Resumen de Estructura de pérdidas en la adultez mayor: una propuesta de medida

Amando Rivera Ledesma, María Montero López-Lena

• español

  La estructura de pérdidas puede ser definida como el conjunto de objetos significativos (susceptibles de ser agrupados en diferentes clases de pérdidas), percibidos bajo amenaza de ser perdidos, efectivamente perdidos, o cuya pertenencia es insegura o ambigua (concebibles como tipos de pérdidas), en una etapa determinada de la vida, y cuya influencia define cogniciones, afectos y conductas ante ella. La estructura de pérdidas presente en la adultez mayor, sin precedente en la vida del sujeto, podría definir diferentes rutas de desajuste. La Escala de Estructura de Pérdidas (EEP) propuesta aquí, es un instrumento cuyo propósito es permitir la exploración de las pérdidas que suelen ocurrir en la adultez mayor. La EEP permite la exploración sistemática de un abanico de pérdidas previamente validadas en un contexto latinoamericano, mexicano, como una primera aproximación a las posibles causas psicosociales del desajuste psicológico en la adultez mayor.

  La EEP propuesta aquí, obtuvo una estructura factorial compuesta de nueve factores bien definidos que en conjunto incluyeron 36 reactivos, con una consistencia interna alfa de .91 que explicó 67.4% de la varianza. La consistencia interna de los nueve factores fluctuó entre valores alfa de .74 y .83.

  Además, se obtuvieron correlaciones moderadamente altas entre el total del puntaje de la EEP con todas las variables de desajuste psicológico (entre r = .50 y r = .66; p<.01), excepto con la ansiedad ante el envejecimiento. Así, se encontró una asociación negativa entre la frecuencia de no pérdidas y dichas variables, destacando la depresión (r = –.70, p<.01) y la soledad (r = –.68, p<.01). La frecuencia de pérdidas ambiguas se correlacionó positivamente con Depresión (r=.54, p<.01), Soledad (r = .47, p<.01), Ansiedad (r = .42, p<.01) y Ansiedad ante el envejecimiento (r = .40, p<.01). La frecuencia de pérdidas consumadas se correlacionó de manera importante con soledad (r=.53, p<.01), depresión (r = .50, p<.01) y enfermedad percibida (r = .47, p<.01).

  La escala fue útil para discriminar sujetos con altos y bajos niveles de desajuste psicológico. Adicionalmente, se incluyeron valores normalizados de los distintos puntajes de la Escala de Estructura de Pérdidas.

  Asimismo, la EEP permitió definir teóricamente, a partir de la evidencia empírica reportada aquí, la existencia de una estructura multivariable de pérdidas, con efectos estresores para el adulto mayor, íntimamente ligada al desajuste psicológico y que puede variar de sujeto a sujeto. Esta es una aportación útil al conocimiento empírico de la vejez en nuestro país, y a la investigación en psicología de la salud, porque permite evaluar el impacto de las pérdidas en modelos de exploración de los efectos del estrés en adultos mayores.

  El constructo de Estructura de Pérdidas, desarrollado para esta investigación, fue resultado del análisis de la experiencia generada por las pérdidas sufridas en la adultez mayor. El viejo se enfrenta a pérdidas (a una estructura de pérdidas) que de manera acumulada exigirá de él un reajuste constante a sus condiciones de vida. Por lo tanto, las nueve áreas resultantes de la Escala de Estructura de Pérdidas pretenden cubrir un amplio espectro de las posibles pérdidas susceptibles de ocurrir en la adultez mayor.

• English

  The term "loss" in this article refers to the lack of a significant adaptive resource that is a central part of the affective world of the subject. The absence of such resource can generate psychological distress. Old age is seen as a time in which numerous changes occur that are associated with losses in important areas of life and which, as a whole, constitute a major source of stress. These losses involve a series of physical, social and psychological changes that affect and define old age and that require the subject to develop a process of adaptation to many intense stressors. Loss structure can be defined as a set of significant objects (that can be grouped under different loss categories), perceived as being under threat of being lost, effectively lost, or whose existence is uncertain or ambiguous (conceived of as types of loss), and whose influence continues to define cognitions, affection and behaviors. The unprecedented loss structure found in elderly adults could set up different routes of maladjustment. Maladjustment appear in three fundamental areas: psychological, physical and social. Hence, frustration can lead to depression. Successive losses seen as a series of failures can generate feelings of despair; losses related to sources of affection can produce loneliness, etc. The Loss Structure Scale (LSS), proposed here is an instrument for exploring losses that usually occur in old age. It also allows a systematic exploration of a wide range of losses previously validated in the Mexican context as a first approach to possible psychosocial causes of psychological maladjustment in old age.

  Method The project was divided into two phases. The first corresponded to the design of the LSS, and the second to a psychometric evaluation. Four samples were used with subjects chosen by availability in Mexico City. One model of the scale was explored that consisted of 60 items linked to experiences of loss with three reply options for each item: No loss, Ambiguous loss, and Definite loss in a final sample of 193 subjects (69.34% women, N = 134). The following instruments were used: The Center of Epidemiological Studies Depression Scale; Beck's Anxiety Inventory; Hunter Opinions and Personal Expectations Scale; the perceived disease subscale of WHOQoL– Brief; The World Health Organization Quality of Life Assessment, Brief; the Lack of Emotional Wellbeing subscale of the Multifaceted Loneliness Inventory and the Anxiety About Aging Scale.

  Results Factor structure. A factor analysis was carried out using the principal components method with varimax rotation and eigen values greater than one. The final factor structure showed nine well defined factors covering 36 items with an internal alpha consistence of .91 explaining 67.4% of the variance. Alpha values for the internal consistence of the 9 factors fluctuated between .74 and .83.

  Construct validity. 1) Moderately high correlations were obtained between total score on the Loss Structure Scale and all psychological maladjustment variables (between r=.50 and r = .66; p<.01), with the exception of aging anxiety, which seems to point to the important pathogenic role of losses suffered in most of the maladjustment variables, 2) a negative association was found between the frequency of no losses and the afore mentioned variables, with depression (r = –.70, p<.01) and loneliness (r = –.68, p<.01), 3) ambiguous loss frequency correlated positively with depression (r=.54, p<.01), loneliness (r = .47, p<.01), anxiety (r = .42, p<.01) and aging anxiety (r = .40, p< .01), 4) the frequency of definite losses correlated strongly with loneliness (r = .53, p<.01), depression (r = .50, p<.01) and perceived disease (r=.47, p<.01).

  Predictive ability. In order to determine the degree to which the loss categories can predict psychological maladjustment, a multiple regression analysis was carried out taking these categories as independent variables. The better predicted variables were depression (R2adjusted=.487, gl=9, F = 21.22, p<.000), perceived disease (R2adjusted =.443, gl=9, F = 17.97, p<.000), loneliness (R2adjusted = .423, gl=9, F = 16.62, p<.000), anxiety (R2adjusted =.347, gl=9, F=12.33, p<.000) and despair (R2adjusted =.311, gl = 9, F=10.61, p<.000).

  Discriminant validity. The scale's ability to discriminate subjects with high and low levels of psychological maladjustment was analyzed. The scale proved to be useful for significantly discriminating the subjects in each type of loss in each maladjustment category.

  Normalization. Standard deviation ranges were calculated for the total natural scores on the LSS. Subjects with a natural score equal to or greater than 66, could be considered as having a higher loss structure than the majority of elderly adults that could, very well, be associated with high levels of psychological maladjustment.

  In regard to the empirical evidence reported here, the LSS provide a theoretical definition of a multivariable loss structure with stressor effects for the elderly adult that is closely linked to psychological maladjustment and can vary from subject to subject. This is a useful contribution to empirical knowledge of old age in Mexico and to research about health psychology, because it could contribute to evaluate the impact of losses in models that explore the effects of stress in elderly adults.

  The Loss Structure construct developed for the purpose of this research was the result of an analysis of the experience generated by losses suffered in old age. Elderly persons have to face losses which, as they accumulate, will demand constant readjustment of life conditions. The nine areas resulting from the Loss Structure Scale attempt to cover a broad spectrum of possible losses that can occur in old age.