The contribution of resilience to healthy ageing

Gill Windle from the Dementia Services Development Centre at Bangor University looks at the role of resilience in healthy ageing Global demographic changes in the ageing population have made healthy ageing policy an international priority.i Policymakers recognise that healthy, independent, and active ageing can enhance individual lives, negate the social and economic implications of an ageing population, and potentially reduce public spending on services. More recently, interest has been placed on the importance of good mental health, wellbeing and the role of resilience.2,3,4 Resilience certainly seems to be a 'buzz' word at the moment. Although resilience research can be traced back at least five decades (see Luthar5 for review), a large proportion of this work is derived from the discipline of developmental psychology, and has mainly been undertaken with children and adolescents. Far less is known about the determinants of resilience in adulthood and later life, especially when faced with a prolonged and significant exposure to an adversity, such as chronic illness. What is resilience? Resilience is the process of negotiating, managing and adapting to significant sources of stress or trauma. Figure 1 gives an example of a resilience framework, and demonstrates how assets and resources within the individual, their life and environment facilitate this capacity for adaptation and 'bouncing back' in the face of adversity.6 This definition acknowledges key features of resilience; the encounter with adversity (e.g. ill-health); the ability to resist and adapt to the adversity (drawing on resources); and the avoidance of a negative outcome, or the maintenance of mental health. An important thing to grasp is that resilience is not necessarily about superior functioning or flourishing, it is about doing okay, or better than could be expected, given the individual circumstances. In many instances the risk or adversity is not an isolated event that the person is able to actively change. For example, a common adversity in studies of resilient children and adolescents is poverty and deprivation. From a life course perspective poverty and deprivation can persist. However, as adults develop there are a number of other adverse occurrences that create irreversible losses, such as bereavement of friends and relatives, unemployment, and the onset of physical ill-health or the diagnosis of Alzheimer's disease. How can resilience be promoted? In general, human beings (along with families and communities) have the capacity to respond well to adversity, but not everyone develops the abilities to do so.7 Resilience is not necessarily a rare occurrence, at least not in children, and has been described as 'ordinary magic'. 8 So how can resilience be promoted? As part of the work programme of the Resilience and Healthy Ageing Network1 a scoping review of resilience interventions found very few peer reviewed publications of interventions that promote resilience in relation to health outcomes (mental and physical), especially in relation to older people. The lack of identified peer-reviewed papers reflects the results of an earlier review of children and adolescent resilience.9 They note: 'the literature on resilience promotion, while empirically based, includes relatively few accounts of conscious and specific strategies used to promote resilience, and fewer still that have been subject to a robust evaluation using controlled trials'. It would appear there is a need for further development and refinement of interventions to promote resilience, especially within later life, and within the UK the Medical Research Council's Lifelong Health and Well-Being Programme recently funded research with resilience as a key area. However given the current lack of evidence for the direct promotion of resilience, what can interested practitioners do? Qualitative research from Canada suggests people/organizations may be already engaged in delivering services that promote resilience, but not necessarily aware that they are doing so. …