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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 2  |  Page : 82-85

Elderly population and the presumptive stressful life events scale: An empirical appraisal


Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission20-Aug-2020
Date of Decision04-Oct-2020
Date of Acceptance17-Oct-2020
Date of Web Publication21-Jan-2021

Correspondence Address:
Dr. Anindya Das
Department of Psychiatry, AIIMS, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgmh.jgmh_38_20

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  Abstract 


Introduction: Presumptive stressful life events scale (PSLES) is used widely in Indian life-event research. The use of PSLES in the elderly has been rather mechanistic, without giving due emphasis on the unique experiences of the elderly, particularly within the context of contemporary social change of family values in India. This research aimed to critically appraise the relevance of PSLES in the elderly. Methodology: The research was part of a larger project on stress, coping, and religiosity in (faith bases) ashram-dwelling elderly. A single consenting ashram for the elderly (for aged > 60 years) consented to the study. Participants were included if they had stayed for more than 6 months and had no impairment that compromised understanding of the research. We used the PSLES (a checklist method) for evaluating life events. We supplemented our exploration with open-ended interviews to evaluate the relevance and salience attributed to these life-events. Results: Ninety-four elderly participated (response rate was 70.15') with a mean (standard deviation) age of 74.56 (7.39) years, equally represented by either gender, with a mean duration of ashram stay of 10.85 years. Most frequent events reported were death in the family, going on a trip/pilgrimage, personal illness, and changes in biological functions. Discussion: PSLES was developed for adult Indians, and its use in the elderly may need modification due to qualitatively and quantitatively varying life events, such as the importance of nonegocentric stress (loss of job of one's child) versus egocentric stress (own hospitalization) or change of salience of events (e.g., lack of son versus daughter). Conclusion: To improve the relevance of PSLES for life-event research and capture the unique experiences of the elderly, suggested modifications are necessary.

Keywords: Elderly, India, life events, presumptive stressful life events scale, stress


How to cite this article:
Das A, Chaudhary A, Tyagi L. Elderly population and the presumptive stressful life events scale: An empirical appraisal. J Geriatr Ment Health 2020;7:82-5

How to cite this URL:
Das A, Chaudhary A, Tyagi L. Elderly population and the presumptive stressful life events scale: An empirical appraisal. J Geriatr Ment Health [serial online] 2020 [cited 2021 Mar 2];7:82-5. Available from: https://www.jgmh.org/text.asp?2020/7/2/82/307591




  Introduction Top


Presumptive stressful life events scale (PSLES)[1] is a useful tool for life-event research in India. It is based on the Holmes and Rahe[2] Social Readjustment Rating Schedule, and the items were reconstructed and standardized for the Indian population. It contains 51 defined life events and is reliable and valid for Indian adults.[1] It is used widely for research on diverse mental[3],[4],[5],[6] and physical[7],[8],[9] illnesses, including the elderly,[10],[11],[12] but none have critically appraised its bearing on elderly research.

Concerning the frequency of various life events reported by the elderly, the international literature[[13],[14],[15] suggests negative events such as personal illness/hospitalization/activity limitation, death of loved ones/relatives/close friend, illness of spouse/family member, financial difficulties, dwelling change, illness, and death of children/grandchildren, while commonly reported positive events include traveling, birth of grandchildren, and recovery of personal or spouse's illness. Researches from India have seldom reported the frequency of elderly life events, rather they have used the PSLES or another checklist method to either enumerate number of events or generate a score for various statistical maneuverers.[12],[16],[17] Among those reporting the frequency of life-events, the elderly most frequently report conflicts in the family, unemployment of children, personal illness, illness in family members and death of loved ones.

The importance of studying life events in the elderly is due to the accumulation of several stressful events that one accrues over a lifetime, and within the stress paradigm, this increases not only psychiatric vulnerability but also to other chronic disorders.[18] Viewing from a different perspective life event can be conceived as developmental transitions and the strategies individual recruits toward social adjustment. Moreover, from the latter perspective “normative” and “nonnormative,” events can be thought to be context and culturally dependent. Moreover, contemporary social change in family values, kinship relations, and economic environment has transformed the landscape of elderly care and their experience of stress. Keeping these issues in mind, an understanding of life events exclusively in the elderly may enrich the literature.

Considering the lack of research in India relating to critically appraising the nature or characteristic of life events in the elderly, we applied PSLES in a group of institutionalized (ashram dwelling) elderly to assess its usefulness and relevance. Furthermore, we suggest modifications.


  Methodology Top


This report is part of a larger project for researching stress, coping, and religiosity in (faith based) ashram-dwelling elderly. We surveyed for faith-based ashrams around Haridwar and Rishikesh. Both these places are dotted with ashrams. Out of five, only a single ashram, located at Haridwar, catering to the elderly population, consented for the study. Institute Ethics Committee approved the project.

In this paper, we report the experience gained while using PSLES to assess stress. Preliminary experience suggested that the PSLES was an inappropriate tool to evaluate stress in the elderly; hence, we did not include it for reporting our primary research. This was mainly due to the inappropriateness of many items of PSLES for the elderly. Moreover, the scores on individual events as per PSLES did not match the salience that the participants reported on the primary interview. Yet, as the protocol was approved, we continued using it with a purpose to enrich our experience to suggest modifications. We conducted supplemental open-ended interviews with the participants while administering the PSLES to explore relevant stressful life events and attended salience in the participants' life. We took notes while conducting the interviews. Two researchers collected the data, of which one administered the tool and conducted open-ended interviews, while the other took notes during the process.

All consenting participants living for more than 6 months in the ashram were recruited for the study and excluded if they were seriously ill that would interfere with cooperativeness or comprehension of the process of research. After an initial familiarizing conversation and due explanation of the purpose of research and consent, we administered the PSLES. We conducted interviews on the campus of the ashram either inside the participant's quarters or at a place that ensured confidentiality.

The data of this research are available on request to the first author and are submitted with the Institutional Research Committee.


  Results Top


Of 134 residents in the ashram, a total of 94 participants were included in the study (response rate of 70.15'). [Table 1] shows the sociodemographics of the sample. Briefly, the mean (standard deviation [SD]) age of the sample was 74.56 (7.39) years, half were females, and all were Hindu. Most participants were married (64.9') and lived with their spouse (58.5'). Large proportions were graduates (62.8'), and pension was the primary source of their income (69.1'). The mean (SD) duration of stay in the ashram was 10.85 (7.02) years.
Table 1: Sociodemographic characteristics (n=94)

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In [Figure 1], the bar graph represents the percentage of participants commonly reporting various life events (with stress score) in the past 1 year. The most common life events were the death of a close family member (22'), followed by a desirable event as going on a trip/pilgrimage (21'). Other common events reported were changes in biological functions (sleep and eating habits). Twenty-eight percent of the participants reported no life events in the past 1 year.
Figure 1: Bar graph showing the percentage of participants reporting life events (with stress score) in the past 1 year (n = 94)

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[Table 2] shows a sample of different open-ended questions used to further explore on various life events taking a cue from PSLES items. The frequency of affirmative responses on different issues is also provided. The list shows some of the most frequent responses. In open-ended interviews, the salience attributed by the elderly to certain events differed from what is commonly understood by the (stress) scoring system of PSLES. These issues are elaborated in the discussion section for the sake of fluency and critical understanding.
Table 2: Sample of open ended questions that further explored source of stress and the response rate in affirmative

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  Discussion Top


Our research suggests that life events reported by the elderly most frequently are the death of a close family member, going on a trip/pilgrimage, followed by events of personal illness. Moreover, a significant proportion also did not report any life event. Although the checklist method, as in PSLES, for evaluating life events has its problems for use in the elderly,[19] the tool helped to enumerate frequent stressors experienced by the participants in the past 1 year. The commonly occurring life events in the elderly differ from that of the adult population as reported by Sing et al.[1] and include the death of a close family member, getting engaged or married, pregnancy of wife, and illness of family member. On the other hand, previous studies report similar common life-event experiences by the elderly as our study (death of loved ones, personal illness, hospitalization, or activity limitation, illness in family member).[13],[14],[20] Among health issues, the most common disability among aged persons is a locomotor disability and visual disability as per the Census 2011. Among positive life events, previous studies have reported traveling as one of the prevalent events.[13] In our study, going on a pilgrimage is found to be frequent.

Singh et al.[1] developed PSLES in reference to the Indian adults. Although no differences in age, education, or marital status were noted, few items had sex differences. Parakh[21] has discussed the latter issue. The criteria for comparing age groups were above and below 35 years, which explains the absence of age-related differences. Moreover, no attention was lent for older adults. Moreover, the perceived stress of the commonly reported events in adults observed by Singh et al.[1] was not large enough. On the other hand, our experience suggests otherwise. Considering the above-stated limitation and as discussed in methodology, in the ensuing discussion, we supplement our understanding of life events of the elderly from the insight gained through additional open-ended interviews.

Developmental issues in the life-event experiences

Our participants not only reported the death of a close family member (including a reduction of family members) as a frequent life event but also affirmed the importance of this event in their lives. From a developmental understanding, the elderly experience qualitatively and quantitatively different life events compared to adults, such as the greater importance of nonegocentric stress (events' occurring to significant others, e.g., loss of job of one's child) compared to egocentric stress (intimate/personal ones, e.g., own hospitalization),[22] a concept aligned to the Erikson's stage of generativity, and nurturance at late life. Our research suggests a similar concern explored further.

Moreover, as seen in our sample, events such as personal illness/injury or changes in biological functions (sleep and eating habits) are more frequent and salient in an elderly's life compared to adults or compare the relevance of suspension/dismissal from job versus that of a child's/significant other's job (as explored in the open-ended interview). Similarly, change in residence causes more pronounced stress for the elders than adults due to variation of environmental adaptability at different life stages.

Death of close family member (child, sibling)/friend having a lower stress score compared to that of the death of a spouse as per the PSLES is appropriate for adults. However, for elderly, closer valence of loss of spouse (occurring at a ripe age) as that of a child (in particular if one is the breadwinner/financer of the family) may be appropriate, as may be the death of a long-standing friend almost like family given the specificity of Indian culture. A friend's death is significant as the elderly experience such events more frequently compared to adults. Similarly, illness in the family (spouse/child) is more stressful in the elderly than in adults.

On the other hand, items of PSLES such as getting engaged/married, broken engagement/love affair, failure in examination, pregnancy, or appearing for an examination/interview, are irrelevant in the Indian elderly.

Other nuances specific to elderly life events

Items such as conflicts with family/in-laws should ideally be able to explore any conflicts with daughter-in-law, but elderly in our experience concentrated only on conflicts with siblings or parents in earlier life, while they admitted to conflicts with daughter-in-law only when specifically asked. If this reflects upholding family honor or the items intrinsically do not elicit such strife, it is difficult to comment. Thus, specific questioning on conflicts with daughter-in-law resolves this issue.

Lack of a son has a place in PSLES while that of a daughter does not. Yet, it was realized that views on son preference change with age, partly as daughters are more loving and supportive in old age. Moreover, Indian women (wife, daughter, or daughter-in-law) are the primary caregivers in old age. Under this precondition, son preference seems to change in old age to daughter preference.[23]

Moreover, older adults avoid discussion of their health problems, but express concern about their spouses' health[22] (particularly those with ailing spouses). In the latter situation, being a caretaker for a spouse/significant other is salient.[15] Similarly, events such as house needing major repair and birth of grandchild[24] are missing in PSLES.

Gender aspects of elderly stress/life events

Single parenthood does not feature in PSLES, yet having a differing impact over the lifetime of elderly males versus females. Similarly, single parents may evaluate the event of the marriage of the daughter differently than parents sharing responsibility. Thus, unique items like “early death of a spouse” or “single parenthood for most of life” or “marriage of a daughter by single mother” may better reflect such stress.

Many of the issues discussed are also contributed by the changing scenario of the family context in India impacting the elderly, such as living alone, migration of children for employment purpose, and changing values of the younger generation around family ties, which are starkly relevant for our ashram-dwelling participants.

Our research was limited to elderly living in an ashram, whose experiences may differ from a community-dwelling elderly population living in the family context. Thus, the findings should be interpreted accordingly, yet the sample is more representative than a sample selected from a hospital as done by other Indian studies on life-event research.


  Conclusion Top


PSLES is used widely for research on life events in the Indian population. Research also has included the elderly, but the relevance of PSLES for the aged is yet not appraised. A combination of experience of using the tool in an elderly population and literature search on elderly stress suggests qualitatively and quantitatively varying life events compared to that of the adult Indians. To improve the relevance of PSLES for life-event research in old age, we propose modifications to capture the unique experience of the elderly's life.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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