Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level

Depósito de Investigación de la Universidad de Sevilla https://idus.us.es/ This is an Accepted Manuscript version of the following article, published by Taylor & Francis in Aging & mental health : Rubio, L., Dumitrache, C. G., García, A. J., & Cordón-Pozo, E. (2018). Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level. Aging & Mental Health, 22(2), 226–232. https://doi.org/10.1080/13607863.2016.1247416 It is deposited under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits noncommercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way. 1 Coping and activity in old age Title: Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level Journal: Aging & Mental Health Laura Rubio1, Cristina G. Dumitrache2, Alfonso J. García3, Eulogio Cordón-Pozo2, 1 Universidad de Jaén, España 2 Universidad de Granada, España 3 Universidad de Sevilla Correspondence address: Laura Rubio – PhD, Department of Psychology, University of Jaén. Campus Las Lagunillas, s/n, 23071 Jaén (Spain). Phone number: +34 686729361, E- mail: [email protected] Cristina G. Dumitrache – PhD, Department of Developmental and Educational Psychology, University of Granada, Campus de Cartuja s/n, 18071, Granada (Spain). Phone number: +34 958241958, E-mail: [email protected] Alfonso J. García – PhD, Department of Social Psychology, University of Sevilla, C/ Camilo José Cela, s/n, 41018, Sevilla (Spain). Phone number: +34 954557705, E-mail: [email protected] Eulogio Cordón-Pozo – PhD, Department of Management, University of Granada, Campus de Cartuja S/N, 18071, Granada (Spain). Phone number: +34 958242341, E-mail: [email protected] 2 Coping and activity in old age Title: Coping strategies in Spanish older adults: a MIMIC model of socio-demographic characteristics and activity level Abstract Objectives: The aim of this study was, on the one hand, to analyze the combined effect of socio-demographic characteristics and activity level on coping strategies, and on the other to test which of these variables has a greater impact on coping. Method: A sample of 243 men and women aged 55 to 99 years-old was selected from different elderly activity centers in Granada, Spain, using a convenience sampling. Associations between 8 coping strategies measured by CSI inventory and the above mentioned variables were examined using a MIMIC model. Results: Age was negatively related with the use of problem solving (β=- .182), express emotions (β=-.150) and social support (β=-.181) strategies. Activity level was positively related with problem solving (β=.214), cognitive restructuring (β=.143), express emotions (β=.245) and social support (β=.148) and it was negatively associated with social withdrawal (β=-.192). Gender only predicted the scores in self-criticism (β=.228) and living alone was related with higher emotional expression (β=-.151). Participation in creative activities, attending University for the third age and practical physical exercise were related with differences in the use of several coping strategies. Conclusions: There is a complex relationship between socio-demographic characteristics, activity level and the coping strategies used by the elderly. It is important to understand how these variables influence coping strategies in order to define a psychological profile for older adults who use ineffective coping, and to subsequently include them in 3 Coping and activity in old age intervention programs to improve their coping abilities and therefore increase their probability of aging successfully. Keywords: aging, coping strategies, activity level, physical activity Introduction Older people have to face several changes that could be interpreted as stressful, such as a loss of economic status or a reduction of their social network (Bueno & Navarro, 2003; Rubio, Dumitrache, Cordon-Pozo, & Rubio-Herrera, 2016a). The way in which people cope with these changes, or their coping strategies, can influence their well-being and mental health (Tomás, Sancho, Meléndez, & Mayordomo, 2012). Coping strategies were defined by Mechanic (1970) as instrumental behaviors aimed at facing challenging life events and as a way of protecting oneself from the emotional consequences of these events. For Lazarus and Folkman (1984) coping includes both the cognitive and behavioral efforts that individuals make to face external and internal demands that are appraised as stressful and out of the control of the individual. Coping strategies have been classified using different criteria, among them the attitude towards the stressful event and the goal of the coping strategy. The classification identifies the individual’s attitude towards the stressful event and distinguishes between active and passive coping (Carver, Scheier, & Weintraub, 1989; Lazarus & Folkman, 1984). Active coping, or engagement, refers to those strategies that tend to modify the stressors or the emotional state the individual experiences because of the stressors. Meanwhile, passive coping, or disengagement, includes those strategies that allow the avoidance of the stressor or the emotions that the individual experiences in relation to the 4 Coping and activity in old age stressor (Carver et al., 1989; Carver & Connor-Smith, 2010; García & García, 2013; Lazarus & Folkman, 1984; Tobin, Holroid, Reynolds, & Kigal, 1989). On the other hand, the classification that focuses on the goal of the coping strategies includes behavioral, cognitive and emotional coping strategies (Carver et al., 1989; Lazarus & Folkman, 1984). Behavioral coping refers to two types of strategies: those aimed at directly coping with the situation by modifying it and those aimed at avoiding the situation. Emotional coping refers to the strategies that seek to regulate the emotional consequences of the stressors and to maintain an emotional balance. Emotional coping includes seeking social support or talking about our emotions to other people. Finally cognitive coping alludes to those strategies that are aimed at understanding the origin of the stressful event and at changing the individual’s appraisal of the stressful circumstance. Cognitive coping includes acceptance, positive appraisal or the use of humor (Berk, 2015). There is evidence that supports the hypothesis that, in general, active coping is more effective in adapting to a stressful situation than passive coping in the sense that directly facing problems has a positive impact on people’s mental health and well-being (Carver et al., 1989; Lazarus & Folkman, 1984). However, some studies show that the effect of coping on mental health and its effectiveness does not only depend on the type of strategy used but it is mediated by the type and duration of the stressful event (Navarro & Bueno, 2005; Carver & Connor-Smith, 2010), as well as by personal and by the socio-demographic characteristics of the individual that has to cope with the stressful event (Martin, Kliegel, Rott, Poon, & Johnson, 2008; Meléndez, Mayordomo, Sancho, & Tomás, 2012; Moos, Brennan, Schutte, & Moos, 2006; Yeh, Huang, Chou, & Wan, 2009). 5 Coping and activity in old age Among the personal characteristics that have been more frequently studied in relation to coping are gender and age, although there is some controversy regarding their effect on coping. With regard to gender and its impact on coping, research shows that men and women tend to face demanding circumstances using different strategies. While men prefer using active coping strategies that aim at solving the problem, women use emotional coping strategies such as social support seeking and emotional expression more frequently (Meléndez et al., 2012; Yeh et al., 2009). With respect to age, some authors state that, with aging, there is a decrease in the use of active coping strategies and an increase in the use of passive coping strategies (Carver & Connor-Smith, 2010; LaChapelle & Hadjistavropoulos, 2005; Martin et al., 2008; Meléndez et al., 2012). However, other authors have found an increase in the use of active coping strategies in old age (Bueno & Navarro, 2003; Stefani & Feldberg, 2006). Furthermore, an increase in the use of cognitive strategies, such as acceptance and positive reformulation, and in the use of emotional strategies such as social support seeking and emotional expression has been found in the elderly (Krzemien, 2007; Meléndez et al., 2012), as well as an increase in the use of behavioral strategies aimed at directly facing the problem (Carver & Connor-Smith, 2010; Meléndez et al., 2012; Sumpter, García, & del Pozo, 2015). These findings could be due to the fact that during old age people have to face circumstances that are considerably different from those experienced in other stages in life. In old age, situations such as loosing loved ones, bereavement, significant changes in health due to incapacitating illnesses and difficulties in performing preferred leisure activities are 6 Coping and activity in old age more common than at other times of life (Moos et al., 2006; Navarro & Bueno, 2005). The elderly have very little control or no control at all over these kinds of events, thus using behavioral and active coping strategies might not be adaptive for them. However, it should be acknowledged that this hypothesis has not been thoroughly tested. With reference to the new life circumstances that the elderly have to face when they reach old age, in recent times countries have implemented active aging social policies and programs that recommend well-being maintenance and the promotion of self-efficacy and coping with the potentially stressful circumstances that older people have to deal with (Kaiseler, Polman, & Nicholls, 2012). These kinds of policies underline the importance of improving older people’s training so they increase their self-efficacy, their ability to solve problems, their pro-social behavior and their ability to cope with life cycle changes (World Health Organization [WHO], 2002). However, despite these recommendations there are few studies that connect coping with being active in old age, especially among the Spanish population. At the same time, there is very little evidence on the joint impact of all sociodemographic characteristics on coping in the Spanish gerontological literature, thus we still do not know with certainty which of them has a greater impact on the type of strategy that the elderly use to face stressful situations (Hardcastle, Taylor, Bailey, Harley, & Hagger, 2013; Kaiseler, Polman, & Nicholls, 2012; Webb, Miles, & Sheeran, 2012). As a result of this the aim of this study was, on the one hand, to analyze the joint impact of age, gender, educational level, the fact of living alone or with other people, having offspring and activity level on coping strategies in a group of Spanish elderly, while on the other, to establish which of these variables has a greater impact on the coping strategies the participants use. 7 Coping and activity in old age Method Participants In this study convenience sampling was used. Participants were selected from five different senior activity centers which were located in different neighbourhoods of Granada, southern Spain. These senior activity centers are funded by the local government and offer older adults a wide range of activities such as computer classes, watercolour painting classes, crafts, tai-chi, Pilates, Spanish traditional dancing and cognitive stimulation groups among many others. The activities start at the beginning of October and finish at the end of June. Older adults who attend theses centres were invited to participate in this research. Data collection was conducted between January and May 2014. The final sample of this research comprised 243 elderly people (66.7% were women) with ages between 55 and 99 years old (M = 71.93 years, SD = 8.63). The total response rate was 81%: 300 older people were interested in participating, 57 of them were not interviewed because they did not meet the age criteria of being 55 years old or older or finally they refused to participate. With respect to the participant’s educational level the distribution was the following: elementary studies 50.6%, secondary education 12.4%, high-school education 18.5%, and also 18.5% were college graduates. Regarding their marital status, most participants had a partner 51.9%, while 31.3% were widowed and 16.9% of the participants were single or divorced. In terms of living arrangements, only 28.4% of the sample lived alone, 42.4% lived with their partner, and 8.2% with their partner and children, 11.9% lived only with their offspring, 2.1% lived with a brother, 1.2% with a nephew, a 2.1% with their parents, a 8 Coping and activity in old age 2.9% lived with a caregiver, and finally, the .8% with a grandson or a friend. Finally, 81% of participants had children and 49.8% grandchildren. Instruments and Procedure Before collecting the data each participant was informed about the investigation and was asked to sign the Informed Consent Form. The interviews were conducted individually by trained interviewers and enquired about the following information: Socio-demographic characteristics. Questions regarding participants’ age, gender, having offspring, the fact of living alone or with other people and educational level were included in a semi-structured interview specifically designed for this research. Participation in activities. The semi-structured interview also included questions that inquired whether the participants attended computer classes, University for the Third Age and creative activities and if they practiced any physical exercise or performed any other activities. The activity level was calculated by summing up the number of activities participants engaged in. Coping Strategies Inventory (CSI) (Tobin et al., 1989; Cano, Rodríguez, & García, 2007). This instrument provides information about three aspects: the main stressful situation experienced by the participants, coping style and the degree of perceived coping self-efficacy. The Spanish version contains forty Likert-type items grouped into eight primary scales: problem solving (i.e. “I worked on solving the problems in the situation”), cognitive restructuring (i.e. “I reorganized the way I looked at the situation, so things didn't look so bad”), social support seeking (i.e. “I found somebody who was a great listener”), express emotions (i.e. “I let my emotions out”), self-criticism (i.e. “I blamed myself”), problem avoidance (i.e. “I went along as if nothing were happening”), wishful thinking (i.e. 15 Coping and activity in old age information was collected on the level of support participants counted on, this assumption needs to be tested in future research. Finally, gender was a good predictor of self-criticism. More specifically, it was found that elderly men used the self-criticism strategy more frequently compared with elderly women. A possible explanation of this finding could be that, due to older men’s traditional role in Spanish culture that expects them to provide for their families, they might feel more social pressure to solve problems. According Yeh, et al. (2009), as a result of the different gender roles men and women perform and the expectations society has for each of them, men and women find different situations stressful and cope with them by using different coping strategies. However, the data collected in this study does not allow us to test how the cultural expectations of men and women’s traditional roles influences the link between gender and coping. Therefore, it is important to continue investigating the gender effect on coping and examine variables such as older people’s values that might explain this effect. In addition, it would be interesting to investigate the effect of these variables on the secondary and the tertiary order strategies. To sum up, the results of the MIMIC model tested in our study reflect the complex relationship between socio-demographic characteristics and the coping strategies used by the elderly. In addition, the results highlight the role of activities involvement in the coping strategies of elderly people. Subsequently, the individual analysis of the type of activities in which the participants were involved suggest that taking part in creative activities was associated with higher scores in social support seeking, problem solving and express emotions strategies. Moreover, attending the University for the Third Age and doing physical exercise were most consistently associated with statistically significant differences 16 Coping and activity in old age in the use of six coping strategies. Specifically, an increase in scores of problem solving, cognitive restructuring, express emotions, social support and wishful thinking strategies and a decrease in social withdrawal was observed. Nevertheless, attending computer classes or participating in other activities was not associated with the participants’ coping style. With respect to the type of physical activity and their association with coping, going for walks and dancing were the only two activities that were associated with higher scores in active coping strategies and with lower scores in social withdrawal. A possible explanation for these results could be that physical activity and formative engagement might contribute to an increase in self-esteem and control perception. This fact will influence the secondary appraisal of the stressful situation in which it is determined what resources are available and what the person is able to use (Lazarus & Folkman, 1984) and consequently determine the type of strategies used to deal with the situation. On the other hand, scoring high on some personality traits, such as extraversion, is associated with higher activity level and with higher social participation (Costa & McCrae, 1999), so this association could influence the results. Thus, personality could indirectly influence coping via activities participation. However, this hypothesis cannot be tested in this study as no information on personality, efficacy, self-esteem and control perception was collected. Future studies on coping in old age should include these variables when examining the link between activity and coping strategies. Furthermore, future research should test the possible mediating role of activity in the association between dispositional psychological variables and coping. Similarly, in order to better understand the link between leisure and coping future studies should include the length of time individuals are engaged in different leisure activities in addition to the number of activities they perform. 17 Coping and activity in old age Although this study contributes to the literature on coping and aging, there are several limitations to this investigation that are worth mentioning. The use of convenience sampling might not allow extrapolating the results of this study to the general Spanish population of older adults. Furthermore, results should be interpreted cautiously due to the cross-sectional design we used. Therefore, future studies should use probability sampling techniques and longitudinal designs to test the associations between coping, sociodemographic characteristics and activity level. Also, although the sample was mainly composed of older people, there are a small number participants who are not elderly from a biological (60 years) or a legal (65 year) perspective, hence it would be interesting to replicate the study with a sample that comprises only individuals whose age exceed these limits. In addition, more research is needed on coping in old age, specifically on gender and the association with different variables such as role-stereotypes as subjective evaluation of stressful events, and also to investigate the influence of psychological variables that could be mediating or moderating the use of coping strategies, such as personality, self-esteem, self-efficacy and control perception. However, despite these limitations the findings of this study contribute to a better understanding of what variables determine coping strategies in Spanish older people. 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Express emotions 11.07 6.05 .33 ** .15 ** .87 .6699 .9095 4. Social support 10.73 5.57 .44 ** .33 ** .51 ** .79 .5662 .8634 5. Problem avoidance 5.58 4.33 -.03 .48 ** -.10 -.00 .65 .4474 .7610 6. Wishful thinking 15.57 4.38 .28 ** .05 .28 ** .17 ** -.08 .76 .7324 .9162 7. Self-criticism 4.42 5.22 -.03 .08 -.03 -.10 .16 * -.05 .88 .7391 .9338 8. Social withdrawal 4.96 4.53 -.19 ** -.02 -.40 ** -.41 ** .31 ** -.03 .30 ** .73 .5910 .8464 Note. AVE: Average Variance Extracted; CR: Construct Reliability; Cronbach’s alpha of the scales are on the diagonal; ** p < .01, * p < .05. 24 Coping and activity in old age Table 2 Standardized coefficients estimates for covariates (MIMIC models) Coping strategies Covariates PS CR EE SS PA WT SC SW Age -.182* -.150* -.181* Gender .228** Education level Lives alone -.151* Offspring Activity level .214** .143* .245** .148* -.192* Note. PS: problem solving; CR: cognitive restructuring; EE: express emotions; SS: social support; PA: problem avoidance; WT: wishful thinking; SC: self-criticism; SW: social withdrawal. Only statistically significant coefficients are shown. * p < .05; ** p < .01