The stability of coping strategies in older adults with osteoarthritis and the ability of these strategies to predict changes in depression, disability, and pain

The Perceived Stress Scale as a Measure of Stress: Decomposing Score Variance in Longitudinal Behavioral Medicine Studies

BACKGROUND

The Perceived Stress Scale (PSS) is a widely used measure designed to assess perceptions of recent stress. However, it is unclear to what extent the construct assessed by the PSS represents factors that are stable versus variable within individuals, and how these components might vary over time.

PURPOSE

Determine the degree to which variability in repeated PSS assessments is attributable to between-person versus within-person variance in two different studies and populations.

METHODS

Secondary analyses utilized data from two studies with up to 13 PSS assessments: An observational study of 127 patients with heart failure followed over 39 months (Study 1), and an experimental study of 73 younger, healthy adults followed over 12 months (Study 2). Multilevel linear mixed modeling was used to estimate sources of variance in the PSS total and subscale scores across assessments.

RESULTS

Between-person variance accounted for a large proportion of the total variance in PSS total scores in Study 1 (42.3%) and Study 2 (51.1%); within-person variance comprised the remainder. Between-person variance was higher for shorter assessment periods (e.g., 1 week), and was comparable when examining only the first 12 months of assessments in each study (52.9% vs. 51.1%).

CONCLUSIONS

Within two samples differing in age and health status, between-person variance accounted for approximately half of the total variation in PSS scores over time. While within-person variance was observed, the construct assessed by the PSS may substantially reflect a more stable characteristic of how an individual perceives stressful life circumstances than previously appreciated.

The relationship of coping skills with psychache in patients with depressive disorder

Suicide is a leading cause of death and disability worldwide. Psychache (psychological pain) and diminished tolerance of psychaches are important risk factors for suicide. People experiencing psychaches of similar severity may not demonstrate the same levels of tolerance because of various coping skills. This study aimed to determine the relationship between psychache, tolerance for psychache, and coping skills in individuals with depression and healthy controls. We included 73 patients with depressive disorders without comorbid mental disorders and 65 healthy controls. We applied beck depression inventory, beck hopelessness scale, beck suicidal ideation scale, psychache scale, tolerance for mental pain scale (TMPS), and coping attitudes evaluation scale (COPE) to all participants. People with depression had significantly higher COPE dysfunction scores than those in the control group did. Patients who had previously attempted suicide attempt(s) previously had significantly higher beck hopelessness scale, beck depression inventory, COPE dysfunction, and psychache scale scores, and lower TMPS-10 scores than those who did not attempt suicide. Mediation analyses revealed that dysfunctional coping skills played a partial mediating role in the relationship between psychache and the TMPS. The study revealed that dysfunctional coping skills were related to suicidal ideation and previous suicide attempts. These findings suggest that improving coping skills could help reduce the severity of suicidal ideation.

Nurses’ Pain Assessment Practices for Cognitively Intact and Impaired Older Adults in Intensive Care Units

Introduction

Pain is still under-recognized and undertreated among intensive care unit (ICU) patients, such as those being intubated or with dementia, cognitive impairments, or communication deficits due to inability to self-report. This study aimed to describe nurses' pain assessment practices for cognitively intact and impaired older adult ICU patients.

Methods

A descriptive correlational study of a convenience sample of 200 registered nurses was conducted in private, public, and university-affiliated hospitals in Irbid, Jordan. Descriptive statistics, such as mean, standard deviation, and frequency, were used to analyze the study data.

Results

Statistically significant differences were found in the proportion of nurses who assessed and documented pain every 1–4 h in cognitively intact patients than those with cognitive impairment (n = 67, 63.21% vs. n = 39, 36.79%), p = 0.002, compared to the proportion of nurses who never assessed and document pain in cognitively impaired patients than those without cognitive impairment (n = 38, 76.0% vs. n = 12, 24%), p < 0.001.

Discussion/Conclusion

Our study results showed that the majority of participant nurses felt that the use of pain assessment tools for cognitively intact and impaired older adult ICU patients to self-report is somewhat not at all important. This study also reported that nurses perceived themselves as the individuals who accurately rate the pain in cognitively intact patients, followed by the patients themselves.

Effects of Prevalent and Newly Diagnosed Arthritis on Changes in Perceived Physical Demands and Work Stress Among Older Workers: Results of a 3 Year Panel Study

OBJECTIVES

Examine the effects of prevalent and newly diagnosed arthritis on changes in perceived physical demands and general work stress.

METHODS

Conditional change logistic regression models examined the strength of association between arthritis and perceived (1) work stress and (2) physical demands, using data from the NIDI Pension Panel Study (n = 2099).

RESULTS

Prevalent and newly diagnosed arthritis were associated with increased odds of perceived work stress and high physical demands. Manual workers with newly diagnosed arthritis exhibited a 6.73-fold (95% CI = 2.87-15.77) increased odds of physical demands. Arthritis in three body extremities was differentially associated with increased odds of work stress and physical demands in manual and non-manual workers.

DISCUSSION

Prevalent and incident arthritis were associated with changes in work stress and physical demands in older workers. Policies and workplace interventions to reduce stress and physical demands and improve workability in older workers with arthritis are needed.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context

OBJECTIVE

The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context.

METHODS

Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work.

RESULTS

Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22.

CONCLUSION

PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Expression of resilience, coping and quality of life in people with cancer

Considering the importance of coping strategies and resilience in adapting to the stress caused by cancer, the objective of this research is to explore which coping strategies are the most used, in order to know whether different groups of levels of resilience and an appropriate coping style are related to a higher quality of life and better adaptation to the disease. There were 74 participants with cancer in this study (79.7% of them were women) ranging in age from 29 to 85 years (M = 50.9). Different instruments were used to measure the resilience construct (ER-20 items Resilience Scale), coping strategies (Cognitive Emotion Regulation Questionnaire-Short) and quality of life (General Health Questionnaire). People with higher resilience showed higher scores in the use of adaptive strategies, being acceptance and positive revaluation the most frequent ones. Regarding perception of quality of life, people with lower resilience showed statistically significant differences in the dimensions of pain and general health, which were likewise the most common ones for people with lower resilience. A significant association has been demonstrated between resilience and an adaptive coping, which at the same time are positively linked to quality of life of people with cancer. This study provides information about how different groups of resilience levels are related with coping and quality of life in people with cancer. It could be useful information for psychologists in the oncological area who have to take decisions in the clinical context. A practical consequence would involve trying to modify the type of coping, as well as increasing the level of resilience in people with cancer, in order to achieve a better adjustment to the disease.

Active coping shields against negative aging self-stereotypes contributing to psychiatric conditions

RATIONALE

Psychiatric conditions are often falsely considered inherent to aging. We examined whether negative age stereotypes, which older individuals tend to assimilate from the environment across their lifespan, contributed to an increased risk of developing four psychiatric conditions, and, if so, whether this risk was reduced through active coping.

METHOD

The sample consisted of participants aged 55 years and older, free of the psychiatric conditions at baseline, drawn from the National Health and Resilience in Veterans Study, a nationally representative sample. New cases of posttraumatic stress disorder, suicidal ideation, generalized anxiety disorder, and major depressive disorder were assessed during three waves spanning a four-year period.

RESULTS

As predicted, participants holding more-negative age stereotypes were more likely to develop the psychiatric conditions, and their engagement in active coping reduced the risk of their developing these conditions.

CONCLUSION

Our findings suggest that prevention and treatment efforts designed to reduce psychiatric conditions in later life may benefit from bolstering active coping as well as positive age stereotypes.

Are changes in pain, cognitive appraisals and coping strategies associated with changes in physical functioning in older adults with joint pain and chronic diseases?

BACKGROUND

As the population ages, the number of people with chronic diseases increases. Frequently, older people suffer from joint pain together with other chronic diseases, which can lead to decreased physical functioning.

AIMS

To investigate the associations of the changes in cognitive appraisals, coping strategies and pain with the change in physical functioning in older people, who have chronic pain and chronic diseases.

METHODS

Elderly persons (n = 407, mean age 77 years, and 62% female), with self-reported joint pain and at least two chronic diseases, filled in questionnaires about cognitive appraisals, coping strategies, pain intensity and physical functioning at baseline, at 6- and 18-month follow-ups. The associations of change in physical functioning with changes in cognitive appraisals, coping strategies and pain were modelled using generalized estimating equations (GEE).

RESULTS

Increase in pain, in negative thinking about the consequences of pain, and in activity avoidance and decrease in self-efficacy beliefs were associated with a decline in physical functioning.

DISCUSSION

Observed mean changes were small but large inter-individual variability was seen. This shows that cognitive appraisals and coping strategies are malleable. Statistical model of change clarifies the direction of longitudinal associations.

CONCLUSIONS

The longitudinal findings suggest that joint pain, cognitive appraisals and coping strategies may determine physical functioning in older people who have chronic pain and comorbidity.

The Chronic Knee Pain Program: A self-management model

BACKGROUND

It is vital that patients take an active role in self-management of their chronic knee pain condition. The Chronic Knee Pain Program was developed to assist patients in managing their chronic condition and to improve their overall well-being.

PURPOSE

The purpose of this pilot study was to determine the feasibility of a six-week self-management program and to explore whether it may assist in decreasing body mass index (BMI) and depression symptom severity and increase physical activity levels in obese adults with chronic knee pain.

DESIGN

A one group, pre-test/post-test pilot study.

SETTING

A pain management clinic in the northeastern United States.

SAMPLE

Convenience sample of twelve adult patients with chronic knee pain and a BMI of 30 or greater were recruited, however, six participants completed the full program.

RESULTS

This type of intervention has potential value to improve the lifestyles of those individuals with chronic knee pain, including improvements in BMI, depression symptom severity and physical activity levels. In this study there was a decrease in mean BMI overtime; 41.2 (at week 1), 40.8 (at week 6), and 40.7 (at week 10).

CONCLUSIONS

The Chronic Knee Pain Program had a small sample size and high attrition rate, though yielded positive outcomes for some participants. Future research could focus on depression management, using conservative measures to help manage pain, and increasing pain coping skills. Implementing this program with a larger sample size is recommended to see if BMI, depression symptom severity and physical activity levels reach statistical significance.

Older peoples' strategies for coping with chronic non-malignant pain: A qualitative meta-synthesis

BACKGROUND

There is evidence that chronic pain is not recognised or managed effectively in older people. It is important to examine how older people cope with this because of the impact it can have on their quality of life and mortality. It will also enable nurses to work with older people to support effective coping skills and provide information on other useful coping strategies.

OBJECTIVES

To examine how older people cope with non-malignant chronic pain.

DESIGN

This is a qualitative meta-synthesis using Confidence in the Evidence from Reviews of Qualitative Research developed by Grading of Recommendations Assessment Development and Evaluation working group to evaluate the strength of the evidence.

DATA SOURCES

PubMed and Ovid Medline from 1995 to 2015.

REVIEW METHODS

Following a systematic search strategy all papers were assessed in relation to inclusion criteria and quality. Only qualitative studies were included. Themes were extracted from each study and a meta-synthesis conducted before completing an evaluation of confidence in the findings.

RESULTS

Seventeen primary studies were included in the meta-synthesis. Three meta-themes were identified: 'adjusting to the inevitable', 'doing it my way without medication' and 'the importance of support in managing the struggle'. There was high confidence in the evidence for 'doing it my way without medication' and moderate confidence in the evidence for the other two meta-themes.

CONCLUSION

Given that the participants in the primary studies were generally wary of health professionals and stoic in their response to pain, it is important for nurses to communicate in ways that engage older people and ensure their independence and sense of control remains intact. Identification of current coping strategies will enable the nurse and the older person to work together to assess their effectiveness and to adapt these if more effective coping is required.

Deconstructing Chronic Low Back Pain in the Older Adult--Step by Step Evidence and Expert-Based Recommendations for Evaluation and Treatment. Part V: Maladaptive Coping

OBJECTIVE

As part of a series of articles designed to deconstruct chronic low back pain (CLBP) in older adults, this article focuses on maladaptive coping--a significant contributor of psychological distress, increased pain, and heightened disability in older adults with CLBP.

METHODS

A modified Delphi technique was used to develop a maladaptive coping algorithm and table providing the rationale for the various components of the algorithm. A seven-member content expert panel and a nine-member primary care panel were involved in the iterative development of the materials. While the algorithm was developed keeping in mind resources available within the Veterans Health Administration (VHA) facilities, panelists were not exclusive to the VHA, and therefore, materials can be applied in both VHA and civilian settings. The illustrative clinical case was taken from one of the contributors' clinical practice.

RESULTS

We present a treatment algorithm and supporting table to be used by providers treating older adults who have CLBP and engage in maladaptive coping strategies. A case of an older adult with CLBP and maladaptive coping is provided to illustrate the approach to management.

CONCLUSIONS

To promote early engagement in skill-focused treatments, providers can routinely evaluate pain coping strategies in older adults with CLBP using a treatment algorithm.