Stress has been traditionally defined as an a specific response of the organism to any kind of exogenous or endogenous stimulus that is able, due to its duration or intensity, to activate adaptation mechanisms to face the stimulus and reestablish homeostasis.

1. STRESS AMONG ELDERLY
Presented by:
Arti Sahu
Department of Physiotherapy

2. Stress
• Stress has been traditionally defined as an a specific response of the organism to any kind of
exogenous or endogenous stimulus that is able, due to its duration or intensity, to activate adaptation
mechanisms to face the stimulus and reestablish homeostasis (Selye, 1974).
• Primary and secondary stress responses are indeed crucial to activate the organism and to properly
face an event or situation, thus supporting a controlled response in which the individual feels to have
adequate skills and resources to answer the requests of the context and initiates a positive problem-
solving process.
• Only when the exposure to a stressor agent persists for long periods of time or when the action of
the stressor agent becomes too intense such physiological adaptation mechanisms begin to falter,
homeostatic regulatory processes become less efficient, and the stress response becomes
dysfunctional (Dhabhar, 2014).

3. • “Stress arises in any event, situation or circumstance occurring
in an individual’s environment, which is perceived by the
individual to be threatening his/her wellbeing and healthy
functioning” (Lazarus & Folkman (1984))
• Stress therefore has a physical, Psychological and Spiritual
impact

4. Stress stimulants : Stressors
• Internal causes:
– Lifestyle choices
– Negative self-talk
– Unrealistic expectations
– Personality traits
• External causes:
– Physical environment
– Social interaction
– Organizational
– Major life events
– Daily hassles

5. Types of stress
• Eustress:
• positive/ pleasant/ curative
• motivates action for accomplishments
• can be viewed as ‘stimulation to growth and development
• forward-moving, goal-oriented and achieves something
• Distress:
• negative;
• negative reaction to daily activities.
• imbalance between demands and our ability to meet these
demands

6. Stages of Stress
• ALARM STRESS:
– Primary stage
– Threat encounter- nervous system sends urgent signals to brain
– Body parts and functions coordinate to fight back or flee
– Example: accident
• RESISTANCE STRESS:
– No relief from alarm, energy drops.
– Urge to fight- hastiness, impatience and exasperation
– Cutting short of sleep
– Indications- weariness, exhaustion, anxiety and forgetfulness
– Prone to cold and influenza

7. • EXHAUSTION STRESS:
– Completely tired and drained.
– Hatred towards life.
– System breakdown and mental disequilibrium.
– Results- heart diseases, blood pressure and ulcers

8. SYMPTOMS OF STRESS
• COGNITIVE SYMPTOMS:
– Inability to concentrate
– Memory problems
– Pessimism
– Anxiety
– Constant worrying
• EMOTIONAL SYMPTOMS:
– Irritability/ moodiness
– Agitation/ inability to relax
– Overwhelmed
– Loneliness/ Isolation
– Depression/ Unhappiness

9. • PHYSICAL SYMPTOMS:
– Pain/ ache
– Diarrheas/ constipation
– Nausea/ Dizziness
– Accelerated pulse rate
– Frequent colds
• BEHAVIOURAL SYMPTOMS:
– Eating less/ more
– Sleeping too much/ little
– Isolation
– Procrastination
– Substance abuse
– Nervousness- nail-biting, pacing.

10. Why are elderly more vulnerable to
stress?
• Are economically disadvantaged
• No relatives or friends
• Experienced recent losses
• Changes of lifestyle and financial status after retirement
• Caring for a sick spouse
• Death of relatives, beloved or close friends
• Deterioration of physical abilities and chronic illness
• Worries for not being able to live independently
• Worries for institutionalization

11. EFFECTS OF STRESS
• Behavior:
– Eating too much/ little
– Sudden anger outbursts
– Substance abuse
– Alienation
– Frequent crying
– Relationship problems
• Thoughts/ Emotions:
Anger, Anxiety, Burnout, Depression, Insecurity, Forgetfulness, Irritability,
Inability to concentrate, Restlessness, Sadness, fatigue

12. • Body:
– Sweat
– Body/ chest pain
– Cramps/ muscle spasms
– Fainting
– Headache
– Heart diseases
– Hypertension
– Immunity loss
– Muscular aches
– Nail biting
– Nervous twitches
– Pins and needles
– Sleeping difficulties
– Upset stomach

13. Scales and questionnaires
• Perceived Stress Questionnaire (PSQ)
• Perceived Stress Scale (PSS-10)

14. Stress Management
• Assertiveness
• Nutrition
• Music therapy
• ABC strategy
• Seek professional assistance
• Relaxation techniques
• Yoga
• Exercise

15. Physiotherapy Management
• Deep breathing
• Aerobic Exercises
• Relaxation techniques

16. Deep Breathing
• Deep breathing is a fundamental technique used in various
relaxation methods and is also incorporated in qigong, yoga and
progressive muscle relaxation.
• In Japan, deep breathing is widely used as a method of reducing
tension and mood.
• According to the study conducted by Perciavalle et al (2017), deep
breathing techniques led to an effective improvement in the
management of stress in daily life, and therefore, could exert
positive influences on the stress conditions.

17. Aerobic Exercises
• Aerobic exercises improve CV endurance, decrease stress and
depression, enhance physical activity and enhance sense of well-
being.
• A study conducted by deVries et al (2017) reported a higher
psychological detachment during the exercise sessions and showed a
larger decrease in stress and fatigue, and a larger increase in energy
compared to participants reporting lower detachment.
• Imaging studies have demonstrated a lower amount of aged -
dependent brain atrophy among those who exercise (Saraulli
(2017)).

18. Relaxation Training
• The goal is to promote stress reduction and relaxation.
• A relaxation response is associated with engagement of parasympathetic
responses along with an increase in alpha brain waves.
• Positive benefits of relaxation training include the following:
• Muscle relaxation
• Lowered blood pressure
• Reduced ischemic pain
• Enhanced awareness of emotional state and memory
• Increased energy level
• Increased sense of control

19. • Intervention Strategies for Rehabilitation: quiet deep breathing and
attention on a single focus (thought, word, or object).
• The patient initially practices while lying down and later can shift to
practicing while sitting or standing comfortably.
• Use of imagery is another technique that can redirect the patient’s
focus from the frustrating aspects of performance or pain.
• The environment should be relaxing and quiet, with softened lights.
• Jacobson originally described progressive relaxation exercises to
promote relaxation. While resting comfortably, the patient is
directed to alternately clench and release various different muscle
groups, moving progressively throughout the body.

20. Thank you