Allostatic load: a useful concept for advancing nursing research.
OBJECTIVE
To elucidate the historical development of the allostatic load concept, alongside its use in nursing research, and to explore how allostatic load has been investigated among two stress-vulnerable populations.


BACKGROUND
'Stress' is a prominent term in understanding the development of disease. Allostatic load is among several approaches undertaken to quantify the magnitude of stress and understand how stress can affect health.


METHODS
We explored the advent of allostatic load including its antecedents, and consequences. We used an exemplar case to apply the concept. We reviewed studies that used allostatic load among workers and women of childbearing age.


RESULTS
There remains a need to consolidate a common definition and operationalisation of allostatic load. Despite this need for further work, allostatic load is a good fit for nursing science which focuses on the client, environment and health. Only 12 studies explored allostatic load among workers (n = 6) and women of childbearing age (n = 6). In some studies, allostatic load was used as a predictor while in others it was used as an outcome. None of the studies considered it as a mediator.


CONCLUSIONS
The concept of allostatic load holds promise for nursing researchers to operationalise a holistic view of multiple stressors and to quantify their effects on health. Studies are needed to affirm the role of allostatic load as a potential mediator between multiple stressors and outcomes. Longitudinal studies are also needed to demonstrate a causal pathway from stressor exposure to tertiary outcomes such as chronic conditions and morbidity.


CONCLUSIONS
Allostatic load is a useful concept for nurses working with stress-vulnerable populations. With the use of an interpretable allostatic load index, nurses will be able to intervene at various stages of the allostasis-adaptation process (stress-response) and adjust interventions accordingly.
Department of Systems, Populations and Leadership, University of Michigan, School of Nursing, Ann Arbor, MI, USA.
Marie-Anne S
http://orcid.org/0000-0003-0536-2062
MS
Rosemberg
School of Nursing, University of Michigan, Ann Arbor, MI, USA.
Yang
Y
Li
Department of Systems, Populations and Leadership, University of Michigan, School of Nursing, Ann Arbor, MI, USA.
Julia
J
Seng
D000222:Adaptation, Physiological / Q000502:physiology*; D052636:Allostasis / Q000502:physiology*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015399:Nursing Research; D013315:Stress, Psychological / Q000451:nursing*
allostatic load; biomarkers; concept analysis; nursing research; stress; vulnerable populations; women of childbearing age; workers