Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-082 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYDo Life Events Seem Less Stressful to the Old?A. D. M. DaviesDepartment of Psychology, University of Liverpool, UKINTRODUCTIONProblems in defining, measuring and interpreting the impact of alife event have been much discussed 1,2 . Where events occurring toolder people are concerned, problems are compounded in thattypically, mental health researchers assessing event severity areyounger than the people assessed. A ‘‘social clock’’ view ofdevelopment, however, assumes that the impact of an eventdepends on whether it is seen as normative or non-normative forthe stage of life. The paradox is that older people are generally notthe group that make the judgements of the severity of eventsoccurring to older adults. A study was therefore carried out to seewhether an elderly panel of raters accorded in judgement with ayounger panel of four professional raters trained in the BedfordCollege LEDS scale, and whose ratings had been shown to beconsistent and reliable 3 .The distribution of severity ratings for the older trained panelover the four levels of event severity were as follows: I, 3; II, 27;III, 34; IV, 16. A one-way analysis of variance (ANOVA)comparing the mean ratings of the old trained panel with those ofthe professional panel showed that there were significantdifferences (F=5.6, P=0.004). Post hoc comparisons indicatedthat the old group rated events as less severe than the younggroup. Cross-tabulations showed that, although there was someagreement of the older and professional panels (weightedkappa=0.31), the agreement with the professional panel wasmainly about which events posed little threat. There was pooragreement for the crucial events of type I (severe threat). Of the 20‘‘severe threat’’ events presented, the distribution of ratings for theolder panel were: I, 3; II, 6; III, 10; IV, 1. Most of these eventsconcerned deaths of family members which, in general, the olderpanel (even though they had been trained in the LEDSprocedures) did not see as particularly threatening.METHODSA group of 25 retired university and health service personnel wasrecruited to rate the severity of the events and difficulties thatoccurred to a sample of elderly rural people over a 12 monthperiod. The present results refer to the ratings made by a randomlyassigned subgroup of 10 (age range 65–82) who were thoroughlytrained in the LEDS procedures. Their ratings were compared withthose of a (non-elderly) psychologists’ rating panel. After training,the panel met for six sessions over a 3 month period to rate 80 lifeevents drawn from a pool of 289 events, which had occurred to anindependent sample of 237 rural elderly people living in thecommunity. The events were drawn in a counter-balanced wayaccording to the consensus severity (threat) assigned to theprofessional panel (I=severely threatening, IV=little or no threat)within each of 20 blocks. Training for the older panel useddefinitions and guidelines from the Bedford College Manual,together with taped interviews, group discussion and ratingpractice with feedback about the professional panel’s ratings.After all blocks had been rated, five blocks were re-rated toexamine reliability (20 events). There was a minimum of 1 weekand a maximum of 3 weeks between ratings. All but oneparticipant showed significant agreement between the two ratings(as measured by Kendall’s coefficient of concordance). Theinconsistent participant’s data were excluded from further analysis.RESULTSCONCLUSIONThe results provide support for the view that events such asdeaths and severe illness events may be judged less threateningto older people, perhaps because they are seen as ‘‘on-time’’ 4 .Not all death events were rated equally, however. ‘‘Death of aspouse’’ and especially ‘‘death of a child’’ were regarded as morethreatening than the death of a sibling or friend. However, ingeneral the older panel rated stressful life events moreconservatively.ACKNOWLEDGEMENTI would like to thank J. O. E. James and S. J. Wilkinson for theirhelp in the collection of the data reported here.REFERENCES1. Davies ADM. Life events, health, adaptation and social support in theclinical psychology of late life. In RT Woods (ed.). Handbook of theClinical Psychology of Ageing. Chichester: Wiley, 1997.2. Orrell MW, Davies ADM. Life events in the elderly. Int Rev Psychiat1994; 6: 59–72.3. Wilkinson SJ, Downes JJ, James O, Davies MG, Davies ADM. Ratingreliability for life events and difficulties in the elderly. Psychol Med1986; 16: 101–5.4. Neugarten BL. Dynamics of transition of middle age to old age:adaptation and the life cycle. J Geriat Psychiat 1970; 4: 1–87.