

13.65

13

Stalked

34.70

5.70

14

Robbery

34.85

8.76

15

Physical assault by partner

35.23

7.89

16

Natural disaster

38.52

6.02

17

Unexpected death of a loved one

39.41

53.30

18

Personal illness or accident

43.98

18.39

19

Illness or accident of a loved one

45.84

32.23

Note: n = 3,208.

Sources: Kubany et al. (2000); Ogle et al. (2013).

Nonevents

The last category of stressors are nonevents, defined as anticipated events or experiences that do not happen in reality (Gersten, Langer, Eisenberg, & Orzeck, 1974; Neugarten, Moore, & Lowe, 1965). Normative expectations play an important role in the stressfulness of nonevents such as not getting married by a certain age or not getting an anticipated promotion at a certain career stage (Frost & LeBlanc, 2014). Schuth, Posselt, and Breckwoldt (1992) studied miscarriage in the first trimester as a nonevent stressor. According to Wheaton and Montazer (2010), nonevents that have no tie to normative timing are more similar to chronic stressors, such as expecting a loan for low-income housing, but not receiving one.

Social Stress and Health: Exposure Versus Vulnerability

There are two hypotheses that researchers draw on to explain how social structures link to stressors and health outcomes: the exposure hypothesis and the vulnerability hypothesis (Aneshensel, 1992; Turner, Wheaton, & Lloyd, 1995). These competing hypotheses focus on disentangling whether exposure or vulnerability to stressors leads to disease risk. Stressor exposure is the likelihood that a person will be exposed to stressors given her or his social location, such as socioeconomic status (SES) or gender, and individual characteristics, such as personality (Almeida et al., 2011). On the other hand, vulnerability to stressors relates to the concept of reactivity, which is the likelihood that one will show physical or psychological reactions to experienced environmental demands or stressors (Almeida, 2005; Bolger & Zuckerman, 1995; Cacioppo, 1998).

There is considerable evidence supporting the idea of differentiated exposure to stressors based on sociodemographic, psychosocial, and situational characteristics as an explanation of why some people are healthier than others. For example, researchers have found that SES (Evans & Kim, 2010; Turner et al., 1995; Turner & Avison, 2003), age (Aldwin, 1990; Almeida & Horn, 2004; Hamarat et al., 2001), personality (Bouchard, 2003; Ebstrup, Eplov, Pisinger, & Jørgensen, 2011; Penley & Tomaka, 2002), and social support (Brewin, MacCarthy, & Frunham, 1989; Felsten, 1991; Huang, Costeines, Kaufman, & Ayala, 2014; Kwag, Martin, Russell, Franke, & Kohut, 2011) play critical roles in differentiating individuals’ experiences of stressor exposure.

However, there is also substantial evidence to support the vulnerability hypothesis. For example, a recent analysis of exposure and vulnerability to daily stressors showed that SES was not associated with exposure to daily stressors. However, individuals with lower SES were more reactive to the daily stressors that they experienced (Almeida, Neupert, Banks, & Serido, 2005; Grzywacz et al., 2004; Surachman, Wardecker, Chow, & Almeida, 2018). There are at least four speculated reasons for this (Grzywacz et al., 2004; Surachman et al., 2018), including (a) the experience of chronic stressors may desensitize individuals with lower SES in their reactions to minor day-to-day stressors; (b) the possibility of gender and racial differences that obscure the systematic variation in exposure to daily stressors; (c) individuals with lower SES may be less reflective and articulate when reporting their daily stressors; and (d) individuals from lower SES may encounter similar types of daily stressors, indicating a low number of daily stressors encountered and lower levels of daily stressor diversity.

Psychological Stress Perspective

The psychological stress perspective focuses on an individual’s perception and evaluation of the potential damage caused by external environmental demands (Cohen et al., 1997). The two concepts that are fundamental to the psychological stress perspective are appraisal and coping (Krohne, 2002). The stress appraisal model, developed by Lazarus & Folkman (1984) is the most influential psychological stress model. According to this perspective, the way that we evaluate external events (i.e., stressors) determines our degree of stress. Specifically, Lazarus and Folkman (1984, p. 19) define psychological stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being.”

Psychological Stress and Appraisal

Arnold (1960) was the first theorist to use the term appraisal in the context of emotion and personality. Appraisal became the central concept of Lazarus’s psychological stress theory. The term appraisal refers to the continuous evaluation by individuals of their relationship with the external environment with respect to their implications for well-being (Lazarus, 1999).

Lazarus (1999) emphasizes the importance of differentiating the act of appraisal and appraising. The former focuses on the evaluative product, while the latter is the act of making the evaluation. Lazarus also distinguishes primary and secondary appraisal and appraising. The distinction is based on different sources of information in each evaluation process (Krohne, 2002). Primary appraisal refers to the evaluation of whether external events are relevant to one’s values, goal commitments, beliefs about the self and the world, and situational intentions. Stress occurs when external events threaten these key features of well-being during primary appraisal. There are three different stress conditions: harm/loss (damage that has already happened), threat (the possibility of damage in the future), and challenge (the possibility for growth). The primary appraisal has three main components: goal relevance, goal congruence, and type of ego development (Lazarus, 1999).

Secondary appraisal reflects evaluative processes that assess resources for dealing with or managing stress. During secondary appraisal, individuals provide judgments about who or what is responsible for a harm, threat, challenge, or benefit in order to place the blame or credit for an outcome issue. It is important to point out that the primary and secondary appraisal processes do not operate independently; instead, they reciprocally influence each other over time (Lazarus, 1999).

There are at least three criticisms regarding the concept of appraisal by Lazarus (Smith & Kirby, 2011). First, the labeling of appraisal as primary and secondary is misleading, as people often mistakenly assume that they reflect a sequence. Second, the definition of psychological stress is unclear, especially related to how much demand is considered as taxing one’s resources. Lazarus’s definition of stress is relatively restrictive to extreme conditions (i.e., environmental demands exceed resources). Third, it is not clear whether the three types of appraisal (i.e., harm/loss, threat, and challenge) are shaped purely by primary appraisal or by the combination of primary and secondary appraisal.

Coping Processes

Coping processes are very similar to stress appraisal processes. According to Lazarus and Folkman (1984, p. 141), coping is defined as “constantly changing cognitive and behavioral efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person.” According to this approach, coping follows stress appraisal and involves specific cognitive and behavioral strategies to manage stressful experiences and their consequences (Aldwin & Yancura, 2011). According to the definition of coping by Lazarus and Folkman (1984), coping efforts do not include their outcome or effectiveness. Every form of coping can be both effective and maladaptive (Smith & Kirby, 2011). Thus, coping also can be defined as the efforts to manage stressful situations, regardless of the effectiveness of those efforts (Lazarus & Folkman, 1984; Smith & Kirby, 2011). Indeed, the study of coping is intended to discriminate factors associated with adaptive versus maladaptive coping (Smith & Kirby, 2011).

According to Lazarus and Folkman (1984), coping can be categorized into two types: problem-focused coping (managing or changing the source of stress) and emotion-focused coping (regulation of stressful emotions). Brown and Nicassio (1987) offer an alternative classification of coping, which is active versus passive coping. In addition, Jensen, Turner, Romano, and Strom (1995) classify coping into cognitive versus behavioral types. Finally, Compas and colleagues (2001, 2006) differentiate coping into three different categories: primary-control engagement (e.g., problem solving, changing the situation, and emotion regulation), secondary-control engagement (e.g., positive thinking, acceptance, and distraction), and disengagement coping.

There are clear signs that active/primary-control and accommodative/secondary-control coping are associated with adaptive outcomes such as better emotional well-being and physical health (Compas et al., 2006; Moskowitz, Hult, Bussolari, & Acree, 2009; Walker, Smith, Garber, & Claar, 2005). However, there are numerous null findings linking active/primary-control and accommodative/secondary-control coping and positive outcomes (Compas et al., 2001; Smith, Wallston, & Dwyer, 2003). Coyne and colleagues have extensively discussed limitations in the study of coping (e.g., Coyne & Racioppo, 2000). In general, there are at least two aspects that are needed to be improved in future studies of coping (Smith & Kirby, 2011): (a) coping should be studied in a more situated, context-specific manner, in which coping and the outcomes associated with individual incidents are examined; and (b) more studies are needed to focus on the role of control-related appraisals mediating the relationship between these dispositional antecedents and coping behavior.

Stress Appraisal and Coping Across Adulthood

In terms of age differences in stress appraisal, older adults appraise problems as less stressful (Aldwin et al., 1996; Folkman, Lazarus, Pimley, & Novacek, 1987) than younger adults. One possible explanation for this finding is that older individuals have higher levels of resiliency to stressors because of what they have been through across the life course (Aldwin et al., 1996). Major life events that are common to older adults, such as the death of a spouse or family member, make them more tolerant of minor stressors in their daily lives. Another possible explanation is that the lower stress appraisal among older adults is due to environmental changes (Lawton, Kleban, Rajagobal, & Dean, 1992). For example, retirement may lead to more leisure time for older adults, and thus fewer stressful experiences (Ginn & Fast, 2006; Rosenkoetter, Gams, & Engdahl, 2001).

Another example of environmental change is that older adults receive more respect from family members, which make their social experiences more pleasant (Fingerman & Baker, 2006). For example, others may be more hesitant to argue with or express their negative emotions with older individuals (Fingerman, Miller, & Charles, 2008). These explanations may partly explain why older adults reported fewer stressors with age. However, explanations based on retirement or deference to older adults are less conclusive, given that decreases in stressor appraisal continue long after retirement, and long after people have entered the venerable period (Charles, 2010). Two theoretical frameworks are especially useful to look at for their alternative explanations regarding lower stressor appraisal among older adults: socioemotional selectivity theory (Carstensen, Fung, & Charles, 2003) and the strength and vulnerability integration (SAVI) model (Charles, 2010).

According to socioemotional selectivity theory, time perspective plays a critical role in human goal-directed behavior and motivation (Carstensen, Isaacowitz, & Charles, 1999). As individuals get older, they perceive that they have a relatively more limited future compared to younger individuals (Lang & Carstensen, 2002). This awareness of limited time left is amplified by the fact that older adults increasingly experience the deaths of friends and family members (Cartensen et al., 2003). Change in time perspective is associated with goals among older adults, as they care more about experiencing meaningful relationships and care less about knowledge-related goals (Cartensen et al., 2003). According to socioemotional selectivity theory, older individuals achieve this goal by regulating their social contacts and network (Carstensen, Gross, & Fung, 1997). Thus, older adults reduce their social contacts in order to optimize emotionally meaningful and gratifying experiences and fewer experiences of negative interchanges (Cartensen et al., 2003).

The decrease in social contacts begins relatively early in life, around the 30s (Carstensen, 1992), indicating that this decrease is not unique to older individuals (Charles, 2010). Empirical studies show that social selection promotes affective well-being, such as increased satisfaction and more positive emotional experiences (Charles & Piazza, 2007; Fingerman, Hay, & Birditt, 2004). Finally, even though the size of social networks among older adults is decreasing, their social networks are characterized by warm, satisfying, and trusting relationships (Ryff & Keyes, 1995).

Charles (2010) extended the socioemotional selectivity theory by integrating age-related physiological vulnerabilities when considering emotion regulation among older adults. This concept is known as strength and vulnerability integration (SAVI). According to SAVI, later adulthood is associated with both strengths and vulnerabilities, in which they play important roles in emotion regulation. The strengths include the motivation to maintain meaningful and gratifying relationships due to a change in time perspective (similar to socioemotional selectivity theory), as well as the cognitive-behavioral skills to do so. The vulnerabilities associated with aging include age-related physiological vulnerabilities that affect the recovery process during emotion regulation due to stressful experiences. Thus, increase in age is associated with an enhanced ability to avoid stressors, reappraise them as being less stressful, or both, while at the same time, it is also associated with physiological vulnerabilities that lower the flexibility of response to stress (Almeida et al., 2011; Charles 2010).

According to SAVI, age-related changes in emotion regulation are less likely to happen during exposure to stressors that cause high levels of physiological arousal. When this happens, older individuals will be less able to employ their emotion regulation strategy due to high physiological cues. After physiological symptoms are normalized, older individuals will report higher levels of well-being again, as their emotional states will be less influenced by their physiological states and more affected by their appraisal of an event. Thus, although the motivation to regulate well-being exists, certain circumstances such as chronic stress and neurological dysregulation may interfere with its efficacy on maintaining well-being (Almeida et al., 2011; Charles, 2010; Charles & Piazza, 2009).

There are mixed results regarding the association between coping strategies and age (Aldwin & Yancura, 2011). Folkman et al. (1987) found that older individuals reported less frequent use of problem-focused coping compared to younger individuals. Similarly, Aldwin et al. (1996) found a negative association between age and self-reported use of coping strategies. However, when information about coping was administered using semistructured interviews rather than self-report questionnaires, no age differences were found (Aldwin et al., 1996). Even when older individuals used fewer coping strategies, their approaches to cope with a problem were as effective as those of younger individuals (Hobfoll, 2001). Except among those who suffer from chronic illness, coping efficacy decreases as individuals get older (Barry et al., 2004; Logan, Pelletier-Hibbert, & Hodgins, 2006). Thus, in addition to the frequency of coping strategies, it is important to incorporate the analysis of coping efficacy when studying stress, coping, and aging (Aldwin & Yancura, 2011).

Biological Stress Perspective

This article ends by briefly describing the biological stress perspective, which focuses on the acute and long-term physiological changes that result from social stressors and their associated psychological appraisals. This perspective highlights the activation of physiological systems that are sensitive to stressful situations, especially the sympathetic-adrenal medullary system (SAM) and the hypothalamic-pituitary-adrenocortical axis (HPA) (Cohen et al., 1997, 2007; Koolhaas et al., 2011). Repeated or prolonged activation of these physiological systems is referred to as allostatic load, and it can lead to pathogenesis and disease (McEwen, 2013).

Activation of the Sympathetic-Adrenal Medullary System and Hypothalamic-Pituitary-Adrenal Axis

The experience of stress activates physiological changes that reflect the body’s adaptation to meet the demands. Quick, short-term activation is governed by the SAM system. Activation of SAM releases catecholamines, which work with the autonomic nervous system to regulate cardiovascular, pulmonary, hepatic, skeletal muscle, and immune systems (Cohen et al., 2007). Longer-term adaptations are met by the HPA system. HPA activation leads to the secretion of the hormone cortisol, which regulates anti-inflammatory responses; metabolism of carbohydrate, fat, and protein; and gluconeogenesis (Cohen et al., 2007). Continued and repeated activation of the HPA and SAM systems can disrupt their control over other physiological systems, leading to an increased risk of physical and psychological conditions (Cohen et al., 1997; McEwen, 1998).

Age, Exposure to Stressors, Hypothalamic-Pituitary-Adrenal Axis, and the Sympathetic-Adrenal Medullary System

There is evidence that the SAM system changes as individuals get older (Crimmins, Vasunilashorn, Kim, & Alley, 2008). The association between age and the SAM system is moderated by exposure to stressors (Almeida et al., 2011). Blood pressure is a good example of the change in the SAM system as individuals get older. After the age of 60, systolic blood pressure tends to be higher, whereas diastolic blood pressure tends to be lower (Franklin et al., 2001). Elevated systolic blood pressure among older adults is moderated by acute psychosocial stressors (Uchino, Uno, Holt-Lunstad, & Flinders, 1999). The increase in age is also associated with depleted epinephrine (Esler et al., 1995) and increased levels of norepinephrine (Barnes, Raskind, Gumbrecht, & Halter, 1982). The age-related changes in epinephrine and norepinephrine are also moderated by stressor exposure (Esler et al., 1995; Barnes et al., 1982), although these results were not replicated in other studies, such as Lindheim et al. (1992). Finally, the association between age and the SAM system may be stronger among people with physical problems, such as among older adults with cardiovascular disease (Almeida et al., 2011; Gillum, Makuc, & Feldman, 1991).

The age-related changes in the HPA axis are associated with an altered diurnal pattern and a disruption of the negative feedback loop, which leads to the overproduction of cortisol (Almeida et al., 2011). Older age is associated with an attenuated cortisol awakening (Almeida, Piazza, & Stawski, 2009) and a higher lowest point of evening cortisol (van Cauter, Leproult, & Kupfer, 1996). Similar to the SAM system, exposure to stressors moderates the association between age and the HPA axis (Almeida et al., 2011). The association between age and the HPA axis function is also stronger among people with worse health (McEwen, 1998).

Allostatic Load

One mechanism that might explain how continued and repeated activation of stress hormones influence health risk is deterioration of brain function. This hypothesis, known as the glucocorticoid cascade hypothesis, refers to the cascade effect of stress hormones on health (McEwen, 1998, 2013; Sapolsky, Krey, & McEwen, 1986). Continuous activation of stress hormones gradually deteriorates brain function, leads to a higher level of cortisol, and in turn jeopardizes health. Discussion of the impact of stress on the brain involves two concepts: allostasis and allostatic load (McEwen, 1998). Allostasis refers to adapting to a stressful situation and bringing the body back to homeostasis, whereas allostatic load is the cost of frequent or prolonged adaptations on the body and brain. The release of stress hormones is an example of an adaptive physiological response to a stressful experience. However, prolonged exposure to stressful experiences might lead to wear and tear on the HPA axis.

According to McEwen (1998), there are three types of physiological responses that lead to allostatic load: frequent stress, failed shutdown, and inadequate response. Frequent stress refers to the magnitude and frequency of responses or the frequency and intensity of the hits that lead to allostatic load (McEwen, 1998). Failed shutdown refers to chronic activity and failure to shut off this activity, such as with type II diabetes (McEwen, 1998). Finally, inadequate response refers to the failure to respond to a challenge, such as autoimmunity and inflammation (McEwen, 1998). In general, studies have found that indicators of physiological capacity and physiological reserve decrease as individuals get older, although the rate of decline varies across individuals (Crimmins, Johnston, Hayward, & Seeman, 2003; Lipsitz & Goldberger, 1992; Manton, Woodbury, & Stallard, 1995). Allostatic load index, a composite measure of multiphysical systems related to wear and tear due to stress (for details, see Juster, McEwen, & Lupien, 2010), increases with age (Crimmins et al., 2003). A higher allostatic load index indicates more physical systems that are in the high-risk category.

Stress and Health: Integrating the Social, Psychological, and Biological Stress Perspectives

One significant development in the study of stress over the past several decades is an increased emphasis on multilevel analysis of stress, which stretches from cells to society (Contrada, 2011). Relevant to the discussion in this article, the current trend in this field is the integration of the social, psychological, and biological stress perspectives to better understand the influence of stress on health and well-being. In turn, this knowledge can be utilized to design better intervention programs to improve health and quality of life in general.

Miller, Chen, and Parker (2011), for example, developed a framework known as biological embedding of the childhood adversity model, which links early-life, chronic stressors to chronic diseases in adulthood. According to this model, chronic stressors during childhood, such as living in poverty, are hypothesized to dysregulate physiological systems (e.g., establishing a pro-inflammatory phenotype in the immune system). Across the life course, this physiological dysregulation is amplified by hormonal dysregulation and behavioral proclivities due to the ongoing chronic stressors, causing chronic inflammation, which in turn is associated with accelerated aging, frailty, and chronic diseases. This model is an excellent example of integrating multiple levels of stress to better understand the etiology of chronic diseases associated with aging.

Another example of a study in this area is Surachman et al. (2018), which investigates the interaction between structural factors, such as life-course SES and daily stressors, and daily well-being. The results show that childhood SES is directly and indirectly (through adult SES and daily stressor severity) associated with daily well-being in adulthood, especially daily negative affect and daily physical symptoms. These results may have significant public health implications, given that previous empirical findings have shown that higher daily physical symptoms and negative affect due to daily stressors are associated with long-term health outcomes, such as chronic physical and psychological distress (Charles et al., 2013; Piazza et al., 2013), functional impairment (Leger et al., 2015), and mortality risk (Chiang et al., 2018). In addition, research on the influence of childhood SES on biological functioning in later life has shown the significance of daily stress processes and daily well-being as potential mechanisms of disparities in chronic diseases (Carroll, Cohen, & Marsland, 2011; Desantis, Kuzawa, & Adam, 2015; Miller et al., 2011).

Conclusion

Stress is a broad and complex phenomenon that links three components: environmental demands, internal psychological processes, and physical outcomes. Each of these components are reflected in three theoretical perspectives of stress. The social perspective is likely to emphasize stressful events (i.e., stressors) and the social context of these events; the psychological perspective focuses on internal evaluations and appraisals; and the biological perspective highlights physiological adaptions to these events and appraisals. To understand the role of stress in aging, it is necessary to appreciate each of these perspectives.

As we age, our social roles direct us to be exposed to a variety of life events, chronic stress, and daily hassles. In addition, the way that we appraise and cope with stress is likely to change as we accumulate a lifetime of experience. Finally, it appears obvious that biological changes accompany age, and such changes will likely be accelerated by the stress we experience. We hope that this article has provided the reader with some guidance on the theory of stress and coping across the adult life course.

Further Reading

Aldwin, C. M. (2007). Stress, coping, and development: An integrative perspective. New York: Guilford Press.Find this resource:

Baum, A., & Contrada, R. (Eds.). (2010). The handbook of stress science: Biology, psychology, and health. New York: Springer Publishing Company.Find this resource:

Hariri, A. R., & Holmes, A. (2015). Finding translation in stress research. Nature Neuroscience, 18(10), 1347.Find this resource:

Juster, R. P., Seeman, T., McEwen, B. S., Picard, M., Mahar, I., Mechawar, N., . . ., Lanoix, D. (2016). Social inequalities and the road to allostatic load: From vulnerability to resilience. Developmental Psychopathology, 4(8), 1–54.Find this resource:

Lazarus, R. S. (2000). Toward better research on stress and coping. American Psychologist, 55(6), 665–673.Find this resource:

Lovallo, W. R. (2015). Stress and health: Biological and psychological interactions. Los Angeles: SAGE Publications.Find this resource:

Pearlin, L. I., Schieman, S., Fazio, E. M., & Meersman, S. C. (2005). Stress, health, and the life course: Some conceptual perspectives. Journal of Health and Social Behavior, 46(2), 205–219.Find this resource:

Selye, H. (1978). The stress of life. New York: McGraw-Hill Companies.Find this resource:

Seeman, T. E., Singer, B. H., Rowe, J. W., Horwitz, R. I., & McEwen, B. S. (1997). Price of adaptation—allostatic load and its health consequences: MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259–2268.Find this resource:

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