Editor's note: This work is the focus of a presentation on resilience-building interventions and aging at APA.
The global population is aging rapidly. Over the next 4 decades, the number of individuals 60 years and older will nearly triple to more than 2 billion in 2050. With the aging of the population, the burden and cost of chronic disease will escalate worldwide. To ensure healthy and successful aging and to reduce the cost of care, building resilience and wellbeing among the aging becomes a top priority for individuals, families, and society at large.
Resilience to stress is one of the factors that has had numerous meanings in prior research. But resilience generally refers to a pattern of functioning that indicates a positive adaptation in the context of adversity. People who are resilient display a greater capacity to quickly regain equilibrium physiologically and psychologically following stressful events, and are able to sustain it in the face of adversity.
In a broader sense, resilience refers to the ability to maintain biological and psychological homeostasis under stress. However, components of resilience may vary with context, time, age, gender, and cultural origin. The question remains whether a certain level of adversity or a threshold is required before resilience becomes a meaningful concept, or if resilience can be viewed as a dynamic process of adaptation to everyday challenges of growing old. The latter appears to be more useful in explaining longevity and successful aging.
A coherent pattern has emerged of individual characteristics associated with resilience and successful adaptation. Salient characteristics include commitment, dynamism, humor in the face of adversity, patience, optimism, faith, and altruism. There are emotional and cognitive aspects of resilience that can be innate or learned. The innate affective or emotional styles that are likely to influence resilience refer to the individual styles of affect regulation, which is usually a part of personality structure (eg, optimism or pessimism), or social intelligence.
Protective temperamental factors include sociability, intelligence, social competence, internal locus of control, warmth and closeness of affectional ties, and active emotional support within the family network or within religious groups. As such, resilience may represent an important target of treatment and prevention in anxiety, depression, and abnormal stress reactions in aging.
The question remains whether resilience can be operationalized for training and taught to older individuals coping with daily stress to boost resistence to stress and life’s adversities.
Can happiness be learned?
Therapeutic techniques that enhance psychological resilience may help overcome disability and improve quality of life. Several psychotherapeutic approaches have already demonstrated promise in building resilience, such as positive affect skill-building (eg, in cognitive behavioral or well-being therapy) in individuals with depression. Other approaches with documented success in building a positive attitude include gratitude, positive reappraisal, focusing on personal strengths and attainable goals, and altruism and volunteerism.
Successful stress-reduction and management in the vulnerable elderly can help prevent serious mental and physical illness. Integrated modalities to improve resilience and reduce stress in combination with pharmacotherapy and lifestyle changes are likely to improve the overall functioning and well-being of older adults.
Lifestyle changes can potentially improve resilience by providing better health and enhancing the sense of well-being. Large-scale epidemiological studies demonstrate a strong relationship between diet and inflammation and disorders such as depression or heart disease. Diets high in refined grains, processed meat, sugar, and saturated- and trans-fatty acids and low in fruits, vegetables, and whole grains promote inflammation.
High-fat meals can increase glucose levels and triglycerides, which stimulate production of IL-6 and CRP. In contrast, higher fruit and vegetable intake is associated with lower inflammation, which may counteract pro-inflammatory responses to high-saturated-fat meals. Therefore, improved nutritional intake is likely to have clinical benefit on health and wellbeing through anti-inflammatory pathways.
Exercise has also been shown to be important in maintaining well-being in older adults. Exercise intensity, duration, frequency, and other factors appear to play important roles in anti-aging outcomes, as does physical training. Human and other animal studies demonstrate that exercise targets many aspects of brain function and provides broad effects on overall brain health. The benefits of exercise have been best defined for learning and memory, protection from neurodegeneration, and alleviation of depression—particularly in elderly populations.
Exercise increases synaptic plasticity by directly affecting synaptic structure and potentiating synaptic strength, as well as by strengthening the underlying systems that support plasticity, including neurogenesis, metabolism, and vascular function. Such exercise-induced structural and functional change has been documented in various brain regions but has been best studied in the hippocampus.
Dr Lavretsky is Professor of Psychiatry and Director of the Late Life Mood, Stress, and Wellness Program at the Semel Institute for Neuroscience and Human Behavior at the David Geffen School of Medicine at UCLA. She is also a Semel Scholar in Integrative Mental Health. This work was supported by the NIH grants MH86481, MH097892, AT008383, Forest Research Institute, and Alzheimer’s Research and Prevention Foundation to Dr Lavretsky.
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