Psychosocial Processes in Families

Managing Dementia:
The Stress Response

Nancy A. Hodgson, PhD, RN

 Objectives
• Review the Stress Process
– Define stress and the stress response
• Review leading theories of stress processes
– Apply stress theories to the care of individuals
with Alzheimer’s disease and related dementias
 The Physiology of Stress
• A series of neural and chemical reactions meant
for physical survival
• A person experiences stress when a demand
exceeds a person’s coping abilities, resulting in
reactions such as disturbances of cognition,
emotion, and behavior that can adversely affect
well-being.
 The Physiology of Stress
Theory

• Hans Selye, considered by many as the

father of the study of stress, developed the
idea that a direct relationship exists
between chronic stress and excessive wear
and tear throughout the body.
 General Adaptation Syndrome
Alarm
“Fight or Flight” reaction: body mobilizes resources to combat threat;
activates the sympathetic nervous system.

Resistance
Enhanced ability to fight stressors via moderate physiological arousal;
ability to withstand additional stressors (e.g. infection) is reduced . to
withstand additional stressors (e.g., infection) is reduced.
Exhaustion
Depletion of resources brings on diseases and disorders
(e.g., chronically high heart rate and blood pressure increase chances of
heart attack and stroke).
Three Stages of Effects Associated
with the Stress Response

• Immediate effects of stress

• Intermediate effects of stress
• Prolonged effects of stress
 Two Decades of Brain Research
(1992–2012+)

• Repeated exposure to glucocorticoids from

prolonged stress increases aging process of brain
• Repeated exposure to glucocorticoids damages/
shrinks brain tissue
• Damage due to repeated exposure to prolonged
stress over a life course explains many chronic
illnesses including risk for dementia
Stress and Alzheimer’s Disease

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 Psychophysiology

• Psychophysiology broadens Selye’s

definition and describes the body’s
physiological reaction to perceived
stressors suggesting that the stress
response is a mind-body phenomenon.
 · Training and education programs
· Information-technology based support
· Formal approaches to planning care
· Combination of education and emotional support
· Spiritual support
· Religious coping
Stress · Positive strategies for managing symptoms
· Psychotherapy

Appraisal

Coping

Transactional Model of Stress and Coping

Lazarus, R.S. & Folkman, S. (1984) Stress,
Appraisal and Coping. New York: Springer.
 Mediators/
Moderators
Stressors

Outcomes

The Basic Stress Process Model

Adapted from Pearlin, L.I.(1989) The Sociological Study
of Stress. Journal of Health and Social Behavior, 30,241,256.
 Stress process model based on Pearlin and colleagues' (1990) original conceptualization

Hilgeman M M et al. The Gerontologist 2009;49:248-261

© The Author 2009. Published by Oxford University Press on behalf of The Gerontological
Society of America. All rights reserved.
Hall, G. & Buckwalter, K. (1987). Progressively lowered stress
threshold: A conceptual model for care of adults with Alzheimer’s
Disease. Archives of Psychiatric Nursing 1, (6), 403.
 Importance of theoretical models in
planning care of persons with dementia
• Provide a framework for understanding the
heterogeneity of responses
• Provides a rationale for guiding interventions
• Provides a structure for evaluating outcomes
• Provides a common language for members of
the health care team