Elderly population and the Presumptive Stressful Life Events Scale:

An appraisal

Introduction:
The Presumptive stressful life events scale (PSLES)1 is considered as a useful tool for life-
event research among various populations in India. It has been widely used for research in
diverse mental (2,3,4,5,6,7) and physical (8,9,10) illnesses. Researches on the elderly too have
evaluated stress/life-events with the help of PSLES (11,12,13,14,15,16,17) but none have

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Sharma, I., Ram, D., 1988. Life events in anxiety neurosis. Indian J. Psychiatry 30, 61–67.
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Chandrashekhar, C.R., Reddy, U., Isaac, M.K., 1999. Life events and somatoform disorders. Indian J.
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PraharajSK, Munoli RN,Sharma PSVN. Life events in past one year in alcohol-dependent patients
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and kindling in bipolar disorder: Converging evidence from a mania-predominant illness course.
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Varghese R, Rajappa M, Chandrashekar L, Kattimani S, Archana M, Munisamy M, et al. Association
among stress, hypocortisolism, systemic inflammation, and disease severity in chronic urticaria
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Available at: http://repository-tnmgrmu.ac.in/1930/1/201800307mohamedilyas.pdf accessed 7
April 2019.
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Rizvi A, Gaur RK, Reyazuddin M, Usmani MA. Comparative study of clinical profile and
presumptive stressful life events in patients of psychogenic non epileptic seizure and epileptic
seizure: a cross sectional study. Int J Res Med Sci 2015;3:110-5.
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Dersak R. “Mental health of older people in relation to stressful life events adjustment and social
support”, PhD Thesis, Department of Psychology, University of Calicut, 2006. Available at:
http://shodhganga.inflibnet.ac.in/jspui/simple-
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niversity+of+Calicut%2C+2006&go= accessed 7 Apr 2019
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Singh D, Kedare JS, Vispute C. A study of risk factors associated with depression in medically ill
elderly patients. Ann Indian Psychiatry 2017;1:22-8
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Prakash O, Gupta LN, Singh VB, Singhal AK, Verma KK.
Profile of psychiatric disorders and life events in medically ill elderly: experiences from geriatricclinic
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Nadaf A. Autopsy study of suicides among elderly over a period of 18 months conducted at
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discussed its relevance from a developmental perspective or critically appraised it’s
bearing on elderly research.

Methodology:
The following paper is a critical appraisal of the use of PSLES in the elderly and is an
attempt to improve relevance for this population. The work is generated from the
research18 experience gained while using this tool in an institutionalised elderly population
(living in Ashrams). Thus the methodology entailed literature searches, experience gained
from formal/informal interviews with the above population and administration of PSLES
for the above research.

Results, Inferences and Proposed Modifications

Developmental issues in the life-event experiences of the elderly

Sing et al (1984) developed the PSLES in reference to an Indian adult population. Though
no differences in relation to age, education and marital status was noted, sex differences
were found in few of the items. The latter issues have been discussed in further detail by
Parakh (2011)19. The absence of age related differences in the development of PSLES can
be partly understood by the criteria for comparing age groups, that of 35 years and below
versus 35 years and above. Thus no attention was lent to the older adults.
On the other hand developmental understanding exposes us to the idea of qualitatively
different life-events experienced by the elderly or life-events having very different
significance when compared to the adult population. Such as the greater importance of
non-egocentric stress (resulting from events occurring to significant others, e.g. loss of job
of one’s child) as compared to egocentric stress (events that are intimate/personal, e.g.
own hospitalization)20 a concept aligned to the Erikson’s stage of generativity and
nurturance at late life that includes importance of concern for other’s problems. Our
experience suggests similar concern and explored further in the ensuing paragraphs.

15
Devi U. Effect of stressful life events on health of elderly people. Dissertation for MSc in Home
Science, Department of Human Development, Chaddhary Sarwan Kumar Himachal Pradesh Krishi
Vishvavidyalaya, Palampur, HP, 2012.
16
Deshpande SR, Tiwari SC. A study of stressful life events in an urban setting. International Journal
of Community Medicine And Public Health 2019;6:696-700.
17
Rao SS , Chennamsetty SK, Rao SK. A comparative study of psychiatric morbidity, quality of life
(QOL), coping skills among elderly people living in old age homes (OAH) and in the community.
International Journal of Health Sciences & Research2014;4(8):212-225.
18
Das A, Choudhary A, Tyagi T. Stress and coping among elderly living in an ashram of Haridwar.
Indian Journal of Psychiatry, 2018; 60:126
19
Parakh P. Gender issues in life event research in India: A critical appraisal of the presumptive
stressful life events scale. Asian J Psych 2011;4:19-21.
20
Carolyn M. Aldwin. The Elders Life Stress Inventory: egocentric and non-egocentric stress. In:
Stress and Coping in Later-Life Families. Eds, Mary Ann Parris Stephens, Janis H. Crowther, Stevan E.
Hobfoll. Daniel L. Tennenbaum. Hemisphere Publishing Corporation: New York. 1990 pp 49-69.
Take the example of events as major personal illness or injury (stress score 56) or changes
in biological functions/sleeping habits (stress score 33)/eating habits (stress score 27) or
social activities (stress score 28) which are more frequent and has more salience in an
elder’s life to have the same stress score as in adults. Or compare the relevance of
suspension or dismissal from job (stress score 76) versus suspension/dismissal from job of
child/close family member (item not present) for older adults. While change in residence
(stress score 39) may be of greater stress for the elders, considering the variability of
adaptability to new environments at different stages of life.
Death of close family member (stress score 66) such as that of one’s child or death of
friend (stress score 60) having a lower score compared to that of death of spouse (stress
score 95) might be appropriate for adults. But for the elderly from a developmental
understanding closer valence (and equivalent scores) of loss of spouse occurring (at a ripe
age) as that of a child (particularly so if one is the breadwinner/financer of the family) may
be appropriate, as may be death of a long-standing friend almost like family given the
specificity of Indian culture. In similar lines illness in family members (stress score 52)
(spouse/child) may be more stressful issues in the elderly than adults. Thus no-egocentric
events have a greater relevance in the elderly compared to that of the adults. Consider the
findings of
While on the other hand broken engagement or love affair (item 14), failure in examination
(item 33), or appearing for an examination or interview (item 34) may be irrelevant in the
Indian context for the elderly.

Other nuances specific to elderly and life-events

Although items conflicts with in-laws (stress score 57) and family conflicts (stress score 47)
should ideally be able to cover any conflicts with daughter-in-law, our experience suggest
older adults in these items concentrated only on conflicts with their siblings or parents in
earlier life, while admitted conflicts with daughter-in-law only when specifically asked for.
If this reflects the desire to uphold the honour of the family in front of outsiders
(researchers) or the items themselves are worded in such a way that they fail to elicit any
memories of conflicts with the families of their children, specifically their sons, is difficult
to comment upon. Probably the former may be correct that they are reluctant to discuss
any such problems but a specific questioning on conflicts with daughter-in-law resolves this
issue with a quantitatively different stress score.
Lack of son (item 25) has a place in PSLES while lack of daughter does not. Yet in our
experience with the elderly it was realised that views on son preference change with age
partly as daughters seem to be more loving and supportive than sons in old age.
Moreover literature suggests older adults avoided discussion of their own health problems,
but expressed great concern about their spouses' health21. This may be an important issue
to explore for researching elderly stress/life-events.

21
Carolyn M. Aldwin. The Elders Life Stress Inventory: egocentric and nonegocentric stress. In:
Stress and Coping in Later-Life Families. Eds, Mary Ann Parris Stephens, Janis H. Crowther, Stevan E.
Hobfoll. Daniel L. Tennenbaum. Hemisphere Publishing Corporation: New York. 1990 pp 49-69.
Gender aspects of elderly stress/life-events
Single parenthood do not feature as any item of PSLES, yet this may have differing impact
over the life time of elderly males versus females. Similarly single parent may evaluate
event of marriage of daughter (item 27) differently compared to parents sharing
responsibility more so if we take female gender into consideration. Thus unique items like
"early death of spouse" or "single parenthood for most of life" or "marriage of daughter by
single mother" maybe better suited to reflect the stress experienced by elderly.

Conclusion
Despite PSLES has been widely used for research on life-events/stress in the Indian
population including the elderly its relevance has never been appraised. A combination of
experience of using the tool in an elderly population and literature search on the elderly
stress suggests qualitatively and quantitatively varying life-events compared to that of the
adult Indian population. In order to improve relevance for PSLES for use in older adults we
suggest modification to capture the unique experience of the elderly life.