1. Introduction
The world population is aging. Worldwide, the proportion of people older than 59 years is growing faster than any other age group. This trend is also evident in Spain, where the expectations about the proportion of people aged 60 and over are 31.4% by 2025 [
1]. Aging results from the interaction of the processes that occur over time, the interactions of time, genetics, disease, and environmental and behavioral factors [
2]; it is also associated with numerous physical, physiologic, emotional, and cognitive changes and decrease functions, although there is no prescribed pattern for their order of appearance [
3]. “When an individual ages, their reduced reserve capacity makes them more vulnerable to stresses and places an older individual at greater risk of succumbing to stresses that a younger patient might overcome” [
2] (p. 467). In the late 1990s, the World Health Organization adopted the term “active ageing”, which aims to extend people´s healthy life expectancy and quality of life during aging [
1] and refers to “the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age” (p. 12).
The accumulated evidence indicates that the effects of psychosocial stress are adverse for health, most notably if demanding and repeated [
4]. A variety of psychosocial stressors can hinder the health-related quality of life of the elderly [
5], and biological, social and economic stressors may increase the risk of psychological distress in older adults [
6]. Research linking stress, health and aging differentiates two approaches: the life event tradition, which focuses on the molar impact of major life changes that require significant adjustment by the individual, and a second one that focuses on chronic stressors and the recurrent or persistent difficulties of life that may increase exposure to daily hassles [
7]. Evidence suggests that excessive or accumulated stress can accelerate epigenetic aging [
8], contribute to autonomic dysregulation [
9], impact the immune system through the secretion of hormones, which are also modified during aging [
10], and adversely affect cognitive functions [
11,
12]. The brain is the central organ of stress and adaptation to stressors [
13]; research has acknowledged that stress has negative effects on the brain across lifespan, but their scope is greater in early and late life [
14]. Although many studies have established some associations between stress and health-related outcomes, people do not always present the same effects. There are individual differences in the stress processes, which are influenced by several factors, including socioeconomic status, personal dispositions, and life transition [
7]. While the stress processes are not yet fully known, since the 80s it was generally accepted that exposure to stress alone does not directly lead to health problems, but its effects are mediated and moderated by other variables such as coping and social support [
15]. According to Folkman [
16] (p. 902) “coping refers to the thoughts and behaviors people use to manage the internal and external demands of stressful events”. Coping includes behaviors and strategies that are generally grouped into two kinds, problem-focused coping and emotion-focused coping. In the first case, strategies and behaviors such as information gathering and decision making are aimed at solving the problem causing the discomfort; emotion-focused coping rather deals with the regulating of negative emotions by using strategies such as distancing, escape-avoidance and the search of emotional support [
16]. Emotion regulation and social support are two constructs that contribute to resilience and have specific patterns in older adults [
17].
In addition to the psychosocial stressors and the losses occurring in late life, the risk of distress is greater as frailty and physical illnesses increase [
18]. Psychological distress is a widespread indicator of mental illness and mental health in clinical settings, in research, and in public health [
19]. Moreover, it has been related to increasing rates of death from several major causes, such as cerebral disease, cardiovascular disease, cancer and deaths from external causes [
20,
21]; recent research has likewise reported that psychological distress raises the risk of developing some diseases such as arthritis, cardiovascular disease, diabetes, and chronic obstructive pulmonary disease [
22]. Psychological distress has been considered a key component in the psychosocial functioning of older people [
23]; in the case of the elderly, it may occur as a consequence of poorer cognitive functioning [
24]. Actually, research has reported that psychological distress was associated with and increased the risk of functional disability in the elderly [
25,
26].
Demographic, social and personal factors like gender, socioeconomic status, age, marital status, social support, and self-esteem have been associated with psychological distress [
18,
27,
28,
29,
30,
31,
32,
33,
34]. Psychological distress has been negatively associated with age and with self-esteem [
30]. Besides, in elderly people, psychological distress has been associated with less social support [
28], whereas the risk of psychological distress has proved lower in the case of higher education, higher income and married status [
18,
34]. Studies carried out in several countries have realized gender differences in psychological distress, as women presented a higher mean level than men [
19,
28,
32,
34,
35,
36]. But gender differences in psychological distress seem to be influenced by sociodemographic and occupational variables and the disparities between women and men in psychological distress may diminish or even disappear in case of a high occupational level [
37]. In addition, such gender differences may vary depending on the context of the study [
38]. Another factor that may be relevant when approaching gender differences in psychological distress is stress and coping styles. Although the existence of gender differences in stress may depend on the type of stressor, it has been found that women report more chronic stress than men [
35,
36,
39]. The results of the research on gender differences in coping have not been conclusive, but some studies indicate that emotion-focused coping is more common in women than in men, and problem-focused coping more common in men [
36,
39]. Emotion-focused coping is associated with greater psychological distress whereas psychological distress provides lower levels in the case of problem-focused coping [
36,
39,
40,
41]. Gender differences in psychological distress are an important clinical and public health issue, and further researches are needed to know the factors underlying these differences [
19].
Research has by and large concluded that there are resources influencing indirectly and negatively on psychological distress, and stressors whose effect on distress is direct and positive. However, the dynamic mechanisms involved in the relationship among stressors, resources and psychological distress are not yet clear [
6]. Studies have not generally approached the relevance of gender in such processes. Gender is acknowledged an important social determinant of health [
42]; in fact, the WHO in its “Ageing and Health” Programme highlights the importance of recognizing gender differences [
1]. The main aim of the present study has been to perform a gender-focused analysis so as to examine the relevance of psychological distress and psychosocial factors in the social functioning of the elderly. The specific objectives of the work are three: (1) To know the relevance of gender in psychological distress and social functioning of the elderly. (2) To know the relevance of the sociodemographic variables, psychosocial stress and personal and social resources (coping styles, self-esteem and social support) in the psychological distress of elderly individuals. (3) To know the relevance of sociodemographic variables, psychosocial stress, psychological distress and personal and social resources (coping styles, self-esteem and social support) in the social functioning of aged people. The specific hypotheses for this research are as follows:
- (1)
Women will present greater psychological distress than men.
- (2)
Greater stress will be associated with greater psychological distress.
- (3)
Greater stress, greater psychological distress and older age will be associated with worse social functioning.
4. Discussion
The present study has identified the relevance of psychological distress in the social functioning of the elderly, which improved significantly when people reported less psychological distress. In addition, social functioning was associated in older people with younger age. Although it had been hypothesized that greater stress, greater psychological distress and greater age would be related to worse social functioning, the results have identified that stress did not have a direct significant role in the social functioning of older men and women; nor did emotion-focused coping styles, social support and the number of children. Seemingly, educational level, marital status, self-esteem and rational coping style would neither play any important role in the case of men. In the women group, high self-esteem entailed better social functioning. In addition, a higher educational level and being married or living as a partner were associated with greater social functioning just in case the sociodemographic variables were included in the regression; yet this effect disappeared when stress and psychological distress were entered as predictors.
The results of this work converge and extend the existing literature regarding the risk factor that psychological distress entails for the quality of life of the elderly [
23,
24,
25,
26]; moreover, the results of this work extend the knowledge and document that psychological distress also involves an important threat to the social functioning of old people.
The second hypothesis predicted that greater stress would associate with greater psychological distress; the results found in this study support this hypothesis, although regression analysis identified that chronic stress was no longer statistically associated to psychological distress when stress coping styles were included in the regression analysis. Other studies had revealed associations between stress and psychological distress [
5,
6,
33,
37,
52,
53], but although some researchers had considered chronic stress as a major threat to the health of the elderly [
8], in the present study the number of life events experienced during the previous 12 months was a more important predictor of psychological distress than chronic stress. It may be owing to the fact that the most frequent life events cited by people in the present study sample were the illness and death of family members and loved ones, those events being initially less susceptible to coping by problem-focused coping styles than chronic stress.
In both genders the most noteworthy variable in psychological distress was the emotional coping style; these results are consistent with those yielded by another study conducted in Spain with people aged between 18–65 years old [
36]. Less problem-focused coping was also related in both genders to greater psychological distress, although this association was no longer statistically significant when self-esteem and social support were included in the regression equation. The resulting findings are therefore consistent with those provided by other studies reporting that problem-focused coping was associated to less distress whereas emotion-focused coping was associated with greater distress [
36,
39,
40,
41]. In addition, lower self-esteem was a significant variable in men’s psychological distress, whereas, for women, it had to do with less emotional support and a lower educational level. These results cohere with those identified by other studies [
18,
27,
28,
33,
34] that reveal that a high social support, self-esteem and educational level played a protective role against psychological distress, although this work has also made evident that the relevance of such factors differs in women and men. Such differences are congruent with gender stereotypes and traditional socialization patterns. In this sense, agency is central to men, who are characterized by focusing on the self and orient towards independence and the achievement of personal goals; communion is central to women, more oriented to other people and toward forming connections [
54].
The first hypothesis, which predicted that women would have greater psychological distress than men, has been supported. These findings support those previously found in another research [
28,
32,
34,
36,
39]. In addition, and in line with other studies conducted with younger people, it has been found that women display greater chronic stress than men, that their coping style is more emotional and less rational [
36,
39], and that their self-esteem scores lower [
55]. However, although women’s psychological distress was rated higher than in the case of men, their stress coping style being less healthy and their self-esteem lower, the present study has revealed no differences between women and men in terms of social functioning. This may indicate the presence of protective factors in women which have not yet been identified, a task that should be addressed in future work.
Although the results of the present work allow to advance in the knowledge of the factors that are relevant in the active ageing of women and men, as well as in the risk and protective factors of such ageing, it presents some limitations. First, this is a cross-sectional study, therefore, it can only test the association between variables but not cause-effect relationships. Second, the sample, although large, has not been obtained through random sampling. The fact that people participated voluntarily in the study may imply some kind of bias since participants were older people who might have presented greater health and/or social functioning. Third, all the measures were self-report, so they may be influenced by social desirability. Fourth, all the participants lived in Spain, which may limit the generalization of the results with respect to other countries. Fifth, only a little more than a third of the variance in psychological distress and social functioning has been explained. Future research is needed to investigate the causal link between the variables, so as to increase awareness of the relevance of gender in active aging, to confirm the generalizability of these results in other countries, as well as to expand knowledge of the variables that determine the social functioning and psychological distress of elderly women and men.