Geriatric considerations - Mental health: Nursing

Stress is a normal response to internal and external threats to homeostasis, or the body’s stable equilibrium, caused by a real or perceived threat. The two types of stress are eustress and distress.

Eustress, or positive stress, results from beneficial and motivational stressors, like starting a new job, whereas distress, or negative stress, occurs in response to a negative stressor, like the death of a loved one.

Regardless of the source of stress, the body responds by undergoing a series of physiologic changes.

In the short term, the body can adapt and return to homeostasis; but if sustained, stress can be detrimental to physical and even mental health, leading to problems with cognition, memory, depression, and anxiety, especially in those who aren’t able to cope, or effectively manage stress.

As the nurse caring for an older adult patient, you’ll identify common stressors, recognize signs and symptoms of ineffective coping, and implement patient-centered care strategies to promote effective coping.

Now, stress happens across the lifespan, but some stressors are more likely to impact older adults, such as major life changes involving loss and health conditions.

Loss can be social, like losing independent driving privileges; emotional, such as the death of a partner; financial, like reduced income due to retirement; and physical, such as losing eyesight from a chronic condition like macular degeneration.

Remember, older adults may use coping strategies that are both effective and ineffective to deal with stress. For example, an effective coping strategy is sublimination, when negative energy is channeled into a positive activity, like exercise; whereas an ineffective coping mechanism is suppression, when an individual avoids thinking about a stressor altogether.

Alright, sustained stress over time can deplete the energy reserves required for effective coping, resulting in signs and symptoms of ineffective coping that can be categorized as physical, cognitive, or behavioral.

Physical manifestations initially result from triggering the “fight or flight” response, where hormones are released in response to stress to protect the body and maintain homeostasis.

Specifically, norepinephrine and epinephrine, released by the adrenal medulla, increase the heart rate, blood pressure, and respiratory rate; while cortisol, released from the adrenal cortex, results in increased glucose supply. If stress is dealt with effectively, body functions return to normal.

However, when stress continues, exhaustion occurs, which can lead to muscle tension, typically in the head, neck, and back; altered bowel and bladder function, like constipation or diarrhea; as well as decreased appetite; sleep disturbances; and even diabetes mellitus and decreased immunity.

Likewise, temporary mild stress can lead to greater cognitive alertness; however, when sustained, it can lead to mental exhaustion, difficulty solving problems, impaired concentration, and problems with memory.