Study Shows Stress May Increase the Risk of Peripheral Artery Disease
- Christopher Leonard, DO, MHI
- May 28, 2020
Study Shows Job-Related Stress May Increase the Risk of Peripheral Artery Disease (PAD)
Peripheral artery disease (PAD) is a cardiovascular condition. In 2010, it affected 202 million people around the world. By 2015, the number had risen to 236.62 million people. PAD can affect anyone over the age of 25 and is a serious public health problem. The condition is caused by narrowing of the peripheral arteries as a result of fatty plaque, called atherosclerosis. Peripheral arteries are located away from the heart, such as in the legs, arms, stomach or head. More commonly, PAD is seen in the lower extremities.
The classic symptom of PAD is intermittent claudication. This is pain in the legs a person experiences with physical activity, which usually gets better after resting. However, asymptomatic PAD is several times more common than disease with intermittent claudication. This is usually discovered with non-invasive test measures, such as the ankle-brachial index.
Epidemiological studies show the prevalence and incidence rise sharply with age. Since the aging population is rapidly growing as the last of the Baby Boomer generation reaches 65 by 2030, it’s reasonable to expect an increasing number of people may suffer from PAD.
Other symptoms of PAD include wounds that don’t heal, poor nail or hair growth on the extremity, or an extremity that is cooler to the touch than the other extremities. People may not seek medical attention, or complain of these symptoms, as some mistaken them for stiffness associated with age, or the pain associated with arthritis.
People who have PAD have a higher risk of coronary artery disease (CAD). The known risk factors for PAD and CAD include diabetes, hypertension, older age, smoking and high cholesterol. If the condition is left untreated, it can lead to poor healing wounds, gangrene and ultimately amputation.
Data Show People Who Experience Low Levels of Personal Control May Have Increased Risk of PAD
A new review of the literature published in the Journal of the American Heart Association found a link between job stress and the diagnosis and hospitalization for PAD. The researchers used data from 11 cohort studies in four countries. This included 139,000 men and women who had no previous history of PAD when the studies began.
The average follow-up in each study was 12.8 years. When the researchers evaluated the hospital records, they found a link between work-related stress and a history of PAD. Those who stated they experienced stress at work were 1.4 times more likely to be diagnosed with PAD.
Measurements of stress were based on statements used to describe the psychosocial aspects of their job, which can be associated with a disconnect between high expectations and lower levels of personal control. Work-related stress has also been linked to other forms of atherosclerotic conditions, such as coronary artery disease, heart attack and stroke.
Older Adults in Communities and Long-Term Care Facilities at Risk for Stress
Older adults living in communities or long-term care facilities may be at risk for stress, loneliness and depression that also stems from a lack of personal control. While researchers investigating the link between stress and PAD focused on those who experienced work-related stress, a lack of personal control and unreasonable expectations are not unique to the workplace.
Older adults experience loss, isolation and declining health, which are pertinent factors in the development of stress and depression. A study from the University of California at San Francisco found older adults do not have to live alone to feel lonely, and residents in long-term care facilities can feel lonely with people around them.
It is not uncommon for nursing home residents to be at risk for depression. Some data show as many as half of those living in a long-term care facility have symptoms of depression, which also increases the experience of stress and a lack of personal control. The contributing factors include loss of loved ones, isolation, declining physical health and poor mobility.
Chronic pain can also increase symptoms of depression and anxiety. One study found newly admitted long-term care residents have a high incidence of a triad of symptoms at admission: pain, depression and anxiety. Stress and depression have a direct effect on disrupting healthy coping strategies and producing additional mood symptoms, which further increase the experience of stress.
Older adults may also experience a lack of respect, which is common in many Western cultures as people age. This is an added stressor for those who may have once held positions of authority and respect in their community.
Watch For Signs of Stress in Your Patients
It’s important to watch for signs of stress in older adults. These may have emotional, physical or behavioral symptoms. The human body is designed to function under some stress, as it keeps people alert and out of danger. However, chronic stress has negative health consequences, only one of which is an increased risk of atherosclerosis leading to CAD and PAD.
Symptoms of stress may present differently in those who are cognitively impaired or nonverbal. Some elderly may experience different responses to stress related to a reduced resilience and poor coping mechanisms. Common signs of stress in the elderly include but are not limited to:
Physical | Emotional | Behavioral |
Nightmares Loss of appetite Insomnia Weight changes Frequent urination Muscle pain Fatigue and exhaustion Stomach/head/chest pains Indigestion Diarrhea | Anxiety Fear Frustration Depression Irritable Moody | Poor concentration Forgetfulness Restlessness Feeling pressured or rushed |
How to Help Seniors Reduce Stress
Since asymptomatic PAD may be more common than those who present with intermittent claudication, it may be wise to help all older adults reduce their stress levels to lower the risk of poor wound healing. Interventions to help seniors reduce stress will depend on their cognitive ability. For instance, for those who are cognitively impaired or nonverbal, music has been successfully and widely used.
One literature review found those with Alzheimer’s disease who were given an individualized music program had the best results. The researchers found passive listening helped the individuals to relax. Using active music therapy improved the participants social interactions and cognition, while reducing behavioral symptoms. These improvements demonstrated a reduction in depression and stress that the participants experienced and the potential to lower the risk of vascular changes that may lead to ulceration.
Depending on the level of cognitive impairment, older adults also respond to many of the same interventions that help healthcare professionals reduce their stress levels. These include:
Exercise: Movement and exercise are significant mood boosters. Older adults often spend hours sitting and sleeping. Encourage movement every hour if possible. If they are able to walk or exercise, even small amounts or short distances help, especially when it can be outside in a green space.
Relaxation Techniques: Activities that may help seniors relax include meditation, deep breathing, visualization and progressive muscle relaxation.
Social Interaction: Too often, older adults suffer from loneliness, whether they are alone or are living in a group situation. Engaging in structured social activities can sometimes offer people a chance to engage with each other in ways they would not have initiated on their own.
Sleep: Poor quality sleep reduces a person’s resilience and ability to cope with stress. It is not always the number of hours a person is sleeping, but rather the quality of sleep.
Nutrition: Poor nutrition can reduce the body’s ability to withstand emotional and mental stressors and contributes to poor healing.
Meaningful Work: People do best when they engage in meaningful activity and feel as if they are productive. Even in a long-term care facility, older adults who are capable can contribute to society. Some examples include reading to other residents, making caps or blankets for babies in the NICU or planning structured social activities for the residents.
Talking: Communicating concerns with a compassionate and understanding individual helps people to know they aren’t living in isolation and there are others who care about their situation.
Not all wound healing interventions occur at a wound site. Healthcare professionals can also help reduce the risk of poor healing wounds by addressing the emotional and mental health of their patients.
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