Public Health Nursing Vol. 9 No. 3, pp. 200-208 0737- 1209/92/56.00 0 1992 Blackwell Scientific Publications, Inc.

How Elderly Women Cope: Concerns and Strategies Susan M. Heidrich, Ph.D., R.N., and Carol D. Ryff, Ph.D.

Abstract Forty-two elderly women were asked to describe the problems they faced with aging, and how they coped with both real-life and hypothetical problems in seven areas. Content analysis indicated that their spontaneously reported ongoing strategies were consistent with current theoretical formulations, the strategies differed by area of concern and for real-life versus hypothetical problems, and direct action strategies were related to lower levels of psychologic distress. These results have implications for nursing research and practice.

We conducted an in-depth investigation of how elderly women see themselves coping with the problems of aging. A multimethod approach was used that included open-ended interview questions about coping concerns and strategies, and structured instruments assessing physical health and depression. Of particular interest were women’s spontaneous descriptions of both the problems they face as they age and their strategies for dealing with these problems. Using this approach allowed us to address a number of shortcomings found in the literature related to coping with aging. Although there is a large base of research on coping and aging, relatively little work has been done to determine if lay conceptions of coping fit with the empirical literature. One exception is a study by Keller, Leventhal, and Larson (1989) in which elderly individuals

Susan M . Heidrich, P h . D . , R . N . , is aifiliated with the University of Wisconsin-Milwaukee. Carol D . Ryff, P h . D . is uffiliated with the University of Wisconsin-Madison Address correspondence to Susan Heidrich, School of Nursing, 575 Cunningham Hall, University of Wisconsin-Milwaukee, Milwaukee, WI 53201. Supported in part by Public Health Service, National Research Service Award NR05932, predoctoral fellowship, and a Sigma Theta Tau, Beta Eta Chapter research award to the first author.

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were asked to describe how they coped with aging-related changes. The authors identified some strategies that were different from those in current coping inventories. They suggested that the differences were due to the goals of these strategies being specific to the types of aging-related losses. Thus, one objective of this study was to determine if self-reported coping strategies of elderly women were adequately described by the broad themes that have been identified in factor-analytic or descriptive studies employing standard coping inventories; for example, direct action, passive cognitive, or emotion- versus problem-focused strategies (Essex & Klein, 1989; Pearlin & Schooler, 1978). The aim was to identify any strategies that might be especially relevant or specific to elderly women that may not be captured by the use of standard inventories. A second shortcoming in the literature is that little attention has been given to coping vis-8-vis particular life domains. The goal in this study was to investigate day-to-day coping with a broad domain of concerns including physical health, family, friendship, finances, and time spent in activities, all areas that have been identified as important to subjective well-being in the elderly (Blazer, 1980; Diener, 1984; Larson, 1978), and to determine if the women responded differently to them. For example, do the women use different strategies when faced with health problems versus family problems? An additional impetus for using a broad domain of concerns was the debate over whether age differences exist in an individual’s choice of coping strategies and, if so, whether they are due to the nature of the stressor or to cohort or maturational differences. In this debate, the most prevalent stressor in old age is typically characterized as physical health problems or chronic illness (Felton & Revenson, 1987; Folkman et al., 1987; Lazarus & DeLongis, 1983). Although health problems undoubtedly are a major concern, other life domains, such

Heidrich and Ryff How Elderly Women Cope 201 as family, economic matters, and time management might be equally important to elderly women’s mental health. Furthermore, when coping strategies across events were compared, they were assessed in response to different discrete events or to discrete events that have been classified as, for example, loss, threat, or challenges (McCrae, 1989). McCrae (1989) suggested that responses be aggregated over a large number of stressful events. In fact, some of life’s problems may not be discrete events, but rather continuing problems of daily living (Costa & McCrae, 1990). By addressing women’s coping strategies in response to broad domains of continuing concern, an attempt was made to address some of the issues that McCrae (1989) and others have raised. A third issue is confusion about problem-focused versus emotion-focused coping by the elderly. A number of studies indicate that problem-focused coping is related to more adaptive mental and physical health outcomes (Aldwin & Revenson, 1987; Billings & Moos, 1984; Felton, Revenson, & Hinricksen, 1984; Felton & Revenson, 1984; Folkman et al., 1986; McNett, 1987; Roberts et al., 1987). In addition, the benefits of problemfocused strategies are increased, relative to emotionfocused strategies, when individuals perceive that the strategies are effective (Aldwin & Revenson, 1987). However, problem-focused coping decreased with age in some studies (Felton & Revenson, 1987; Quayhagen & Quayhagen, 1982; Folkman et al., 1987), but not in others (McCrae, 1982, 1989; Folkman & Lazarus, 1980; Felton & Revenson, 1984). Thus, the relationship among age, problem-focused coping, and psychologic adaptation is unclear. Furthermore, the definition of problem-focused coping differs across coping inventories and includes such diverse strategies as direct action (Pearlin & Schooler, 19781, planful problem solving (Folkman & Lazarus, 1980), information seeking (Billings & Moos, 1984), instrumental action (Aldwin & Revenson, 1987), and cognitive strategies (Felton & Revenson, 1984). Although this study was not designed to address problem-focused coping per se, we wanted to emphasize such an approach in framing our interview questions to ensure that the spontaneous strategies reported by the respondents would include such strategies. In this way, we hoped to identify what problem-focused coping means to elderly women in their daily life, and to examine how the strategies derived from such an approach are related to mental health. A final concern was with the different methodologies described in the coping literature versus the problemsolving literature, which addresses age differences in specific intellectual or cognitive problem-solving abilities; for example, means-end thinking, the ability to

generate alternatives, reasoning, and concept learning (Denney, 1990). Studies most relevant to coping research are concerned with how individuals solve practical or everyday problems. The standard methodology is to ask individuals how they would solve hypothetical problems (Cornelius & Caspi, 1987; Denney, Pearce, & Palmer, 1982). In coping research, on the other hand, individuals are asked to report strategies used in response to a stressful event they had experienced in the recent past. The specific event may differ from subject to subject, however, making comparisons difficult. In the case of the problem-solving methodology, comparisons are easier because the problem does not change from person to person, but the relevance or familiarity of the problem to the individual is unknown. In this study, women were asked to respond to both real-life and hypothetical problems to see if the different methods of assessing coping responses resulted in different strategies being identified. METH0DS Subjects

Forty-two community-dwelling women participated in this study. Their average age was 74 years. The majority (42%) were widowed (average I 1 yrs), 29% were married, 21% divorced, and 7% never married. All were retired. Overall, this was a highly educated sample (mean 15 yrs of education) with adequate incomes (rated as fair to good by the majority). Self-rated health was 3.6 (SD 0.91) on a scale from 1 (poor) to 5 (excellent). Procedure

Women were recruited through various community agencies and church groups serving the elderly, and by word of mouth. Those who volunteered were sent a packet of questionnaires that contained demographic questions and instruments related to physical health and depression. These were completed independently prior to a home interview. Interviews took place within one week of receiving the mailed questionnaires. They were conducted by a female interviewer and were audio-recorded. The interview tapes were transcribed for coding purposes. The average length of the interviews was one and one-half hours, and women were paid $10 for their participation. Measures Coping Interview The interview consisted of 27 open-ended questions that asked women to describe the aging process, the types of concerns and problems they were facing as they aged, and how they coped with these concerns.

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Reported here are the responses to 13 questions related Mental Health to concerns and coping strategies. Two questions were Mental health was assessed using the CES-D depression related to identifying the day-to-day and major con- scale (Radloff, 1977), a 20-item self-report scale decerns, and I 1 were related to identifying coping strate- signed to measure depressive symptomatology in the gies in response to actual and hypothetical problems. general population. This tool was chosen because it Coping with actual problems was assessed by seven measures current levels of symptomatology with emphasis on depressed mood or affect, has few somatically questions corresponding to seven life domains-health, family, friendships, time management, finances, self based items, and has demonstrated good reliability and concept, and depression. Women were asked how they validity. In this study, the alpha coefficient was 0.88. solved problems or coped with their concerns within Scores above 15 on the CES-D are considered indicative of clinical depression. each domain. The average depression score (mean 9.86, SD 9.19) Coping with hypothetical problems was assessed with four questions, described by the interviewer, that cor- for this sample is similar to that reported for other comresponded to four life domains-health, family, friend- munity samples (Nolan-Hoeksema, 1988). However, ships, and time management. The questions regarding 20% of this sample scored in the range for clinical actual problems were broad; for example, “How do you depression. That is somewhat higher than the 14.6% in cope with concerns about your health?” Hypothetical a large survey of the elderly using the CES-D (Nolenproblems were included to ensure that, for a number of Hoeksema, 1988). questions, responses to identical situations were being compared across respondents. Examples of hypothetiDATA ANALYSIS AND RESULTS cal problems are “How would you deal with a good friend letting you down when you were really counting The objective in the analysis of the coping interview on her?” (friendship domain), and “How would you data was to stay as close to the meaning and words of handle it if your children decided to get a divorce?” (do- the respondents as possible while maintaining an overall main of family). The order of questions was such that, picture of the findings. A content analysis was conwithin each domain, the actual problem was asked first ducted using a two-step procedure (Krippendorf, 1980). and then the hypothetical problem. Categories of concerns and coping strategies were derived from the interview responses by two independent Health Status raters. These categories were based on the themes of Health status was measured in two ways. First, the num- concerns, coping, and problem solving that appeared in ber of health problems was assessed using the Older response to each question. The actual responses to the American Resources and Services (OARS) schedule of open-ended questions were then coded by two raters usillnesses (Duke University, 1978), a 28-item measure ing these thematic categories. Interrater reliability was commonly used for health assessments in community 0.91 to 0.97 using the formula proposed by Krippendorf (1980). Categories with fewer than four responses (10% samples. Three problems were added to this scaleosteoporosis, hip fracture, and depression-because of criteria) were dropped. their prevalence in elderly women. Respondents identified whether or not they had experienced each health Concerns of Elderly Women problem in the recent past, and the total number of problems was computed. Women in this sample re- One of the first purposes of the study was to identify ported an average of 3.6 health problems (SD 2.18). the domains of life elderly women perceive as problemMost frequently reported were arthritis (67%), osteo- atic or of concern. Women were asked to describe their day-to-day concerns or problems, and any major chalporosis (38%), and hypertension (28%). A second measure of health status was the OARS lenges or problems in their life right now. Overall, ADL scale, a widely used measure of functional health the concerns spontaneously described were their own status (Duke University, 1978). Women rated, on a 1 to health, caring for others, maintaining independence, 5 scale, how much difficulty they experienced in car- finances, household management, activity limitations, rying out 13 activities of daily living (ADL) ( 1 = no dif- family problems, health maintenance and illness ficulty, 5 = a great deal of difficulty), and the ratings management, and “no concerns.” The most frequent were added for a total score. In this sample, the alpha day-to-day concerns were evenly distributed among coefficient for this scale was 0.86. The average ADL household management (24%), activity limitations score (mean 16.52, SD 5.47) indicates a low degree of (24%), and none (24%). The most frequent major difficulty, but four women with more severe health concerns were their own health (35%) and caring for problems had high scores. others (29%).

Heidrich and Ryff How Elderly Women Cope

Coping Strategies

Coping strategies were identified for each area of concern in relation to the two different types of problems, actual and hypothetical. The coping strategies differed by domain and problem type, although there was some overlap for certain strategies or for different areas of concern (Table 1). In response to questions about actual health problems, women generally trusted that they were receiving good medical care and that their physicians would take

203

the best care of their health, or that they were actively working to maintain their health by good health practices (e.g., diet, exercise). The hypothetical health problem concerned coping with a fall and subsequent hip fracture. Most women had established a short-term plan (how to get immediate help) or a long-term plan of managing hospitalization and subsequent rehabilitation. Those who referred to being devastated or suicidal all had been hospitalized in the past in a nursing home and had seen patients with hip fractures.

TABLE I . Coping Strategies Identified und Frequency of Mention Within Each Area of Concern in Response to Actirul und Hypotheticul Problems Actual Problem Health concerns Have faith in physician Actively maintain health Accept the situation Have positive attitude Ignore the problem Family concerns Get emotional support Don’t interfere Worry Take care of the person Friendship concerns Have never had a problem Confront the person Try to discuss Ignore the situation Can’t answer Time managment concerns Get organized Have interests, hobbies Can’t cope Don’t have a problem Financial concerns Try to budget Don’t have a problem Husband handles this Get help from others Worry Concerns about self (self-concept) Keep busy Can’t cope Call a friend (to get mind off) Accept self Introspection Concerns about depression Get mind off Talk to someone (to get mind off) Nothing-just go through it Don’t have problem Cry

No.

Hypothetical Problem

No.

18 17 5 5

Make a long-term plan Make a short-term plan Have positive attitude Could not cope (suicidal)

18 15 10 5

Get emotional support Don’t interfere Be upset Encourage counseling

20

4 18

9 7 4

I5 6 6 3 13 13 10

9 6 16

12 5 5

3 16

12 9

6 5

28 12 6 6 3

Feel hurt Keep communication open End the relationship Hide one’s feelings

Develop new interests Plan ahead Develop old interests Increase social interaction

15

13 5

17 15

II 10

18 17

6 2

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In response to an actual family problem, most women tried to obtain or give emotional support. A similar response was made to the hypothetical problem of how to cope with the divorce of an adult child; however, this may be because half of the women had personally experienced this problem. In response to an actual problem with a friend, most women said that one had never arisen. For the hypothetical problem, the responses reflected attempts to communicate with the friend, or hiding the problem, or ending the relationship. Women talked about actual problems with time management in two ways. Those who were very active either had developed systems of organization or were unsuccessful in their attempts to organize their time (i.e., they could not get everything done). The other group had too much time on their hands and were trying to develop new interests or hobbies. The hypothetical problem concerned retirement, and most women developed new interests as a coping mechanism. Finances were no problem for 29% of the women, but were a concern for a number of them, and their most frequent coping mechanism was to follow a budget. Very few had attempted to obtain help from others. Responses to an actual problem about the self (selfconcept) were quite similar. Women were asked how they coped when they were dissatisfied or unhappy with themselves. A few used introspection or tried to learn to accept their limitations. For the most part, however, they admitted either that they were not coping well with this problem or that they used techniques to distract themselves. For example, calling a friend was always mentioned in the context of getting their mind off of it rather than to discuss the problem or obtain help or support. Questions on how women coped when they felt depressed or blue elicited similar responses. A few women said they never had this problem, but the majority tried to distract themselves by keeping busy or active, or by spending time with friends. Overall, these women had a varied coping repertoire. The strategies most frequently reported varied by area of concern or by type of problem (actual vs hypothetical). When strategies were compared across concerns, the responses were specific to the domain or to the problem. Responses in certain areas of concern were more similar than in others, however, and in three areas they were similar: interpersonal problems (family, friendships), intrapsychic problems (concerns about self, depression), and extrapersonal or objective problems (health problems, time management, finances). For example, strategies related to giving or receiving social or emotional support were prevalent for intraper-

sonal problems but not for intrapsychic o r extrapersonal problems. Specific direct actions (planning, getting organized) were more prevalent for extrapersonal problems than in the interpersonal or intrapsychic domains. These differences may indicate the responses that the women learned through experience work for them or, alternatively, that women were not employing strategies that may be effective in one domain in another domain (e.g., using direct action o r social support for intrapsychic problems). Within concerns, some differences emerged when responses to actual and hypothetical problems were compared. In the health domain, cognitive strategies were more prevalent for actual than for hypothetical problems. This may have been due to the chronicity of most health problems versus the frequent interpretation of the hypothetical problem (hip fracture) as an acute rather than chronic condition. In the domain of friendship, the range of hypothetical responses suggested very different and conflicting strategies (keeping communication open vs ending the relationship) that were not apparent in responses to actual problems. This difference may reflect the lack of experience reported by these women in dealing with problems in this domain. For family and time management problems, responses were more similar.

TABLE 2 . Coping Categories and Examples of Subcategories of Responses Category

Responses

Direct action

Actively maintain health Get support from others Make a long-term plan Give emotional support Try to discuss or communicate Plan ahead Develop new interests Increase social interactions Ignore Keep mind busy Hide the problems Let husband handle it Avoid it Do nothing Learn acceptance Have a positive attitude Have faith in others Worry Be upset Cry “I can’t cope” Feel devastated

Passive cognitive coping

Positive cognitive coping Emotional expression

Heidrich and Ryff How Elderly Women Cope 205

tional expression were most frequently used to deal with problems of self-concept and depression. Positive cognitive strategies were rarely reported, except in reTo compare coping strategies found in this study with sponse to actual health problems. However, it should be those in standard coping inventories, and to identify noted that problems in the health domain were the most strategies specific to elderly women, a second coding frequently reported major concerns of these women. method was implemented. Four raters, who had not Second, when percentages were collapsed across participated in the original coding but who were familiar concerns, responses to actual and hypothetical probwith the coping literature, were asked to sort the lems were similar. For example, direct action responses first set of categories into broader categories of coping. were the most frequent and emotional expression the Four such categories were identified that contained re- least frequent overall for both types of problems. Howsponses with a minimum of 75% agreement among ra- ever, within concerns, large differences were seen in the ters: taking action, positive cognitive coping, passive frequency of different coping strategies for hypothetical cognitive coping, and emotional expression. These are versus actual problems. For example, direct action reconsistent with strategies identified in other studies (Es- sponses were more prevalent for hypothetical than acsex & Klein, 1989; Pearlin & Schooler, 1978). A fifth tual problems of health and time management. Passive category was added to identify subjects whose response cognitive strategies were more prevalent for actual to questions was that they “had no problems” (Table 2). health problems and for hypothetical friendship probFor each area of concern (health, family, etc.) and for lems. This difference in the friendship domain may be each type of problem (actual or hypothetical), the per- due in part to the large number of women who, in recentage of responses falling into each broad category of sponse to an actual problem, reported they had no probcoping was determined (Table 3 ) . lems, and may reflect lack of experience in dealing with Two findings emerge from these data. First, evidence issues in this area. Positive cognitive strategies were prevalent for actual again demonstrated different coping strategies for different concerns. Direct action responses were the most but not for hypothetical health problems. Finally, emofrequently reported for dealing with health (hypothetical tional expression was a strategy more prevalent in reonly), family, friendship, time management, and finan- sponse to hypothetical health and family problems, and cial problems. Passive cognitive responses and emo- for actual time management problems. This suggests Comparisons with Coping Strategies from Standard Inventories

TABLE 3. Coping Responses by Problem Domain and Type Coping Responses Direct Domain and Type

Action (%)

Passive Cognitive (%)

Positive

Emotional

Have no

Cognitive (%)

Expression (%)

Problems (%)

-

Health Actual ( n

=

*n

=

46)

38 72

17 7

43 I1

0 It

50

0 0

14

47

36 28

0

53)

25

-

40 49

10

53)

51

0 0

0 0

-

33)

60 I00

0 0

0 0

24 0

-

51

20

0

0

29

0

65

10

25

0

28

44

0

14

14

54)*

Hypothetical (n = Family Actual ( n = 44) Hypothetical (n = Friends Actual (n = 30) Hypothetical (n = Time management Actual (n = 38) Hypothetical (n = Finances Actual (n = 41) Self-concept Actual (n = 48) Depression Actual (n = 43)

the number of coping strategies identified. Subjects could identify more than one strategy.

0

50

16

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TABLE 4. Effects of Health and Coping Strategies on Depression Step 1

Step 2

Predictor

b

Beta

No. of problems

0.88

0.21

Diff ADLs Direct action Positive cognitive Passive cognitive

0.57

0.34*

Step 3 Beta

b

1.07

0.26 0.30*

0.5 1 - 1.10

-0.29*

0.26

0.02

Emotional expression R? change Total R’

0.19‘

0.19”

0.28*

b

1.07 0.58 - 1.07 0.10 1.11 -0.59

Beta 0.26 0.34” - 0.28

0.01 0.16 -

0.07 0.02 0.3(P

*P < 0.05.

that different responses were elicited when individuals were asked to respond to actual versus hypothetical problems. Coping Strategies and Mental Health

Whether or not the coping strategies spontaneously identified by this sample were related to mental health was also examined. Coping strategy scores were derived by computing the mean frequency across concerns of direct action, positive cognitive coping, passive cognitive coping, and emotional expression for each subject. Hierarchic multiple regression analyses were used to determine the effect of physical health and coping strategies on depression. The number of health problems and difficulty with ADLs were entered first in the regression, direct action and positive cognitive coping were entered second, and passive cognitive and emotional expression third. The rationale for this grouping was that the strategies within each group were closely related conceptually. Strategies were entered in steps because the small number of subjects limited the number of variables that could be used. The regressions were repeated with the order of entry of the strategies reversed, with no change in the results. After controlling for physical health status, direct action and positive coping strategies contributed an additional significant 19% to the explained variance in depression. The total R2 was 28%. Direct action coping was the only significant predictor and was negatively related to depression (beta = -0.29). The addition of passive strategies did not improve the prediction (Table 4). DISCUSSION

These results suggest some important avenues to explore in understanding how elderly women cope. Health was the major concern of these women, both in terms

of themselves and others, such as spouses, parents, or adult children. Thus, the concerns nurses have shown for both the physical health status and caregiving responsibilities of elderly women are given credence, and the primacy given to health concerns in prior research is supported. The other concerns and problems women noted may also be related to these two major areas of concern. Difficulties with household management and activity limitations might be due to chronic illnesses o r the demands placed on their time by caregiving responsibilities. These minor concerns might function as “daily hassles,’’ with deleterious effects on physical and emotional health (DeLongis, Coyne, & Dakof, 1982), but they also can be addressed with appropriate assessment, intervention, and support services. The open-ended assessment underscored the relevance of prior conceptual formulations. That is, the lay views of coping fit the categories prominent in prior research (direct action, positive cognitive, passive cognitive, emotional expression). When coping strategies were assessed in an open-ended interview encompassing a broad domain of problems, active strategies were more prevalent than was reported in many studies in elderly populations (Lazarus & DeLongis, 1983; McCrae, 1982, 1984). Of special interest is the finding that, in response to health problems, active and positive strategies were the most frequently mentioned. This stands in contrast to previous research reporting that the elderly use more passive strategies because of the chronic nature of their illnesses (Felton & Revenson, 1987; McCrae, 1984). Nurses thus should not assume that elderly women are not capable of planning and carrying out active health-promotion or illness-management activities. Furthermore, since direct action strategies were associated with lower levels of depression, research aimed at testing the efficacy of teaching or promoting direct action and positive cognitive coping strategies should be encouraged.

Heidrich and Ryff How Elderly Women Cope 207

Also of interest was the absence of positive or active REFERENCES strategies and the prevalence of passive or emotional strategies for coping with depression or other negative Aldwin, C. M., & Revenson, T. A. (1987). Does coping help? A reexamination of the relation between coping and mental feelings about oneself. Most often, these women tried health. Journal of Personality and Social Psychology, 53, to ignore the difficulty or they “couldn’t cope.” This 337-348. underscores the need for research into the assessment Billings, A. G., & Moos, R. H. (1984). Coping, stress, and of mental health problems of aging women and intervensocial resources among adults with unipolar depression. tions aimed at the particular needs of this population. Journal of Personality and Social Psychology, 46, 877Educating them about how to use positive cognitive 891. strategies or active approaches to solving intrapsychic Blazer, D. G. (1980). The epidemiology of mental illness in later life. In E. W. Busse & D. G. Blazer (Eds.), Handbook problems is one potential approach. ojgeriatric psychiatry (pp. 249-271). New York: Van NosIt should be noted that a number of women, in every trand Reinhold. domain except health and self-concept, reported that Cornelius, S. W., & Caspi, A. (1987). Everyday problem solvthey had no problems. Ryff (1989), in open-ended intering in adulthood and old age. Psychology and Aging, 2, views about personal development, found a similar pat144-1 53. tern in elderly men and women. This points to the need Costa, P. T., & McCrae, R. R. (1990). Personality, stress, and to examine individual differences in coping among the coping: Some lessons from a decade of research. In K. S. elderly. An appreciation of such differences may be esMarkides & C. L. Cooper (Eds.), Aging, stress and health pecially helpful in combating negative stereotypes of ag(pp. 269-285). New York: Wiley. ing held by both health professionals and the elderly DeLongis, A., Coyne, J. C., & Dakof, G., (1982). Relationthemselves. ship of daily hassles, uplifts, and major life events to health status. Health Psychology, I , 119-136. The findings from the comparisons of hypothetical versus real-life problems suggest that caution is neces- Denney, N. W. (1990). Adult age differences in traditional and practical problem solving. In E. A. Lovelace (Ed.), sary in formulating research approaches to investigating Aging and cognition: Mental processes, selfawareness problem solving versus coping. Different types of quesand interventions (pp. 329-349). Amsterdam: Elsevier tions elicit different responses regarding coping strateNorth-Holland. gies. Although the interview questions for both hypo- Denney, N . W., Pearce, K. A., & Palmer, A. M. (1982). A thetical and actual problems were framed to elicit a developmental study of adults’ performance on traditional problem-focused approach, hypothetical problems genand practical problem-solving tasks. 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How elderly women cope: concerns and strategies.

Forty-two elderly women were asked to describe the problems they faced with aging, and how they coped with both real-life and hypothetical problems in...
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