By Ryan C. Thompson & Rowena Gomez, PhD (Palo Alto University)
Improving physical health behaviors, such as eating healthy and exercise, is not the only way to protect older adults from stroke. In fact, psychological factors have been shown to play a role in increasing as well as reducing the risk of stroke. For example, recent studies have shown several psychosocial factors to significantly increase the risk of stroke, including the accumulation of life stressors, environmental disturbances, guilt about caregiver stress, socioeconomic stress, and racial injustice (Araki & Ito, 2013; Brainin & Dachenhausen, 2013).
Distress related to these life events places increased strain on the body, especially on the cardiovascular system, placing older adults at even greater risk for a cerebrovascular accident (CVA), commonly known as a stroke (Morris, Oliver, Kroll, & MacGillivray, 2012). As for the psychosocial factors that have been related to decreased risk of stroke, research has shown that increasing optimism and positive coping strategies can protect against CVA in at-risk patients by working to support other physical stroke prevention strategies, such as physical activity (Morris et al, 2012). Furthermore, self-efficacy, locus of control, and self-determination as well as social support have been found to protect against CVA (Morris et al, 2012).
1. Mental outlook: Optimism and coping
Improving your mental outlook is the first psychological strategy that supports other physically oriented prevention approaches. Optimism has been shown to reduce feelings of loneliness, hopelessness, and suicide, ultimately improving one’s quality of life over time (Conversano et al., 2010).
Feelings of loneliness, hopelessness, and suicide are characteristic of clinical depression, which reduce motivation and positive expectations of the future. In patients with chronic illness (e.g., cancer, cardiovascular disease), optimism significantly predicted positive outcomes and better quality of life (Avvenuti, Baiardini, & Giardini, 2016; Hernandez et al., 2015; Schofield et al., 2016), and dispositional optimism has been shown to protect against stroke across race and socioeconomic status (Kim, Park, & Peterson, 2011).
Increasing levels of optimism in older adults maximize the benefits of physically oriented prevention methods by increasing individual motivation to participate in treatment. Optimism has also been shown to support adaptive coping in response to stress (Conversano et al., 2010).
Adaptive coping includes cognitive and behavioral strategies for reconciling discrepancies between demands and available resources (Folkman & Lazarus, 1980) while promoting general well-being. Examples specific to stroke patients include “asserting independence, awareness of recovery, having a positive attitude, reminiscing… and implementing health strategies” (Popovich, Fox, & Bandagi, 2007, p. 1474).
Together, adapting, coping, and optimism strengthen resiliency, reduce the negative effects of psychosocial and physical distress, and protect against the onset of life-threatening illnesses (e.g., stroke, cardiovascular disease, cancer; MacLeod, Musich, Hawkins, Alsgaard, & Wicker, 2016).
2. Self-efficacy: Believing in yourself.
Improving your self-efficacy, or one’s confidence in their ability to accomplish a task, is the second psychological strategy. Self-efficacy has been shown to increase one’s confidence in establishing self-directed physical activity regimes, increased long-term maintenance of physical activity, and overall beliefs about being physically able to exercise (Morris et al, 2012).
For individuals recovering from stroke, self-efficacy improves rates of recovery through increased motor function and balance after stroke (Hellström, Lindmark, Wahlberg, & Fugl-Meyer, 2003). In a study of risk reduction, self-efficacy around self-care and medication management significantly improved behavioral practices of patients with stroke risk (Ireland et al., 2010).
Finally, research suggests that stroke prevention programs should improve on self-efficacy in increasing intentional exercise and health-related beliefs of individuals at-risk for stroke (Sullivan et al., 2008). Self-efficacy supports an individual’s ability to govern their own life and make their choices regarding their healthcare. For older adults especially, increasing understanding and ability to actively participate in own recovery is a more holistic and long-term preventive healthcare.
3. Social support and staying connected with others.
The third strategy for improving stroke prevention is to increase your level of social support and connection with others, including healthcare providers, peers, and family. When people feel connected to those around them, especially healthcare professionals, they feel more motivated to positively respond to their advice and are more willing to engage openly with them about their needs (Morris et al, 2012).
In previous research, lack of a strong social network has been associated with increased risk of stroke and coronary artery disease (Nagayoshi et al., 2014), and patients high in social support show the greatest level of recovery post-injury over time compared to patients with low social support (Glass & Maddox, 1992).
Improving social support for individuals at-risk for stroke improves positive emotions, increases life satisfaction, and provides motivation to maintain physical activity (Morris et al., 2012). Furthermore, the connection to physical health professionals and physicians reduces feelings of loneliness and provides emotional support and encouragement (Morris et al., 2012).
Finally, developing close bonds with peers allows one to create a shared motivation and opportunity to challenge cognitive distortions about ability to maintain preventative strategies (Morris et al., 2012). Social support promotes resilience through connection while also supporting optimism, adaptive coping, self-efficacy, and control.
Psychosocial protective factors must be considered in addition to the physical factors in preventing stroke. Optimism and adaptive coping, self-efficacy, and social support help maintain physical health strategies for stroke prevention while increasing an individual’s motivation and understanding of their healthcare.
Without these essential components, long-term adherence to exercise regimes (a primary preventive strategy for stroke) remains inconsistent, with one not taking full advantage of the benefits from exercise and the other physical health approaches (Morris et al., 2012). Supporting stroke prevention strategies through the inclusion of psychosocial factors can:
reduce incidence of stroke,
create a more resilient aging population, and
reduce the burden on caregivers and the U.S. healthcare system.
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Ryan C. Thompson, Med, NCC is a first-year graduate student in the Clinical Psychology PhD Program at Palo Alto University (PAU). His clinical and research interests include neuropsychological assessment, acquired and traumatic brain injury across the lifespan, and bilingualism.
Rowena Gomez, PhD is Director of Clinical Training for the PhD Clinical Psychology Program and Professor at Palo Alto University. Dr. Gomez’s research focus has been in geropsychology, neuropsychology, and depression.