The Role of Stress and Coping On the Health of Older Adult Residents In Assisted Living

Purpose: Older adults experience stressful life events. Moreover, many older adults live in a high-risk living environments facing issues such as sadness, anger, guilt, hopelessness, or helplessness, thus creating additional psychological and physical problems (Fitzpatrick & Tran, 2002). Many researchers have revealed that highly stressed older adults were, for a variety of reasons, likely to have reduced levels of psychological well-being and physical health (Burton, Halely, & Small, 2006; Grimby, Johansson, Sundh, & Grimby, 2008). Somes researchers have also found that coping resources and responses play a significant role in health outcomes for older adults (Cait, 2004; Cummings, 2002). However, little is known about the role of stress, spiritual coping, active coping, and avoidant coping on depression and physical functioning of older adults in assisted living facilities. Thus, this study attempted to get information for the issue.

Methods: This cross-sectional survey used purposive sampling to recruit 316 older adults, 65 years of age or over, in seven assisted living facilities in Kansas. From 2009 through 2010, face-to-face interviews lasting 60 to 90 minutes were conducted. To measure dependent variables (depression and physical functioning), the Geriatric Depression Scale-Short Form (GDS-SF) and the Short Form 36 health survey (SF36) were used (Jang, Bergman, Schonfeld, & Molinari, 2006; Jenkinson, Coulter, & Wright, 1993). To measure independent variables (stress, spiritual coping, active coping, and avoidant coping), the Perceived Stress Scale (PSS), the Brief Multidimensional Measures of Religiousness/Spirituality (BMMRS), and the Brief COPE scale were used (Cohen, Kamarck, & Mermelstein, 1983; Meyer, 2002; Yoon & Lee, 2007). Respondents' mean age was 82.63 years. Majority respondents were female (71%) and Caucasian (85%). Hierarchical regression method was used.

Results: Average scores of perceived stress for older adults in assisted living were 15.71. This is higher than the average of 12.9 in the general population (Cohen & Williamson, 1988). Hierarchical regression analysis indicates that higher spiritual coping is significantly associated with lower depression of older residents (B=-.267, p≤ .001). Higher active coping is significantly related to lower depression (B=-.116, p≤ .05). Higher avoidant coping is significantly associated with higher physical functioning (B=.127, p≤ .05). Higher perceived stress is significantly associated with higher depression (B=.371, p≤ .001) and lower physical functioning (B=-.319, p≤ .001). Additionally, the ability to maintain driving privileges is significantly related to lower depression (B=-.126, p≤ .001) and higher physical functioning (B=.338, p≤ .001).

Implications: Based on the results of our study several implications are suggested. First, assisted living facilities must develop innovative service delivery plans to help older adults cope with stress. Second, state regulatory bodies must require assisted living facilities to employ professionally trained social workers and allied professionals. Many do not hire licensed professionals simply because they are not required to do so. Most assisted living residents may benefit from creative case management and therapeutic services that only highly trained professionals can provide. Third, assisted living facilities need to create social support groups and spiritual support programs since both have been shown to improve coping skills and psychological well-being among older adults.