Aldwin, Carolyn

Yancura, Loriena A. : L.A. Yancura is Associate Professor, Department of Family and Consumer Sciences, University of Hawai'i, Manoa.

REVIEW ARtICLE â?¼ Effects of stress on health and aging : two paradoxes Aging by Carolyn M . Aldwin and Loriena A . Yancura on Administration Although older adults are thought to experience more stress and to be more vulnerable to its adverse ef - fects , they often report less stress than younger adults and sometimes show more resilience . Paradoxically , while stress sometimes has long - term positive effects on well - being , stud - ies differ as to whether this increases or decreases with age . We conclude that older individuals have learned to appraise and cope differently with stress . This protects them in spite of their increased physiological vulner - ability and may also increase the pos - sibility of stress - related growth and optimal aging . ver the past century , remarkable Ochanges have occurred in the life expectancy and quality of life of older adults . Individuals born in the United States in 1900 had an average life ex - pectancy of 47.3 years ; those born in 2004 are expected to live 77.8 years on average ( NCHS 2006 ) . Life expectancy projections for residents of California are even higher than national estimates : As people age their health trajectories tend to diverge , with some developing multiple chronic individuals born in 2004 are expected to conditions and others maintaining good health ; stress may play a role in this aspect of aging . live 80.2 years ( Springborn 2006 ) . These increases do not come with - ( Rowe and Kahn 1998 ) . In California , optimally aging . In contrast , people in out costs ; they are accompanied by older adults are often actively engaged Cluster 0 started out with the highest corresponding increases in both the in farming , golfing , skiing â?? and even symptom levels , which increased rap - incidence ( new cases ) and prevalence running marathons . idly , while other people showed vari - ( current cases ) of chronic health condi - Individual health differences in - ous nonlinear patterns . Another study tions , most commonly cardiovascular crease with age , and these differences using this sample suggested that indi - disease , arthritis , diabetes and cancer . are thought to be greater in late life viduals â?? in this case combat veterans These chronic health problems may than any other phase of the life span . who had also experienced subsequent greatly influence older adults â?? well - Over time , people have increasingly civilian traumas like serious car acci - being and productivity , as disability different patterns of health trajectories . dents â?? had rapid increases in physical rates increase dramatically after age 65 . Aldwin et al . ( 2001 ) examined patterns symptoms ( Schnurr et al . 1998 ) . This One quarter ( 25.5 % ) of U.S . adults over of change , then clustered or grouped sparked our interest in the effects of age 65 report that their daily activi - individuals by both intercept ( base - stress on the aging process . ties are limited by one or more chronic line level ) and the shape of the curve . Effects of stress on health health condition , but 43.9 % of those Those in Cluster 1 began with the low - Until the 1970s , medical research - over age 75 report similar limitations est symptom levels , which increased ers were skeptical about the effects of ( NCHS 2006 ) . However , many older only slowly with age ( fig . 1 ) . Individuals stress on health . With thousands of adults are in good or excellent health in this cluster can be thought of as http : / / californiaagriculture.ucanr.org â?¢ OCTOBER â?? DECEMBER 2010 183 studies conducted , the impacts of stress A wide range of stressors can evoke Glossary and physiological processes are now physiological responses . We know widely recognized , although showing that stress induced by public speak - Chronic stressors : Enduring that specific illnesses stem from stress ing results in increased cortisol levels problems , especially in social roles , is somewhat difficult ( Aldwin 2007 ) . ( Feldman et al . 2004 ) , and driving buses such as living in poverty or caring Not only our minds but also our bod - in urban settings increases catechol - for a seriously ill family member . ies respond to stressors , which may be amine levels ( Evans and Carrère 1991 ) . Daily stressors : Problems of physical ( such as temperature ) or psy - We also know that family caregivers for everyday life such as commuting or chosocial ( such as a trauma , life event , people with Alzheimerâ??s disease appear minor arguments with a spouse . daily stressor or chronic stressor ) . to have less - efficient immune profiles The stress response begins when than those who are not experiencing Life events : Major changes such as the individual appraises a situation as chronic caregiving stress ( Kiecolt - divorce or being laid off from work . involving a threat , harm / loss or chal - Glaser et al . 2002 ) . While these findings trauma : Stressors that involve lenge ( Lazarus and Folkman 1984 ) . The provide evidence that stress influences mortal threats such as combat or appraisal and its attendant negative parameters in several physiological sys - natural disasters . emotions activate the sympathetic ner - tems , they do not necessarily prove that vous system to bring more energy to stress causes discrete illnesses . the body for a fight / flight response . The the progression of illnesses immediate reaction is that the sympa - A recent review of the literature on thetic neurons release catecholamines levels ) , the cardiovascular system ( in - psychological stress and disease ( Cohen ( adrenaline and noradrenaline ) directly creased heart rate and blood pressure ) et al . 2007 ) concluded that there is con - to the heart and other organs . This in - and the immune system ( changes in siderable support for a link between creases the heart rate , blood pressure circulating T cells , B cells and lympho - stress and certain illnesses such as and respiratory rate so the individual cytes ) . In the short term , these resources depression , cardiovascular disease and can run faster or think more clearly . are useful in helping the body deal with the progression of AIDS . There is also This reaction can be sustained by the stressors . For example , increases in growing evidence for the role of stress sympathetic - adrenal - medullary ( SAM ) blood glucose levels provide more fuel in the incidence and progression of system , which is also involved in the for the muscles and brain , and increases other diseases such as upper respiratory release of catecholamines from the ad - in certain immune cells can facilitate tract infections , asthma , autoimmune renal medulla , or center of the adrenal blood clotting in response to an injury . diseases and delayed wound healing . gland ( fig . 2 ) . In the long run , however , elevated blood Research using animals provides strong Adrenaline in large amounts can be glucose and lipids ( cholesterol ) in the evidence for a link between stress and toxic , so for sustained stress responses , blood can lead to chronic illnesses such cancer , but in humans this link is much the hypothalamic - pituitary - adrenal as diabetes and cardiovascular disease , weaker . ( HPA ) axis becomes activated ( fig . 2 ) . and the immune system can become In humans , stress may have more Cortisol and other glucocorticoids are suppressed . This is why chronic stress influence on the progression , rather released from the adrenal cortex , which may contribute more to the develop - than the occurrence , of these diseases . mobilize resources to sustain action . ment of chronic illnesses than life For example , a woman who has expe - These include changes in metabolism events per se ( Friedman and McEwen rienced a great deal of chronic stress ( increased blood glucose and lipid 2004 ) . 35 Stress Cluster symptom012 30 s Sympathetic nerves Sympathetic nerves 25 34 Norepinephrine Adrenal cortex physica56 20 l Medulla Target organs 15 Predicted 10 + Heart and respiratory rates + Perspiration Epinephrine 5 + Blood flow to muscles + + Muscle strength norepinephrine + Cognitive activity 0 in the bloodstrem â?? Gastrointestinal activity 35 39 43 47 51 55 59 63 67 71 75 Age Fig . 1 . Patterns of individual differences in symptom change over time . Fig . 2 . two pathways in the stress activation of the sympathetic nervous Source : Aldwin et al . 2001 . system . Source : Aldwin et al . 2007a . 184 CALIFORNIA AGRICULTURE â?¢ VOLUME 64 , NUMBER 4 Paisley decreased status and income with re - Suzanne tirement , and live alone . But an early re - view of the literature showed that older adults report fewer life events than do young adults ( Rabkin and Streuning 1976 ) . If older adults face so many chal - lenges in their lives , why do they report less stress ? Early life - event scales focused on events that mainly affect young people , such as graduation , marriage , divorce or being jailed . As a postdoctoral scholar at UC Irvine , the first author lived briefly in a large retirement community and spent much of her time simply ob - serving and chatting with individuals , which yielded a glimpse of the prob - lems that older adults were facing . This informal research was the basis for Adults often face multiple challenges as they age â?? such as providing full - time care for the Elders Life Stress Inventory ( ELSI ) , grandchildren â?? but on the whole they report less stress than younger adults . which included more of the types of events faced by middle - aged and older might have the same odds of getting under certain conditions , stress can adults . These included deaths of family breast cancer as a woman who has not . have positive , or toughening , effects on members and friends as well as â?? net - However , if both women get cancer , it physical health ( Dienstbier 1989 ) . work stressors â?쳌 such as their childâ??s might progress more quickly in the one We have been investigating these divorce or indebtedness . Preliminary with the high level of chronic stress . paradoxes in two major longitudinal studies found few age differences in the Despite the indisputable fact that studies , the Normative Aging Study number of stressful life events between stress has adverse effects on health , it ( NAS ) and the Davis Longitudinal middle - aged men and older men in is by no means assured that stressed Study ( DLS ) . The original sample in the NAS on the ELSI ( Aldwin 1990 ) , al - individuals will always get sick , or the NAS was 2,280 men aged 22 to 80 , though subsequent research suggested that sickness will come only to indi - mostly veterans , who were screened a slightly nonlinear relationship , with viduals who are stressed . Indeed , the for good health in the mid - 1960s . They the number of life events increasing correlations in naturalistic field stud - have been followed ever since through until about 65 and decreasing thereafter ies are modest for self - reported health a series of biomedical examinations , ( Yancura et al . 1999 ) . outcomes , and weaker even than that surveys and interviews that include Nonetheless , studies using the DLS for biomedical outcomes such as el - measures of personality , stress , coping data showed that there are age dif - evated cholesterol levels ( Aldwin 2007 ) . strategies and other factors . ferences in the types of problems re - Nonetheless , stress may play a role in The DLS is composed of UC Davis ported as â?? low points â?쳌 by young versus the different trajectories of health across alumni from the classes of 1967 to the life span , and may partially account 1969 , 1979 , 1989 and 1999 , split roughly Young for the increase in individual health dif - equally between men and women . iStockphoto / Lisa ferences in later life ( age 65 and older ) . Started by Professor Mary Reagan in the mid - 1960s , the studyâ??s original focus Stress paradoxes was the impact of education on value Our laboratory has carried out stud - systems . By 1990 , though , the focus had ies of two major stress paradoxes . The shifted to stress and health . Funded first paradox concerns some surprising largely through Hatch funds from the findings about the relationship between Agricultural Experiment Station , DLS age and stress â?? that older adults re - participants responded to surveys of port less stress , often despite poorer stress , coping and health in 1990 , 1996 objective circumstances such as chronic and 2001 . illness , bereavement and reduced in - Older people and life events come . Further , there is disagreement For decades it was a truism that in the research literature as to whether In standardized stress inventories , middle - aged stress increased in later life . After all , older adults are more or less vulnerable adults reported family issues such as their older people are more likely to develop to psychosocial stressors than younger parents â?? health as stressors , while older adults chronic illnesses , become widowed , adults . The second paradox addresses reported that their own health problems and â?? daily hassles â?쳌 were stressful . lose friends and loved ones , experience the positive aspects of stress â?? that , http : / / californiaagriculture.ucanr.org â?¢ OCTOBER â?? DECEMBER 2010 185 Booher middle - aged adults ( Shiraishi and Aldwin 2002 ) . Middle - aged adults were Andrea more likely to list family problems , FEMA , parents â?? health and other health prob - lems , reflecting their position as the â?? sandwich â?쳌 generation , while young adults were coping with work problems and â?? angst , â?쳌 a general category that included problems with oneâ??s identity or mental health . The number of major problems does not seem to decrease much , if at all , with age , but the types of problems may change , as stressors are often linked to our social roles . Young adults struggle to establish their own careers , while in middle adulthood and late life , individuals often have more generative concerns about taking care of their families and older relatives . The increase in social responsibili - ties , however , does not seem to lead to Some studies have shown that older adults are more resilient and less susceptible to the an increase in hassles , or daily stressors . psychological impacts of stressful life events . Above , a senior was displaced by a Southern California earthquake . In the NAS , older adults reported fewer daily stressors ( Aldwin , Sutton , Chiara , How vulnerability to stress changes et al . 1996 ) . Not surprisingly , the types mortality rates than poorer individuals with age is more complex . We know of problems reported also varied by age : with less education and thus are less that both infants and older adults are middle - aged men reported more daily likely to survive to late life ( Marmot et more vulnerable to physical stressors , stressors with work and family life , al . 1991 ) . Also , personality affects mor - such as temperature extremes or mas - while older adults reported more prob - tality : individuals who have a high de - sive population dislocations . These two lems with health and â?? daily hassles , â?쳌 a gree of hostility are more likely to die in groups are more likely to contract influ - category that included activities such as midlife ( Krantz and McCeney 2002 ) . enza or die in refugee camps . Neither home maintenance and volunteering . There may also be age differences group regulates body temperature Despite extensive questioning , nearly in the types of illnesses that stress af - well , so they are more likely to die of 20 % of individuals 80 and older could fects . Preliminary research from our heat stroke . For example , thousands of not come up with a single problem in laboratory suggests that chronic stress older adults died during heat waves in the past week . in young adulthood results in acute ill - Chicago and Europe a few years ago . nesses such as headaches , backaches Dealing with problems However , there is a controversy over and colds , while chronic stress in Given that older adults have more whether the health of older adults is midlife results in chronic illnesses ( and health difficulties and losses , why donâ??t more or less vulnerable to psychosocial their risk factors ) such as hypertension they report more problems ? The an - stressors than that of younger adults . or high cholesterol ( Aldwin et al . 2002 ) . swer seems to be in how they appraise While many assume that older adults In 2003 , we received funding from problems . Older adults are less likely are more vulnerable due to impaired the UC Davis College of Agriculture to perceive their problems as stressful . immune function and chronic illnesses , and Environmental Sciences , as This does not seem to be due either to some studies have found that those who well as the American Psychological personality changes with age , or to the survive into late life may be fairly re - Association , to hold a conference where types of problems they face . Rather , we silient and less vulnerable to stress . For researchers from a variety of disciplines example , we have known for were asked to specifically examine this many years that older adults question . The immediate answer result - who are widowed have higher ing from the conference was , â?? We donâ??t Older adults are less likely to perceive mortality rates in the follow - really know , â?쳌 because studies either had their problems as stressful . ing year . However , Johnson et not yet been done or yielded contradic - al . ( 2000 ) found that middle - tory results . Nonetheless , the resulting aged adults who lost their publication pulled together enough believe that older adults â?? greater experi - spouses had higher mortality rates than information to support an intriguing ence with many types of problems gives bereaved older adults . hypothesis ( Aldwin et al . 2007a ) . We them a more balanced perspective on In part , this may be due to survivor think that older adults actually may be their daily stressors ( Boeninger et al . effects . For example , people in higher physiologically more vulnerable to both 2009 ) . socioeconomic status groups have lower physical and psychosocial stressors . 186 CALIFORNIA AGRICULTURE â?¢ VOLUME 64 , NUMBER 4 Even in healthy older adults , the neu - type of problem did not seem to matter , temporary ) setbacks discourage them . roendocrine and immune systems for example , whether it was related to However , the middle - aged adults were often show slower returns to normal family or work ; rather , how individuals more likely to use positive coping after stress activation , but some stud - coped was of greatest importance . The strategies , which in turn was positively ies found that older adults have lower use of positive coping strategies such associated with stress - related growth . stress responses . as problem - focused coping â?? defined There may be individual differences in We hypothesize that this is because , as cognitive and behavioral attempts perceiving benefits . If individuals learn knowing their greater vulnerability , to solve or manage the problem , tak - to derive positive benefits even from older adults consciously avoid be - ing perspective and self - regulation â?? low points in their lives . This ability coming upset by minor problems to allowed individuals to benefit from may become enhanced with age . prevent increases in health problems stressful experiences , while negative However , why was there still a nega - ( Aldwin et al . 2007b ) . For example , one coping strategies such as blaming oth - tive correlation between age and stress - older man in one of our NAS studies ers , escapism and the use of drugs or related growth ? Recently , we examined remarked that he used to get upset alcohol to regulate emotions were as - two other stressor characteristics â?? the about little things , but now that he has sociated with poorer outcomes ( Aldwin , severity of the problem and its duration high blood pressure , he canâ??t afford to Sutton , Lachman 1996 ) . ( Bi et al . 2008 ) . The more stressful the anymore ( Aldwin , Sutton , Chiara , et al . A critical issue in the field of stress - problem , the more likely people were to 1996 ) . Older adults may be less likely related growth is whether older indi - report stress - related growth . Yet , there to appraise situations as problematic viduals are more or less likely to find was no relationship between stress se - ( Boeninger et al . 2009 ) , which might benefits in problems . The literature is verity and age . The duration of the low account for both their lower levels of mixed , with many studies showing no point was positively associated with reported stress and sometimes better age effects , some showing that younger stress - related growth , but middle - aged physical profiles under stress . adults are more likely to report stress - individuals were more likely experience related growth , and a few studies show - chronic stressors such as caregiving Positive aspects of stress ing that older adults are more likely to for loved ones or chronic illnesses . It is The second paradox concerns do so ( Stanton et al . 2006 ) . therefore unclear why there is a nega - the positive aspect of stress , some - In a DLS follow - up study , we exam - tive correlation with age . times called â?? post - traumatic growth â?쳌 ined the effects of age on stress - related Optimal aging ( Tedeschi and Calhoun 2004 ) or â?? stress - growth , and found two contradictory California and most of the rest of related growth â?쳌 ( Park and Fenster 2004 ) . paths ( Aldwin et al . 2009 ) . First , age was the world will experience a massive Although we know that stress has ad - negatively correlated with stress - related verse effects on health , even individuals growth , suggesting that younger Byron undergoing extreme stress can point to adults were more likely to per - Janet the â?? silver lining â?쳌 in their experiences . ceive the positive aspects of stress . Negative experiences like divorce , war In many ways , this makes sense , or job loss can often become â?? turning because we encourage our young points â?쳌 for positive change . people to â?? learn from their mis - These individuals often point to in - takes , â?쳌 and not let ( presumably creases in mastery and coping Colwell skills , more positive values , closer relationships with loved Conor ones , and sometimes , increased spirituality . A study using data from the DLS found that only about 10 % of individuals Suckow reported exclusively negative long - term outcomes of low Will points in their lives , while 20 % reported exclusively positive long - term outcomes . Only about 10 % said there were no Experiencing stressful events can have a â?? silver lining â?쳌 for long - term effects , while most ( 60 % ) re - older persons , who report the ported mixed outcomes , that is , there development of positive coping were both positive and negative long - skills , increased spirituality term consequences ( Aldwin , Sutton , and closer relationships with family and friends as a result . Lachman 1996 ) . Above , 85 - year - old Ets Igarashi ; In this study , we also examined top right , 98 - year - old Blanche factors that were associated with the Reiman ; right , Fred Suckow and daughter Ann McGarry . long - term outcomes of low points . The http : / / californiaagriculture.ucanr.org â?¢ OCTOBER â?? DECEMBER 2010 187 Mosin increase in the number of older adults better perspective on oneâ??s problems , Shutterstock / Juriah in the next three decades . It is impera - and life in general . This enhanced per - tive that we understand what promotes spective may become protective in later optimal aging in order to maintain life . Older adults who are successfully seniors in good health as long as pos - aging may have learned how to avoid sible , protect their quality of life and de - becoming upset over relatively minor crease the economic burdens on society . problems â?? or even chronic ones â?? Understanding how to protect individu - thereby decreasing their negative re - als from the negative effects of stress is sponses to stress , protecting their health one way of doing this . and promoting optimal aging . Stress is ubiquitous â?? we all will experience problems at various points in our lives . The process of finding ben - efits in even the worst of problems may C.M . Aldwin is Professor , Department of Hu - be protective of psychological health man Development and Family Sciences , Oregon and perhaps physical health . Further , State University ; and L.A . Yancura is Associate it is likely that the two paradoxes Professor , Department of Family and Consumer discussed here are linked . Positively Sciences , University of Hawaiâ??i , Manoa . Data col - While stress is ubiquitous in life , older adults coping with stress as a young or lection on the DLS study was supported by Hatch who have learned how to manage it may age middle - aged adult may well provide a the most gracefully and healthfully . funds from the Agricultural Experiment Station . Boeninger DK , Shiraishi RW , Aldwin CM , Spiro A III . [ NCHS ] National Center for Health Statistics . 2006 . References 2009 . Why do older men report lower stress ratings ? Health , United States , 2006 : with Chartbook on Aldwin CM . 1990 . The Elders Life Stress Inventory Findings from the Normative Aging Study . Int J Aging Trends in the Health of Americans . Table 27 . Life ex - ( ELSI ) : Egocentric and nonegocentric stress . 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