ALSO IN THIS SPECIAL REPORT
Phebe Tucker, MD
Ping Zheng, MD, PhD; Andreas Maercker, MD, PhD
What does 'resilience' include for older adults?
SPECIAL REPORT: EXPLORING RESILIENCY
In psychiatry and psychology,
We
Phebe Tucker, MD
Ping Zheng, MD, PhD; Andreas Maercker, MD, PhD
Aspects of Resilience
Resilience, as envisioned by the NAS, is composed of 4 separate phases: preparing for a disruption, absorbing a disruption by decreasing certain critical functions (such as rationing food, water, energy, and communication during a disaster), recovery, and finally, if possible, adaptation to improve critical functions. For older adults, these phases occur within an expected decline due to the normal aging process, and resilience theory aims at recovery that fits a patient’s specific aging trajectory. A patient’s decline can be accelerated by disruptions such as the death of a partner, serious accident, or a pandemic.
Among aging individuals, mental health and illness adversity may be long-term chronic, episodic, or acute, and it may require consideration of the life course. For instance, some individuals struggle with depression or bipolar disorder over many years, whereas others may face life crises, such as dementia or suicidal ideation, that arise during later life. Additionally, we can identify 2 contrasting generic resilience and aging trajectories: (1) declines in physiological and psychological resilience due to normal aging; and (2) increases in resilience due to social learning and successful coping strategies. The unique contexts of aging are incorporated into the
The resilience matrix, originally conceived by
Building Resilience Together
To apply these components of psychiatric resilience and aging, the clinician will need to work with each individual patient to determine the critical function(s) most important for their recovery. Such critical components might include identity and self-image development to enhance meaning in life, relationships with family members, and the ability and desire to live independently. Clinicians can structure resilience-oriented treatment using the aforementioned matrix to prioritize critical functions before or during disruptions in order to manage the absorption, recovery, and adaption process.
For clinicians to operationalize the resilience matrix, they must differentiate
In the case of clinicians, this resilience matrix can help frame the external support (resilience-by-intervention) that a clinician might offer their patients. In addition to supporting patients after disruptions, the resilience matrix framework can provide avenues for patients to build internal resilience (resilience-by-design) for the future, or to mobilize existing internal resilience. A clinician focused on a particular patient can tailor resilience strategies that capitalize on the patient’s unique strengths and circumstances, which for older adults, compared with young individuals, include considerable experiential contexts and learning. Similar to designing resilient systems in engineering, psychiatrists can develop strategies to enhance individuals’ mental health. Ensuring overall mental health through the use of relevant medications and treatments approximates resilience-by-intervention in broader governance (like stockpiling resources in the case of crises).
Disruptions can take many forms for patients, and a resilience-oriented treatment plan is not predicated on predicting which disruptions will arise. For clinicians, the preparation phase should establish a relationship with the patient that is characterized by trust. This relationship, and other preparation areas that can be identified in collaboration with the patient, constitute a suite of potential resilience systems that can be leveraged and enhanced before a disruption occurs.
Building a patient’s resilience-by-design in the preparation phase provides the patient with the appropriate tools or learned perspectives to apply when a disruption occurs, thereby initiating the absorption process. Absorption is the process of encountering the disruption and subsequent loss of critical function, which can vary in magnitude according to resilient resources available. Such resources include collaborative work with the clinician, who can evaluate the components of the resilience matrix and identify elements or skills that may need clinical direction. The clinician can help the patient identify when the switch is made from absorption to recovery and guide the patient to the tools best suited for each stage. These resilience-by-interventions rely on the clinician’s understanding of the patient’s needs and goals, and existing foundational resources, and the clinician’s ability to supplement any resources that are missing or depleted.
Finally, adaptation asks the patient to use the disruption as an opportunity to reevaluate and potentially change habits or behaviors that were either previously deficient or have become untenable under new circumstances. This phase of resilience invites the patient to reimagine ways to support their critical functions, which should either ensure the return to the patient’s original trajectory or, possibly, their return to an improved trajectory, if they have embraced the opportunity to evaluate and carefully optimize beliefs and behaviors.
Concluding Thoughts
This resilience matrix framework can be empowering to older adults. At a population and public health level, the coronavirus pandemic has revealed that older adults may be
Ultimately, degradation to death remains an inevitability, but resilience can be part of the tool kit to prolong life and, equally important, to prolong the period when quality of life can be maximized. Some study results suggest that
Dr Linkov is the senior science and technology manager of the US Army Engineer Research and Development Center (ERDC) and an adjunct professor at Carnegie Mellon University. He is responsible for ERDC’s project portfolio in the areas of crises management and resilience. He has published widely on environmental and technology policy, and on risk and resilience analytics, including 25 books and more than 400 peer-reviewed papers and book chapters. Ms Galaitsi works with the Risk and Decision Science team within the US Army Corps Engineer Research and Development Center. Her research topics include the public health response during the 2020-2021 coronavirus pandemic, governance of synthetic biology, stakeholder engagement in water resources management, automated algorithms and artificial intelligence, and resilience applications in fields like gerontology, team behavior, and value chain analysis. Ms Klasa is a PhD candidate in health services organization and policy at the University of Michigan’s School of Public Health, Department of Health Management and Policy. She uses mixed methods to explore the intersection of health policy, risk/resilience, and politics, drawing from cross-disciplinary training in nursing, health care management, public health, economics, and political science. Dr Wister is director of the Gerontology Research Centre and a professor in the Department of Gerontology at Simon Fraser University. His work has been published often on topics such as baby boomer health dynamics; population aging and population health; resilience and aging; social isolation; and environmental adaptation among older adults. His most recent book, Resilience and Aging: Emerging Science and Future Possibilities, co-edited with Theodore D. Cosco, was published in 2021 by Springer.
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