Mohammed T. Abou-Saleh

380 PRINCIPLES AND PRACTICE OF GERIATRIC PSYCHIATRYoverwhelmed by them. The same environmental conditions orlife events that might devastate one person may have less of anegative impact on another.The Support/Efficacy Model 8 proposes a lifespan framework toexplain these differences. This model suggests that supportiveinteractions over time are essential to developing in the individuala sense of efficacy that instills in that person the belief that he/shecan successfully meet the challenges of life. With time, exchangesand interactions accumulate which either lead the individual tofeel competent and capable of coping with the problems he/sheconfronts (i.e. efficacious) or, under less optimal circumstances,leaves the individual feeling overwhelmed by, and personallyincapable of, coping with the problems and circumstances of life.It is also important to consider the influence of non-psychiatricfactors on the experience of events in old age and how one copeswith stress. Jackson et al. 9 have noted that racial, cultural andother sociodemographic factors fundamentally affect how asituation is experienced. If an individual is one of many sufferingthe same negative experience(s), the etiology of that experiencemay not be devastatingly personalized. On the other hand, ifeveryone else in one’s reference group is significantly moresuccessful, the relative comparison can be devastating, even if‘‘objectively’’ the situation is quite positive. Similarly, there nowexists empirical evidence indicating that different national groupsappear to vary considerably in the degree to which they respondnegatively to environmental factors and life events. Fuhrer et al. 10have shown that normal French elderly score markedly higher onmeasures of depressive symptomatology than their Americancounterparts, despite the fact that their general environmentalcircumstances and their experienced life events are actually quitesimilar. Antonucci et al. 11 , comparing Black and White Americanswith French elderly on a variety of factors, have shown that thegeneral mental health of American and French elderly are similarin some respects and different in others. All three groups arenegatively affected by functional limitations. On the other hand,Black American and French elderly men are less satisfied with lifethan women in these groups, although there is no sex differenceamong White Americans. A recent study of the elderly in theNetherlands and Italy 12 is also of interest. It suggests thatobjective characteristics, such as living arrangements, which somemight consider indicators of coping, need to be understood interms of the individual’s psychological state. Dutch elders tend tolive alone, while Italians tend to live with their families. However,Italian elders reported less social integration and more lonelinessthan Dutch elders. Despite the appearance of family integration,these data suggest that an individual’s ability to cope withenvironmental factors is not always directly predictable from theobjective characteristics of the situation. As with the French andAmericans reporting of depressive symptomology, this couldsimply, but importantly, be a difference in expressive style.It has been suggested that an individual’s ability to cope withspecific environmental conditions and life events is best understoodthrough a consideration of the resources and experiencesavailable to that person. One simplistic way to consider this is thatsuccessfully coping with stresses and strains in early life is the bestpredictor of the individual’s ability to cope with stressfulsituations in later life. This is likely to be true, even if the exactnature of the stressful event varies. There is also reason to believethat some individuals develop coping styles over their lifetime thatcan be seen to be generally successful and adaptive, while othersdevelop coping styles that are generally unsuccessful or maladaptive.At best, these coping strategies match the environmentalconditions and life events that the individual experiences. Forexample, Jackson 13 and Jackson et al. 14 have argued that the harshenvironmental conditions faced by many racial and ethnicminorities lead to the development of novel and effective copingstrategies. Over the lifecourse, however, many of these strategiesactually may be deleterious to health status, e.g. alcohol use.Although the specific nature of these experiences will change withage, an individual’s ability to cope with these environmentalevents is likely to show fairly stable lifespan continuity. At thesame time, as research clearly demonstrates, individual copingand adaptation competencies can be improved through informaland professional intervention at all points in the individuallifecourse.REFERENCES1. Baltes PB, Reese HW, Lipsitt LP. Life-span developmentalpsychology. Ann Rev Psychol 1980; 31: 65–110.2. Kahn RL, Antonucci TC. Convoys over the life course: Attachment,roles, and social support. In Baltes PB, Brim O, eds, LifespanDevelopment and Behavior, vol. 3. New York: Academic Press, 1980;3: 253–86.3. Antonucci TC. Personal characteristics, social support, and socialbehavior. In Binstock RH, Shanas E, eds, Handbook of Aging and theSocial Sciences, 2nd edn. New York: Van Nostrand Reinhold, 1985;94–128.4. Gouldner AW. The norm of reciprocity: a preliminary statement. AmSociol Rev 1960; 25(2): 161–78.5. Taylor SE, Kemeny ME, Reed GM et al. Psychological resources,positive illusions, and health. Am Psychol 2000; 55(1): 99–109.6. Baltes PB, Baltes MM, ed. Successful Aging: Perspectives from theBehavioral Sciences. Cambridge: Cambridge University Press, 1990.7. Cartensen LL, Isaacowitz DM, Charles ST. Taking time seriously: atheory of socioemotional selectivity. Am Psychol 1999; 54(3): 165–81.8. Antonucci TC, Jackson JS. Social support, interpersonal efficacy, andhealth. In Carstensen LL, Edelstein BA, eds, Handbook of ClinicalGerontology. New York: Pergamon, 1987; 291–311.9. Jackson JS, Antonucci TC, Gibson R. Cultural, racial and ethnicminority influences on aging. In Birren JE, Schaie KW, eds,Handbook of the Psychology of Aging, vol. 6. New York: AcademicPress, 1990; 6: 103–23.10. Fuhrer R, Antonucci TC, Alperovitch A et al. Depressivesymptomatology and cognitive functioning in later life. PsycholMed 1992; 22: 159–72.11. Antonucci TC, Fuhrer R, Jackson JS. Social support and reciprocity:a cross-ethnic and cross-national perspective. J Soc Pers Relat 1990;7(4): 519–30.12. Tilburg T, de Jong Gierveld J, Lecchini L, Marsiglia D. Socialintegration and loneliness: a comparative study among older adults inthe Netherlands and Tuscany, Italy. J Soc Pers Relat 1998; 15(6):740–54.13. Jackson JS. African American experiences through the adult years. InKastenbaum R, ed., Encyclopedia of Adult Development. Phoenix,AZ: Orvx Press, 1993; 18–26.14. Jackson JS, Williams DR, Lisansky Gomberg E. Aging and alcoholuse and abuse among African Americans: a life-course perspective. InLisansky Gomberg ES, Hegedus AM, Zucker RA, eds, AlcoholProblems and Aging 1999; 33: 63–87.