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SUBSCRIBE: eNewsletter

Resilience, Stress, and the Neurobiology of Aging

  • Helen Lavretsky, MD, MS
Sep 1, 2010
Volume: 
27
Issue: 
9
  • Geriatric Psychiatry, Cultural Psychiatry

aging and mental healthThe aging of the world’s populations represents one of the most remarkable success stories in medicine and of humankind, but it is also a source of various challenges. Getting older can be stressful because of multiple losses (eg, interpersonal, financial) and a decline in health, independence, and cognitive and functional abilities.

Worldwide, human life expectancy has increased steadily for nearly 200 years and this trend is expected to continue. In every decade of the past century, life expectancy increased by about 2 years. This increase was driven in the first decades by improvements in sanitation, housing, and education. A steady decline in early and midlife mortality was mostly the result of our ability to prevent and treat infections. The increase in life expectancy in the latter half of the century was almost entirely attributable to a decline in late-life mortality secondary to medical advances and improved socioeconomic conditions.1

Many older adults are living longer with chronic illnesses yet are making the best of their later years. As George E. Vaillant2 pointed out in his book Aging Well, “The major factors involved in negative personality change at midlife are the same factors that caused negative aging at 70: bad habits, bad marriage, maladaptive defenses, and disease.”

The benefits of a positive outlook

Empirical evidence now supports the long-held belief that positive emotions are good for one’s health. Fredrickson’s “broaden-and-build theory” shows how positive emotions contribute to psychological and physical well-being through more effective coping.3,4 It is a natural drive to seek personal happiness and fulfillment regardless of age. Successful aging is associated with a positive psychological outlook in later years, general well-being, and happiness.2,5-7

With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality of life and additional years of health.7 One direction is to improve resilience to stress.

Depp and Jeste6 have defined resilience as “the ability to maintain biological and psychological homeostasis under stress. It may vary with context, time, age, gender, and cultural origin. Inquiry into resilience has evolved from descriptions of resilient qualities to uncovering the process of resilient adaptation. In older adults, resilience has been studied mostly in the context of successful aging (eg, in centenarians) or in the context of recovery from injury or illness.” The question remains whether resilience can be operationalized and taught to older stressed individuals and whether any interventions exist that boost resilience to stress and life’s adversities.

 

CHECKPOINTS

  • Human responsiveness to stress may be attenuated by learned or adaptive skills, retraining, or increased resilience to future stress
  • Physiological mediators such as adrenaline from the adrenal medulla, glucocorticoids from the adrenal cortex, and cytokines from the cells of the immune system act on receptors in various tissues and organs to produce effects that are adaptive to stress in the short run but can be damaging if the mediators are not shut off when no longer needed
  • Prospective determinants of resilience for future studies include neuroendocrine, immunological, neural, genetic, temperamental, and environmental influences.

 

Stress and aging

Selye8 coined the term “stress” to define the alarm reaction, the stage of resistance, and the stage of exhaustion in animals and in humans. Only when the subject is overwhelmed or derailed does the stress response system begin to cause disease.9 Exposure to stress can be characterized in several ways: duration (acute, chronic), responsiveness (adaptive, hyperadaptive, nonresponsive), and severity (mild, moderate, extreme).10

Human responsiveness to stress may be attenuated by learned or adaptive skills, retraining, or indifference to future stress. The hypothalamic-pituitary-adrenal axis can be up regulated by a stressful experience, with increased amounts of circulating glucocorticoids, catecholamines, serotonin, and cytokines. These acute responses can lead to pathological changes that may be amplified by the aging of the brain.10

The adaptive physiological response to acute stress that involves internal milieu adjustment to change in the environment was initially described by Sterling and Eyer.11 McEwen12 extended this definition to include the concept of a set point that changes because of the process of maintaining homeostasis in the body that is mediated by the neuroendocrine, autonomic nervous, and immune systems. Allostasis is the term used to describe this process of “maintaining stability through change.”

Physiological mediators such as adrenaline from the adrenal medulla, glucocorticoids from the adrenal cortex, and cytokines from the cells of the immune system act on receptors in various tissues and organs to produce effects that are adaptive in the short run. If the mediators are not shut off when no longer needed, they can lead to deleterious effects of chronic stress, including receptor desensitization and tissue damage.

Aging can contribute to poor responsivity to stress because of reduced resilience.13 Accumulation of wear and tear caused by daily experiences and major life stressors can interact with genetic constitution and predisposing early life experiences to produce individual differences in the age-related diseases.10,13,14

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References: 

References

1. Dominguez LJ, Barbagallo M, Morley JE. Anti-aging medicine: pitfalls and hopes. Aging Male. 2009;12:13-20.
2. Vaillant GE. Aging Well. Surprising Guidepost to a Happier Life From the Landmark Harvard Study of Adult Development. New York: Little, Brown and Co; 2002:373.
3. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. Am Psychol. 2001;56:218-226.
4. Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional well-being. Psychol Sci. 2002;13:172-175.
5. Rowe JW, Kahn RL. Successful Aging. New York: Dell Publishing; 1999:265.
6. Depp CA, Jeste DV. Definitions and predictors of successful aging: a comprehensive review of larger quantitative studies. Am J Geriatr Psychiatry. 2006;14:6-20.
7. Peel NM, McClure RJ, Bartlett HP. Behavioral determinants of healthy aging. Am J Prev Med. 2005;28:298-304.
8. Selye H. The Stress of Life. New York: McGraw-Hill; 1956.
9. McEwen BS. The End of Stress as We Know It. Washington, DC: National Academies Press; 2004:239.
10. Miller MM, McEwen BS. Establishing an agenda for translational research on PTSD. Ann N Y Acad Sci. 2006;1071:294-312.
11. Sterling P, Eyer J. Allostasis: a new paradigm to explain arousal pathology. In: Fisher S, Reason J, eds. Handbook of Life Stress, Cognition, and Health. New York: John Wiley & Sons; 1988:629-649.
12. McEwen BS. Sex, stress, and the hippocampus: allostasis, allostatic load and the aging process. Neurobiol Aging. 2002;23:921-939.
13. Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: McArthur studies of successful aging. Proc Natl Acad Sci U S A. 2001;98:4770-4775.
14. Karlamangla AS, Singer BH, McEwen BS, et al. Allostatic load as a predictor of functional decline. MacArthur studies of successful aging. J Clin Epidemiol. 2002;55:696-710.
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17. Ferrucci L, Harris TB, Guralnik JM, et al. Serum IL-6 level and the development of disability in older persons. J Am Geriatr Soc. 1999;47:639-646.
18. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, et al. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci U S A. 2003;100:9090-9095.
19. Krabbe KS, Pedersen M, Bruunsgaard H. Inflammatory mediators in the elderly. Exp Gerontol. 2004;39:687-699.
20. Papanicolaou DA, Wilder RL, Manolagas SC, Chrousos GP. The pathophysiologic roles of interleukin-6 in human disease. Ann Intern Med. 1998;128:127-137.
21. Harris TB, Ferrucci L, Tracy RP, et al. Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med. 1999;106:506-512.
22. Davidson RJ. Affective style, psychopathology, and resilience: brain mechanisms and plasticity. Am Psychol. 2000;55:1196-1214.
23. Davidson RJ. Anxiety and affective style: role of prefrontal cortex and amygdala. Biol Psychiatry. 2002;51:68-80.
24. Lavretsky H, Irwin MR. Resilience and aging. Aging Health. 2007;3:309-323.
25. Werner EE. The children of Kaui: resiliency and recovery in adolescence and adulthood. J Adolesc Health. 1992;13:262-268.
26. Ryff CD, Singer BH, Dienberg Love G. Positive health: connecting well-being with biology. Philos Trans R Soc Lond B Biol Sci. 2004;359:1383-1394.
27. Richardson GE, Waite PJ. Mental health promotion through resilience and resiliency education. Int J Emerg Ment Health. 2002;4:65-75.
28. Fava GA, Rafanelli C, Cazzaro M, et al. Well-being therapy. A novel psychotherapeutic approach for residual symptoms of affective disorders. Psychol Med. 1998;28:475-480.
29. Fava GA, Ruini C, Rafanelli C, et al. Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. Am J Psychiatry. 2004;161:1872-1876.
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37. Motivala SJ, Sollers J, Thayer J, Irwin MR. Tai chi chih acutely decreases sympathetic nervous system activity in older adults. J Gerontol A Biol Sci Med Sci. 2006;61:1177-1180.
38. Lutgendorf SK, Antoni MH, Kumar M, Schneiderman N. Changes in cognitive coping strategies predict EBV-antibody titre change following a stress-or disclosure induction. J Psychosom Res. 1994;38:63-78.
39. Segerstrom SC, Taylor SE, Kemeny ME, Fahey JL. Optimism is associated with mood, coping, and immune change in response to stress. J Pers Soc Psychol. 1998;74:1646-1655.
40. Phillips AC, Burns VE, Lord JM. Stress and exercise: getting the balance right for aging immunity. Exerc Sport Sci Rev. 2007;35:35-39.
41. Epel E, Daubenmier J, Moskowitz JT, et al. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres. Ann N Y Acad Sci. 2009;1172:34-53.
42. Lavretsky H, Siddarth P, Irwin MR. Improving depression and enhancing resilience in family dementia caregivers: a pilot randomized placebo-controlled trial of escitalopram. Am J Geriatr Psychiatry. 2010;18:154-162.
43. Connor KM, Sutherland SM, Tupler LA, et al. Fluoxetine in post-traumatic stress disorder: randomised, double-blind study. Br J Psychiatry. 1999;175:17-22.
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