CLINICAL ISSUES Stress and coping in older people with Alzheimer’s disease Juliana Nery de Souza-Talarico, Eliane Corre ˆa Chaves, Ricardo Nitrini and Paulo Caramelli Aim. To investigate stress intensity and coping style in older people with mild Alzheimer’s disease. Background. The potential risk assessment of a stress event and the devising of coping strategies are dependent on cognitive function. Although older individuals with Alzheimer’s disease present significant cognitive impairment, little is known about how these individuals experience stress events and select coping strategies in stress situations. Design. Survey. Method. A convenient sample of 30 cognitively healthy older people and 30 individuals with mild Alzheimer’s disease were given an assessment battery of stress indicators (Symptom Stress List, Cornell Scale for Depression in Dementia, State-Trait Anxiety Inventory), coping style (Jalowiec Coping Scale) and cognitive performance (mini-mental state exam) were applied in both groups. Statistical analysis of the data employed the Mann–Whitney test to compare medians of stress indicators and coping style, Fischer’s exact test to compare proportions when expected frequencies were lower than five, and Spearman’s correlation coefficient to verify correlation between coping style and cognitive performance. Results. Both groups suffered from the same stress intensity (p =0Æ254). Regarding coping styles, although differences were not statistically significant (p =0Æ124), emotion-oriented coping was predominant in the patients with Alzheimer’s disease. How- ever, those individuals displaying better cognitive performance in the Alzheimer’s disease group had selected coping strategies focused on problem solving (p =0Æ0074). Conclusions. Despite a tendency for older people with Alzheimer’s disease to select escape strategies and emotional control, rather than attempting to resolve or lesser the consequences arising from a problem, coping ultimately depends on cognitive performance of the individual. Relevance to clinical practice. The findings of this study provide information and data to assist planning of appropriate support care for individuals with Alzheimer’s disease who experience stress situations, based on their cognitive performance. Key words: cognition, coping, dementia, older people, nursing, stress Accepted for publication: 19 May 2008 Introduction The neurodegenerative process of Alzheimer’s disease (AD) is characterised by diverse cognitive and functional alterations expressed as progressive changes in affection, behaviour and independence of older individuals, leading to impairment in performing daily life activities (Dawbarn & Allen 1995, Mesulam 2000 ). In AD subjects, these daily life changes resulting from cognitive impairment eventually become a threat to biopsychosocial equilibrium, thus constituting a Authors: Juliana Nery de Souza-Talarico, BSN, MS, Doctorate Student, Department of Medical-Surgical Nursing, School of Nursing, University of Sa ˜o Paulo, Sa ˜ o Paulo, Brazil; Eliane Corre ˆa Chaves, BSN, MS, PhD, Associate Professor, Department of Medical- Surgical Nursing, School of Nursing, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil; Ricardo Nitrini, MD, PhD, Associate Professor, Department of Neurology, Faculty of Medicine, University of Sa ˜o Paulo, Sa ˜ o Paulo, Brazil; Paulo Caramelli, MD, PhD, Associate Professor, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil Correspondence: Paulo Caramelli, MD, PhD, Federal University of Minas Gerais, Av. Alfredo Belena, 190-2° andar-sala 246, Belo Horizonte, MG, Brazil, 30130-100. Telephone: +55 31 34099745. E-mail: caramelp@usp.br Ó 2008 The Authors. Journal compilation Ó 2008 Blackwell Publishing Ltd, Journal of Clinical Nursing, 18, 457–465 457 doi: 10.1111/j.1365-2702.2008.02508.x