Demographic trends of the last decades show that, due to increasing life expectancies, for the first time in Mexican history, family members of four different generations are interacting with each other for a considerable length of time before the oldest family members pass away (CONEVAL 2018; CONAPO 2006). These changes in life expectancy and in generational interaction mean that it is of increasing importance for researchers to identify the relevant variables that positively contribute to good and healthy aging. It is not enough to be able to live longer, as older adults must also have access to a high quality of life, both in physical and in psychosocial terms.
One way to ensure that this occurs is to identify the factors that mitigate feelings of depression that are likely to occur in aging populations and then to target these factors in policy programs. Indeed, depression is now considered one of the main mental health disorders based on worldwide data and indicators (World Health Organization 2018), and it is equally likely to affect both younger and older adults. Some theoretical frameworks in psychology have tried to explain the main factors that are specifically linked to depression among older adults. For instance, according to Erickson (1985), depressive episodes occur more frequently in the last stages of life given that older adults have to cope with their aging process, loneliness, and their proximity to death. For older adults, finding meaning in life in their advanced age, as well as dealing with episodes of loneliness while moving naturally to death, is part of a continuous challenge. The components of such struggles at the end of life and the resources to face them tend to occur in diverse systems of social interaction, such as the family, the local community, and the social, cultural, and normative context.
Bronfenbrenner’s perspective (1977, 1986) is useful in understanding the aging process, as it takes into account these different social systems and contexts. Bronfenbrenner’s theory (1986) emphasizes the progressive transactions and adjustments that occur in human development, placing them within an environment in constant change until the end of their lives. The environment is not only the immediate context surrounding the individual, as it also encompasses the social context in which people develop and interact in their everyday lives.
Bronfenbrenner (1977) defined the term “system” as the changing interaction between the subject and the environment in which he develops; there are five hierarchical ecological systems that are distinguished from one another based on the proximity and immediate influence that they have on the individual: the microsystem, the mesosystem, the exosystem, the macrosystem, and the chronosystem. Of the five ecological systems, in this study, we emphasize the interactions that occur at the microsystem level, given this system’s direct impact on the psychosocial functioning of older adults; in this regard, the microsystem refers to the reciprocal interactions between the individual and his or her most immediate environment.
Although Bronfenbrenner’s theory emphasizes childhood, it is possible to consider its relevance to understand other stages of development, such as advanced age. For instance, the microsystem may involve the direct and reciprocal social interactions between an older adult and his or her primary caregivers at home or in a nursing home. These interactions will have an impact on the perception of family and social support, loneliness, and stress of the older adult. In fact, prior research has confirmed that the frequency and quality of micro-level interactions that older adults establish with others in their physical and social environments have an impact on their mental health and emotional well-being (Bekhet and Zauszniewski 2012).
Thus, it becomes relevant that social researchers continue to inquire about the elements in the different hierarchies of the socio-ecological environment that are relevant for the promotion of the well-being and quality of life of older adults. The goal of this paper is to consider the factors that relate to mental health in older adults by specifically asking how micro-level interactions might contribute to or attenuate the perception of loneliness and stress in an aging population.
Variables linked to mental health in older adults
Loneliness
Loneliness is considered an essentially subjective and potentially stressful phenomenon produced from either real or perceived affective deficiencies (Montero-López Lena 1999). It should be noted that although physical isolation is associated with loneliness, they are not the same phenomena. Insofar as isolation has a physical correlate, loneliness is an essentially subjective experience (Montero-López Lena and Sánchez-Sosa 2001). In Mexico, the study of loneliness is relatively new; only recently has it been recognized that loneliness is a phenomenon that may impact the mental health of those who experience it (Montero-López Lena 2016b). At the end of 2017, it was reported that approximately 43% of older adults in Mexico City were living in conditions of isolation and vulnerability (INEGI 2018).
With regard to psychological research on loneliness in Mexico, Montero-López Lena (2003) analyzed the objective and subjective meaning that adolescents and adults give to the concept of “loneliness.” The results of this study indicate that loneliness was frequently defined as an unpleasant experience. It was also found, however, that as people get older, they tend to apply positive terms to loneliness: self-knowledge, tranquility, and transcendence, for example. These results suggest that there are both personal and contextual components that may shape the experience of loneliness as either something negative or positive. Research conducted in Mexico shows that there might be a link between loneliness and chronic conditions such as renal failure, diabetes, and hypertension among older adults (Rivera-Ledesma et al. 2012; Montero-López Lena 2018). Both women and men in the latter stages of their lives tend to perceive loneliness as a reaction to the perception of stress (Montero-López Lena and Díaz-Castillo 2017).
Consistently over the last few decades, sex differences have been noted in the frequency of the reported experience of loneliness in English-speaking countries (Borys and Pelman 1985; Lau et al. 1992). In Mexico, it has also been documented that women tend to cognitively link the meaning of loneliness with more semantic concepts (Montero-López Lena 1993), and they also tend to perceive experiences of loneliness more frequently as compared to men (Guevara and Montero-López Lena 1994).
Stress
The perception of stress is a psychological process associated with specific external and/or internal demands commonly evaluated as disproportionate given the cognitive, emotional, and behavioral resources available to the individual (Lazarus and Folkman 1986). The perception of stress among older adults is commonly considered an indicator of mental health. When older adults are embedded within a physical and social context that provides security and stability, these individuals tend to perceive lower stress in their environment; by contrast, this perception of stress increases when older adults feel vulnerable or at risk.
In this sense, Marshall et al. (2015) mention that frequent exposure to stressful situations can negatively affect the mental health of older adults, specifically obstructing their working memory. In a similar manner, Liu et al. (2016) reported that after older adults have lost their cognitive faculties, their satisfaction with life functions as a mediator between their perceived stress and the severity of their depression. The frequent experience of stress, regardless of its origin, may harm older adults’ social interactions with other people, especially their families (Cutrona et al. 1986).
Quality of family interaction
Family interaction is a psychosocial factor that tends to diminish the perception of stress. Bronfenbrenner (1986) documented how the quality of the microsystem linked to the family context constitutes a protective factor for the efficient development of the individual. This security in the family microsystem is particularly critical for the optimal functioning of older adults, due to the potential inverse relationship between the ability to adapt to the environment and the social dependence that humans have with their close relatives. In this way, positive family interaction is a protective factor for the emotional and mental health of older adults. If family interaction is inadequate, harm is done to the adaptive ability of older family members. By contrast, when family interaction is present and successfully provides older adults with a stable and protective environment, then the physical and psychological transition into the last phases of life will be less stressful, helping older adults to potentially live in a more dignified way.
In this regard, prior research has documented that family interaction is an important factor in the prediction of the experience of loneliness among older adults in Mexico (Montero-López Lena 2016a). Similarly, Marin and Huber (2011) reported that older adults’ perceptions of their own families operated as a protective factor against self-reported anxiety. Overall, family interaction in combination with social support may enhance the ability of older adults to adapt to their environment, thus acting as a protective factor of their mental health.
The quality of family and social interactions is a relevant factor that may either intensify or alleviate the experience of loneliness and stress in older adults (Cutrona et al. 1986; Krause 1987). Therefore, it is reasonable to assume that the social support perceived by older adults is essential in the promotion of their mental health.
Social support
Social support is regarded as a multidimensional construct that has two basic components: a structural component that refers to the extension of social networks and a functional or expressive component that represents the type of support received. Meanwhile, social support can either be emotional, when an individual receives encouragement from friends or family during a life crisis; instrumental, when he or she receives physical assistance in accomplishing a specific task; or informative, when he or she receives expert advice on a particular topic. According to Da Silva Pedro et al. (2008), social support is understood as any type of systematic support offered by groups of people that has positive effects on the recipient.
Former research focused on social support among older adults has shown that insufficient social networks during the later stages of life may lead to higher disability and mortality rates (Andrew et al. 2008; Holt-Lunstad et al. 2010).
Public policies for older adults in Mexico
Although psychological variables contribute to the well-being of older adults, the context in which they develop and socially interact may promote or reduce mental health. In this regard, it is reasonable that public policies function at different social levels as tools to regulate and promote the well-being of the populace. Specifically, most of the public policies for the care of older adults that have been implemented in Mexico have been adopted from abroad, with mixed efficiency in their implementation and results.
In terms of public policies for the care of older adults, the United Nations has been analyzing the state of the aging process across countries worldwide (United Nations 2016). Since 1982, the year that the First World Assembly on aging was held, the assembled countries solemnly reaffirmed their conviction that the fundamental rights enshrined in the Universal Declaration of Human Rights must be fully applied to older adults. Consequently, public policy is required to consider older adults as an integral part of society who may enjoy, within their families and communities, a full, healthy, safe, and satisfying life.
On December 16, 1991, the United Nations Principles for Older Persons were adopted, and governments were encouraged to incorporate these principles into their national programs in order to establish conditions that protect and respect older adults (United Nations 2016). Among the actions to be promoted by these principles, five stood out: (1) independence, emphasizing the providing of older adults with greater access to adequate education and training programs, food, water, housing, clothing, and safe environments, as well as allowing them to reside at home (when possible); (2) participation, calling for older adults to remain integrated in society via their participation in the formulation and application of public policies that affect their well-being, as well as their ability to share knowledge with younger generations; (3) care, focusing on the care and protection of older people on behalf of their families and communities, including access to health, social, legal, protection, and rehabilitation services; (4) self-realization, aiming at the promotion of opportunities for the full development of older adults, including access to educational, cultural, spiritual, and recreational resources; and (5) dignity, an action implying that older people have the right to live with security and dignity, free from exploitation, physical and mental abuse, and that they must receive dignified treatment regardless of age, sex, race, disability, or economic condition.
Regarding public policies focused on mental health, it is also relevant to emphasize the role of public policies aimed at supporting older adults. These policies taken from abroad have been designed and implemented in an inconsistent manner in Mexico. The first government policies concerned with the care of older adults date from 1979, when the National Institute of the Elderly (INSEN) was created. This institute was renamed as the National Institute for Older Adults (INAPAM) in 2002. This institute serves Mexican adults over 60 years old nationwide, coordinating public policies regarding social and human development and aimed at producing changes in society to enhance the support, care, and respect for older people.
Specifically, Mexico City’s Institute for the Care of the Elderly (IAAM 2017) was created in 2017. Its purpose is to support the well-being of older adults and to promote social awareness on topics related to the aging process. This institute aims to encourage a change in attitudes within the general population, such a move towards considering older people as socially active citizens and framing the aging process as a normal part of the life cycle.
Current government support programs for older adults in Mexico, however, are narrow in their scope and objectives. For instance, assistance initiatives consisting of cash payouts to older adults equivalent to $67.00 USD per month are insufficient to cover the health expenses that older people face (Secretaria de Bienestar 2019).
Healthcare is also a common challenge faced by older adults in Mexico. Citizens affiliated with one of the two main health institutions, the geriatric care units run by ISSSTE (2002) and the Center of Social Care for the Health of Older Adults run by IMSS (2012), benefit from support programs focused on physical activity and recreation. The coverage of these programs for older people, however, is still limited. Current challenges in public health policies for older adults involve the planning and implementation of comprehensive health interventions tailored for different social groups, as well as mechanisms to provide healthcare for older people not supported by either ISSSTE or IMSS. In this regard, programs that seek to promote dignified aging must identify the particularities of this developmental process both in terms of the psychosocial characteristics of the aging population as well as their sociocultural contexts.
The development and improvement of public policies for older adults require the collaborative work of experts from different areas of expertise, as well as advancements in knowledge that may guide current efforts towards evidence-based interventions. In congruence with these ideas, this study proposes the empirical verification of a multidimensional model that accounts for variables linked to mental health among older adults. Based on a theoretical background, research on loneliness is gaining relevance due to its impact on mental health. Still, it is important to understand the impact that loneliness may have on additional psychosocial variables such as the perception of stress, family interaction, and social support. Thus, the empirical corroboration of a descriptive model that identifies the direction and magnitude of the relationships among these variables is the main objective of this study.