Love Life: A Holistic Understanding of Ageing
Managing the Stresses of the Older Years
Stress is part and parcel of life, including the older years. It is our ability to cope with it that makes the difference between fulfilled and unfulfilled living. Learning to cope with the inevitable stresses of life involves understanding more clearly what stress is, what its effects are, and what are effective methods to cope with it.
What is stress?
The word stress has an engineering background. Materials are checked out under different stresses to discover their strength and durability. If the pressure or strain is too great, there is a point at which the material will bend, crack or break. The same idea is used when talking about personal inner strength. If the pressure or strains of life are too great to cope with, we can, in phrases commonly used, ‘crack up’ or ‘break down’. It is difficult to define personal stress, but a possible definition is ‘when we are pushed beyond comfortable limits’. Stress can cut across our sense of wellbeing to the extent that we no long feel comfortable with ourselves. There is a good form of stress which is normally termed challenge. Artists, sports people, those working in projects they are interested in, often benefit by being stretched to give their best. The stress referred to here is the bad form, namely, distress.
Often we are not sufficiently aware of our level of stress until it is quite severe. Trying to manage it then becomes increasingly difficult. When we are aware of our personal stress, we can pick up the warning signs early on. If we admit to it and do something early to remedy the situation, then much suffering can be prevented. The consequences of stress are many and varied, the predominant one being that a lot of joy goes out of living, with positive feelings receding and negative ones taking over. A severe result of uncoped-with stress is ‘break-down’ or ‘burn-out’. Those who find their final years at work particularly stressful might enter their retirement period in a state of burn-out, which might call for a period of rest and possibly professional help before fuller living can emerge and the positive aspects to ageing begin to be appreciated and lived.
Our ‘stress threshold’ varies over life, even over one day. To an extent it depends on the multiplicity of stresses that can come together at any one time. We may be coping well with a major crisis and then something small happens, the threshold is crossed, and we can no longer manage. In other words, we have gone beyond our tolerable limit. Stress is present from the teenage years on, and each period of life, while containing the stresses common to all periods, has also its own particular stresses to contend with. If the art of coping with stress has been developed over life, then we are fortunate in having this skill to rely on when coping with the particular stresses of the older years.
Understanding the three sources of stress can be helpful:
The first source is the environment, that is anything outside of ourselves, including places, things, people, circumstances or events. The physical surroundings in which we live can be pleasing or act as a stressor. An untidy kitchen, diminished personal living space, a dark room, a dirty house, drab buildings, lack of colour, no plants in a house or no trees in a neighbourhood, messy bins nearby, can all be potential stressors. However, relating to other people remains the most common source of stress. Personal circumstances and events can also act as profound stressors.
A second source of stress, already noted, is our own body. If we are not comfortable with our body as it ages, then we live with a constant source of irritation. If there is some disease or disability in addition, and this is not accepted, then our body becomes an even greater source of stress.
The third source of stress, and the commonest cause of it, is our own thoughts. Personal thoughts label how we perceive and interpret life’s happenings. Places, events and relationships have no emotional content. It is our thinking which evokes the type of feelings that are aroused. Stress is often the result of ‘twisted thinking patterns’, such as prejudices, tunnel vision, black and white thinking, and exaggeration.
Our thoughts flow from our beliefs, values and attitudes. Beliefs change slowly and imperceptibly; core beliefs tend to last a lifetime. Regarding values, people notice that over the years their values change, sometimes radically, sometimes in small ways, and some values remain constant. Looking back over a decade or more, we discover possibly that values we previously held as sacrosanct are no longer so. Changes are noticed only over a period of time; the change as it occurs is largely imperceptible. Attitudes, on the other hand, can be changed more easily as we consciously set to work, challenging ourselves on some of our personal attitudes. This involves checking out with ourselves why we have adopted certain attitudes to see if they are true, fair to the person or situation as it really is. By deliberately standing back and objectively looking at ourselves in relation to people, circumstances, or events, we can decide to alter particular attitudes. The change is not easy. It happens for us in the very act of understanding, as we stand back and see things in new and different ways.
Stresses arise from different types of situations:
In the first place are sudden unexpected events like an accident, an illness, a death of someone close. It is appropriate at such times to be under stress, but it is also normal to work through this stress in a reasonable period of time.
Another category can be those associated with entering a fresh period in life such as a new job, retirement, leaving one’s home, maybe to living with a relative or to a nursing home. Learning to live with a disability is in this second category, as well as learning to cope with the disability of a spouse or other close family relative with whom one lives. It takes time to adjust to the new situation. It requires us to be gentle with ourselves as we move into an altered lifestyle.
There are the minor stresses of everyday life, like difficulties in relationships, worrying about one’s children or grandchildren, financial concerns etc.
Finally, the unconscious self can be a source of stress. Hidden anxieties, fears, hurts, can emerge at any stage throughout life and especially in our older years, when the unfinished business of our earlier years calls for attention. Such buried feelings can be resurrected unexpectedly by almost anything, such as at the death of a sibling, even by looking at old photographs. Some feelings may have been buried since childhood, when they were too difficult to face. Help may be necessary to cope with these and other feelings connected with the darker side of our past.
There is a close connection between our mental and physical health. For example, if we have the flu, or have broken a bone, we will feel down in ourselves at least at times during the period of recovery. The period of convalescence may prove more difficult than the acute phase. Conversely, if we are psychologically low, for example following bereavement, we are more prone to physical ailments. It is now generally accepted that the psychosomatic dimension can play a part in illness. Recovery from sickness or learning to live with a disability takes longer and is less complete if there are stresses not adequately coped with.
The first stage in coping with stress is to be aware that we are under stress and take responsibility for this fact. Following on from that it is helpful to be able to identify the source(s) as specifically as possible. For instance, to say one’s stress comes from a relationship, or one’s physical environment, or a particular disablement is too general. There is a need to find out what precisely are the factors in the situation that make it bothersome and to name these.
The effects of stress
The effects of stress are numerous and vary from person to person. Being aware of the early onset of stress, by knowing our personal signs and symptoms (triggers), can help minimise its effects, provided such signs are taken seriously and we do something to alleviate the situation. The more common signs and symptom can be categorised under physical, emotional and intellectual aspects of our lives (categories already familiar when speaking about wellbeing). Several symptoms are likely to appear if the stress is severe.
Physical symptoms include the following: tiredness which is not related to levels of activity; sleeplessness, either going to sleep with difficulty or wakening early; headaches (sometimes referred to as tension headaches); stomach pains; chest tightness; vague aches and pains, especially in the neck and shoulders; palpitations; breathlessness and sweating. Such symptoms could mean there is an underlying physical disorder which would require checking with the doctor. If, however, nothing is discovered and you are in a known stressful situation and this symptom has been noticed before in other stressful periods, then stress is likely to be the cause of these symptoms and treatment is required to manage the stress.
Emotional symptoms which are commonly experienced when under stress are: feeling edgy, irritable, drained; negative feelings predominating; inability to manage your feelings as you normally would, crying becoming intense sobbing; failing to overcome emotional upsets in a normal time span, where for example anxiety, anger, sadness linger or where our reaction is out of proportion to the cause, such as losing your temper over some small incident.
Intellectual symptoms can be significant and they include: inability to concentrate; listlessness; racing thoughts; preoccupation with the traumatic event; lack of interest in things; a general sense of apathy; nightmares.
Spiritual symptoms can also act as indicators of stress. These can include: a persistent inner restlessness; searching for meaning in events and in your own life; unconnected outer and inner self; life not in tune with your inner desires; wrestling with suffering and pain (physical and emotional); scruples.
Changes in normal patterns of behaviour could indicate the presence of stress. For instance, addictive behaviours usually increase – a person drinks, or smokes more than is normal. Eating habits can alter –some eat more, others less. Some people become tight with money, others overspend. It is not uncommon to find older people who are overly concerned about money and constantly check their financial affairs. This could be stress-related or an early sign of dementia. A lack of attention to personal appearance might indicate the presence of stress. If stress is severe a person can become withdrawn.
Knowing the signs of stress in a relationship can be helpful. Such signs could be showing an absence of gestures of affection that previously were normally shown; entering a pursuing/distancing cycle in the relationship; small problems becoming catastrophes; having difficulty in acknowledging needs without blaming the other person.
Why some physical symptoms appear as a result of stress is due to the way our bodies work. There are two systems involved in a stress situation: the nervous system and the endocrine or gland system. In acute stress, an alarm reaction is aroused in the body and this is sometimes called the fight/flight response. The body does not distinguish between stress and fear, so when under stress the body reacts as if it had a fright and hence the fight/flight reaction is aroused. Because of circumstances and conditioning we tend to do neither. However, the alarm warning has gone off and this results in a higher level of adrenalin in the body which has certain effects. It causes the heart to beat faster and blood pressure to rise. Breathing quickens and muscles tightened ready to spring into action. Without such action the tightness tends to settle in three areas: the shoulders are raised, and the teeth and hands clench. The skin can sweat and emptying the bladder becomes an urgent need.
Symptoms of heart thumping, sweating and breathlessness are seen in panic attacks as well as in fears and phobias. Fears and phobias can be acute realities in the lives of some older people – for example some are terrified of being burgled, (especially when an unusual sound is heard) or if they go out they are fearful of being attacked. Others may have phobias that their home will be taken from them. In more chronic situations, such symptoms may not be visible, but there is a low level of arousal, with an increase in adrenaline which, if persistent, can cause harm
Managing stress well plays a large part in the level of wellbeing we experience. It is not the frequency or intensity of stress that is the most significant; it is our ability to cope with it that makes the difference. This second stage in coping is important since it enables us to recognise and be alert to the signs and symptoms which show us that stress is there. It then requires us to take responsibility for doing something about it. Signs and symptoms differ – the important thing is to know our own.
Ways of managing stress
Being able to name our stresses, as well as knowing their signs and symptoms, leads to the third and final stage of developing ways of coping with it. This requires understanding, determination and practice. It means taking personal responsibility for our mental health. Coping, managing stress, is not just about surviving, but is concerned with living positively. Each of us has to manage our own coping; it is not something that can be done by others, no matter how supportive they may be. Some people appear to cope better than others; everyone copes better at certain times, no one copes all the time.
Managing stress has to be learnt, and taking control of our lives and the various happenings that unfold is the key. An attitude of trying to manage our stresses, rather than letting them take control is the first step. Stress worsens when people feel helpless and feel they have no control over an issue, incident or relationship. This is never in fact true, as there is always something that can be done to reduce the stress effect. At times this will involve being pro-active, making things happen rather than always letting things happen. Learning from past experiences of success or failure can help us to see what we can do for ourselves, as well as when it might be preferable to get outside help.
There are some people who hold onto their stresses and become martyrs, in a way similar to some who hold onto their mental or physical illnesses because they cannot face life ‘well’. Acting like a martyr can unconsciously be a way of getting attention, but it is a sad diminishing way to live.
Before examining specific coping strategies it is essential to stand back and see if the source of the stress can be removed or lessened in some way. This may not be possible for example in situations where a terminal illness is diagnosed or maybe a grandchild is born with a congenital disability. In these instances perceptions and attitudes have to change and this takes time as altered meanings and a deepening of insight develop. Most situations, however, can be changed, even radically. Major changes like moving out of home; or much smaller things may require alteration, like changing timetables, home rituals or ways of doing things. People may often complain about things without considering what can be done to ease matters, even in some small way, or going to others who could do something to lessen the stress.
There are often many ways of getting around a problem. For example if you can no longer drive a car that does not have to mean that you become housebound. Even if public transport is no longer usable or does not exist, taking a taxi, lifts from friends, neighbours or voluntary organisations are all possibilities. A taxi fund could be set up from the benefits of no longer having to pay money for car tax, NCT, insurance or petrol; quite a nest egg could accrue. It is sad to see people complaining and yet doing nothing about the problem.
Everyone has to discover for themselves effective ways of coping with stress that work for them, and put these into practice. Below are set out psychological strategies, and nine more specific physical approaches that are helpful.
Psychological ways that help in managing stress
The first and most important is learning the ability to live reflectively. This means allowing time and space to know what is happening in our inner world. It enables us to become sensitive to early signs of stress, and as to whether personal needs are being adequately met. Growth in self-knowledge is a great asset in life. In order to tune in daily to our internal radio and hear what it is saying, certain steps have to be taken. Ideally, everyone should set aside some personal time for oneself each day. Many find this difficult, so starting with short five-minute periods or less could prove beneficial.
Admitting that stress is there is an obvious step towards coping with it. As with alcoholics, nothing can be done until the problem is admitted and its reality faced. Depending on an individual’s previous history and experiences, there may be the expectation on the part of others that a particular person has been and is good at coping. Inevitably, some of the stresses of the older years are different and hence have not been previously encountered. Admitting to stress is not admitting to failure. In fact, it could show strength of character and a sense of realism.
Talking the matter over with someone, whether a partner, relative, friend or professional, is a well-recognised way of helping. It requires more than just talking ‘about’ the issue. It is helpful if, during the conversation, we come to discover and name as specifically as possible exactly what the problem is, and also to name the feeling that is present as a result of the stress. For instance, if one is deeply hurt, then say that, and don’t soften it by saying you were ‘a bit put out’. If one is in the listener role, it is all about listening, and not giving advice. At a later stage it might be helpful to indicate impartially other courses of action. Developing good support systems in life, such as friendships, is desirable for everyone so that there is someone to turn to in crisis moments. It is also helpful if we are aware of possible low points or moments, such as seasons of the year or anniversaries, and seek out supports around such times.
Trying to be objective about what has actually happened to cause the stress, whether it arises from an event or a relationship, is not easy. When we are calm, it is useful to try and stand back and view the problem as if we were standing in someone else’s shoes. When as objective a stance as is possible is reached, then there is need to face what has happened and see what requires changing and what has to be accepted. There is a tendency, when under stress, either to blame others or to blame oneself. Staying in the blaming place does not help us to cope; trying to be objective in order to gain insight into the reality of what has happened does.
Being open to seeing things differently follows from the above. We need to challenge ourselves to see if our personal views and interpretations are correct. Questions like ‘Am I being too rigid, too narrow in my thinking?’ or ‘Am I prejudiced?’ can be helpful. Watching the use of certain words like ‘must’, ‘should’, ‘ought’, can be indicative. Often people use these words of themselves or others, for example, ‘I must do this’ or ‘He should do that’. Such statements need to be challenged by further questions, ‘Why must I do this?’ or ‘Why should he have to do that?’ The only ‘must’ in life is not to harm ourselves or others; everything else is relative. It is desirable that we do many things in life, but they are not absolute imperatives.
Aiming not to give in to negative thinking is vital. Negative thoughts are likely to come when we are under stress, but the important thing is not to ‘nurse’ these, but instead to try and move as quickly as possible from the ‘poor me’, ‘why me’ place. Watching our inner conversation is useful. Often our self-talk is negative, especially if we are low. Phrases like ‘I’m no good, no one really cares about me, I’m too old, no one is interested in my opinions anymore’ can surface. If we feed on negative thoughts, that can lead to expecting unpleasant things to happen and so the stress level gets worse.
Trying to take a positive approach, and beginning by taking one small step, loosens the grip of the negative. Beginning with a shift towards positive self-talk helps: ‘I’m OK’, ‘I’m OK despite my inadequacies, uncertainties’, ‘I value my opinions and the wisdom I have gained over the years’. The problem on hand may be difficult and the way forward unclear, but it is important to start somewhere and to begin by taking one small step. Doing nothing is not an option in managing stress.
Setting goals and making action plans is a practical way to cope with stress. There are always alternative ways of looking at and doing things, so examining options and setting priorities, and having the courage to try out new things, are steps that need to be taken. The decisions to be specific and to have a precise time-scale built into them. For example ‘I will have my main meal in the middle of the day starting next Monday’. ‘I will go and see the solicitor about my will this week’. ‘Tomorrow I will phone the hairdresser for an appointment on Friday morning.’
Searching out relevant information to deepen understanding can considerably reduce stress. Not knowing, not having sufficient information about something raises anxiety levels which can add to the existing stress. Often when the truth is known, even if it brings bad news, it can also bring a sense of relief, since there is no longer the feeling of being in the dark. Fear of the unknown, especially if something sinister is anticipated, is always stressful, so again information regarding knowing what to expect in particular circumstances can considerably reduce stress.
Looking for something positive is always helpful. In acute stress this may be difficult, but where there is chronic stress this can be very beneficial. People speak of the new friends they made in and through their difficulties, of the things they have learnt about themselves, of how their values have changed for the better, of how they have gained an insight into suffering that they would otherwise never have known.
Learning the art of saying goodbye is often necessary in the stresses of life. What is required may involve a letting go of people, pets, places, tasks or roles. The process of letting go and moving on is painful. However, it is only by entering into the pain and going through it that we discover this is the way out of the stress. As noted earlier in this book, letting go and saying goodbye involves loss and it is important to grieve adequately over the losses so that we can move on.
Setting realistic goals plays a large part in both preventing and coping with the stresses ingrained in the ordinary everyday happenings of life.
First of all, there are the goals we set for ourselves. We can set goals that are unrealistically high, as may happen with a perfectionist. When personal expectations are too high, and they are not achieved, negative feelings are aroused. People become despondent, worry and then feel guilty because they do not achieve or do as much as they think they ought. What is demanded of each of us is to do what is reasonably possible. And even if we do fall short of what is reasonable, the managing of such a failure can become something positive.
Secondly, we can allow others to make unrealistic demands on us, expecting us to be or act in certain ways. This can happen in all relationships and especially in close ones. It is important not to take these unrealistic expectations on board. We need to know our limits and not to allow ourselves to become over-stretched by another person.
Finally, setting goals for others can also cause stress. Parents for example, can sometimes do this with their children. Apart from being unhelpful for the son or daughter, it is also unhelpful to the parent who will have to cope with feelings of disappointment, of being let down. Such feelings can last for years, causing persistent stress.
Physical ways that help in managing stress
Enjoyment is a great stress reducer. Life can become overly serious so there is need to counteract this at times by developing a ‘playful’ element. Enjoyment is an essential component to living fully. It is never too late to learn this important dimension of living. It is especially necessary not to allow ourselves become so low and despondent that we can no longer enjoy anything. Enjoyment is often not connected with the exotic, but rather the simple things of life, like a walk or talking to a friend.
Leisure activities are something we enjoy doing, but they are done on a regular basis and so some discipline is necessary in such activities on the days we do not feel like participating. Adherence to a leisure activity can both prevent and considerably lessen the stresses of life.
Moving out of the environment is sometimes indicated as part of stress management. In an emergency situation, for instance after a serious quarrel, or at a deadline moment and one’s computer breaks down, it can be useful to escape for a while in order to cool off and stand back from what has happened. A day’s outing, a weekend away, holidays, are all beneficial in times of stress. Everything tends to be seen differently after a break away from our normal environment.
Doing one thing at a time without rushing enables us to get into the present moment. Being at what we are at in a particular moment of time can be very therapeutic. This is specially necessary during times of acute stress when it is difficult to settle down to anything, For example, to say ‘now I am going to make a cup of tea’ and do just that.
Putting energy into things we like doing and do well is valuable with acute forms of stress. Such moments are not the time to tackle difficult and unpleasant tasks. It is also not the time to put ourselves in circumstances where over-reaction is possible. For example, if a person has recently been bereaved or separated, social events in the early days following such events need to be chosen with thought.
Knowing and holding onto ‘anchor points’ helps in both acute and chronic stress. For example, these could be places (a favourite spot), relationships that we enjoy (especially those that restore confidence and bring life), gardening, going to a film, a walk in the park…
Doing something for someone else can be a good stress reducer. This might seem strange for someone who is incapacitated by illness or disability, yet it is true for everyone. The doing of a task, like visiting someone, or making a phone call, or even reaching out in concerned thought to someone helps restore a sense of perspective about our own difficulties.
Looking after our own general health is required by everyone but this is particularly necessary during periods of stress. Adequate rest, exercise and diet must be attended to with more care. If our physical health is in reasonable order this will enhance a sense of wellbeing which in turn enables us to cope better with stress
Relaxation exercises are often the first thing that comes to people’s minds when stress is spoken about. While coping with stress demands much more than just being able to relax, relaxation exercises are helpful to many people.
There are a large number of techniques available but all include certain basics, which are as follows:
Take up a comfortable, well-supported posture, ideally lying down or well supported in a chair with arms.
Set a quiet atmosphere, without too much light, and with sufficient heat.
Give sufficient time, 20 minutes minimum, to arrive at a reasonable level of relaxation. There is no such thing as instant relaxation.
Close one’s eyes, just listen to your breathing. Do not change the rhythm, just listen to it and go with it. This can be done for most, or all, of the exercise.
Other techniques can be added but are not essential. Examples include: using a mantra or focusing on an object, such as a lighted candle or flower.
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