A systematic review and correlational meta-analysis of factors associated with resilience of normally aging, community-living older adults

The effectiveness of preventive home visits on resilience and health-related outcomes among community dwelling older adults: A systematic review

BACKGROUND

This research aimed to assess the effectiveness of preventive home visits (PHVs) in enhancing resilience and health-related outcomes among older adults living in the community.

METHODS

A comprehensive literature search was conducted in nine databases (PubMed, MEDLINE, CINAHL, Embase, Emcare, Web of Science (WOS), Scopus, PsycINFO and Cochrane Library. The search was undertaken between March 15 and 31, 2022 with subsequent updates performed on October 15, 2023 and April 10, 2024. This review also included grey literature sourced via Google, Google Scholar and backward citation searches.

RESULTS

Out of 5,621 records, 20 articles were found to meet the inclusion criteria with a total of 8,035 participants involved and the mean age ranged from 74.0 to 84.4 years. Using McMaster Critical Review Form for Quantitative Studies, we ascertained that the studies included in our analysis had moderate to high levels of quality. In addition to health-related outcomes, PHV interventions were also conducted to evaluate psychological effects (16 studies) and social outcomes (seven studies). Five studies conducted financial assessment to evaluate the costs of health and social care utilisation during PHV interventions. Regarding the results of the review, seven studies showed favourable outcomes, five indicated no effect and eight had equivocal findings. Only one study assessed resilience and determined that PHV had no effect on the resilience of the subjects.

CONCLUSION

This review found that the effectiveness of PHV interventions was uncertain and inconclusive. PHV interventions often prioritise health-related objectives. The incorporation of a holistic approach involving psychosocial health into PHV interventions is relatively uncommon. Due to the paucity of research on resilience as PHV outcome, we are unable to draw a conclusion on the effectiveness of PHV on resilience. Resilience should be prioritised as a psychological assessment in the future development of comprehensive PHV interventions, as it enables older adults to adapt, manage, and respond positively to adversities that may arise with age. Performing financial analysis such as costs and benefits analysis to incorporate the return on investment of PHV interventions is an added value for future research on this topic.

CLINICAL TRIAL REGISTRATION

PROSPERO registration number: CRD42022296919.

Socially-supported sleep in older adults aged 50 and older: a concept analysis

Introduction

The population of older adults is growing disproportionately, constituting 13% of the global population in 2022, and is expected to double by 2050. One of public health's priorities is healthy aging, the maintenance of functional ability aligned with well-being. As many as 50% of older adults report poor sleep quality, leading to an increased risk of morbidity and mortality. The quality and quantity of social relationships may broadly benefit sleep in older adults. However, the concept of socially-supported sleep is underdeveloped as a basis for intervention.

Methods

Existing literature was searched without time restriction in PubMed, CINAHL, PsycINFO, and Scopus ending in August 2022. Thematic analysis was used to determine the defining attributes, antecedents, and consequences of socially-supported sleep guided by Rodgers' evolutionary concept analysis.

Results

Twenty-nine articles written in English, peer-reviewed, and examined social support and sleep in participants aged ≥50 were included. The defining attributes reflect dimensions of sleep quality. The antecedents are safe and secure, belonging and connection, and warmth and comfort. The consequences of socially-supported sleep include improved regulatory capabilities, physical and emotional well-being, and quality of life.

Conclusion

Socially-supported sleep has the potential to inform interventions that promote sleep in older adults. Ongoing research is needed to address the antecedents and mechanisms through which socially-supported sleep may promote sleep quality for healthy aging.

The role of implicit theories of intelligence and personality in older adults' resilience: cognitive functioning and social participation as two mediators

OBJECTIVES

Resilience during old age reflects the capacity to adapt to changes and challenges associated with normative aging and is an important component of successful aging. Belief in the incremental theory of intelligence and personality could help older adults maintain cognitive functioning and social engagement, which may further contribute to their resilience. The current study investigated how implicit theories of intelligence and personality affected older adults' resilience and examined cognitive functioning and social participation as two mediators.

METHOD

A total of 108 older adults aged 60-92 were recruited and completed relevant scales and cognitive tasks. Path analyses were conducted to estimate the expected mediation model.

RESULTS

The incremental theory of intelligence, but not personality, was positively related to older adults' resilience. Both cognitive functioning and social participation mediated the effect of the implicit theory of intelligence in the model without covariates. When background variables were controlled, the mediation effect of cognitive functioning remained significant, while the link between the implicit theory of intelligence and social participation was weakened.

CONCLUSION

Older adults' implicit theory of intelligence plays a significant role in fostering resilience in late adulthood, especially through maintaining older adults' cognitive functioning.

Mediating Factors Associated With Physical Activity in Older Adults at Increased Dementia Risk

While regular physical-activity (PA) is beneficial, multimorbid individuals at increased dementia risk may exhibit reduced PA levels. Thus, a more comprehensive understanding of mediating factors responsible for inactivity in this population is needed. This study investigated the impact of a multimodal intervention on PA changes at 24-month follow-up and associated mediating factors among community-dwelling patients aged 60-77, with increased dementia risk determined by the CAIDE Dementia Risk Score. Of 1030 participants recruited, 819 completed the assessment. Thus, a generalized estimating equations model initially assessed differences in PA over 24 months, followed by a tree analysis identifying mediating factors influencing PA changes post-intervention. While no significant effect on regular PA was found during the follow-up (P = .674), subgroup analysis revealed improved self-efficacy (P = .000) associated with increased engagement in PA. Incorporating self-efficacy elements into future strategies is crucial for promoting PA among individuals with multimorbidity and at increased dementia risk.

Self-efficacy, resilience and healthy ageing among older people who have an acute hospital admission: A cross-sectional study

AIM

To examine the associations between self-efficacy, resilience and healthy ageing among older people who have an acute hospital admission.

DESIGN

A cross-sectional study.

METHODS

Survey and medical record data were collected from older people on discharge from hospital. The survey measured self-efficacy with the 6-item General Self-Efficacy scale (GSE-6), resilience with the Brief Resilience Scale (BRS), and healthy ageing with the Selfie Ageing Index (SAI). Medical record data included potential confounders: co-morbidities, frailty items, previous falls and previous admission in the last 28 days. Multi-linear regression and Spearman's rank correlation coefficient were used to examine the independent associations between self-efficacy, resilience and healthy ageing.

RESULTS

Responses were received from 143 older people (mean age 79). After adjusting for potential confounders, co-morbidities (ß = -0.08, p = 0.001) remained negatively associated with healthy ageing, while self-efficacy (ß = 0.03, p = 0.005) and resilience (ß = 0.05, p < 0.001) remained positively associated with healthy ageing (R2  = 0.243). Positive correlations were found between self-efficacy (ρ = 0.33, p < 0.01), resilience (ρ = 0.38, p < 0.001) and healthy ageing. Positive correlations were also found between self-efficacy and resilience (ρ = 0.38, p < 0.01). Those with lower self-efficacy and resilience were more likely to report reduced activities of daily living, mobility, physical activity and mood.

CONCLUSION

Findings indicate that while the number of co-morbidities have negative consequences for healthy ageing among older people who are hospitalised, the promotion of self-efficacy and resilience can potentially contribute to healthy ageing within the physical and psychological domains.

IMPLICATIONS FOR PATIENT CARE

Nurses can promote self-efficacy, which can potentially increase resilience and help to improve self-management of chronic conditions, functional ability in daily activities, mobility and physical activity and reduce both anxiety and depressive symptoms.

PATIENT CONTRIBUTION

Participant feedback throughout the data collection process assisted in the evaluation of study methods and data interpretation. This included processes such as assessing selected tools and clarifying the meanings of healthy ageing factors.

Psychological Resilience in Older Residents of Long-Term Care Facilities: Occurrence and Associated Factors

OBJECTIVES

The researchers aimed to (1) explore the occurrence of psychological resilience in the face of a major life stressor and conflict in older residents of long-term care facilities (LTCFs), and (2) identify factors associated with resilience in this population.

DESIGN

Longitudinal cohort study using the Dutch InterRAI-LTCF cohort.

SETTING AND PARTICIPANTS

Older residents (≥60 years old) of 21 LTCFs in the Netherlands.

METHODS

The researchers selected 2 samples of residents who had at least 2 assessments surrounding (1) an incident major life stressor, or (2) incident conflict with other resident or staff. A resilient outcome was operationalized as not having clinically meaningful mood symptoms at the post-stressor assessment and equal or fewer mood symptoms at the post-stressor relative to the pre-stressor assessment. The researchers used 2 resilience outcomes per stressor: 1 based on observer-reported mood symptoms and 1 based on self-reported mood symptoms. The most important factors from among 21 potential resilience factors for each of the 4 operationalizations of resilience were identified using a backward selection procedure with 2-level generalized estimating equations analyses.

RESULTS

Forty-eight percent and 50% of residents were resilient in the face of a major life stressor, based on observer-reported (n = 248) and self-reported (n = 211) mood, respectively. In the face of conflict, 26% and 51% of the residents demonstrated resilience, based on the observer-reported (n = 246) and self-reported (n = 183) mood, respectively. Better cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health were most strongly associated with resilience in the face of a major life stressor. Better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience in the face of conflict.

CONCLUSIONS AND IMPLICATIONS

Factors with a social aspect appear to be particularly important to psychological resilience in older LTCF residents, and provide a potential target for intervention in the LTCF setting.

Profiles of socially isolated community-dwelling older adults during the COVID-19 pandemic: A latent class analysis

OBJECTIVE

To identify different profiles of socially isolated older adults during the first wave of COVID-19 in Quebec, Canada.

STUDY DESIGN

Cross-sectional data were obtained through a telehealth socio-geriatric risk assessment tool, ESOGER, administered to adults aged 70 years or more between April and July 2020 in Montreal, Canada.

MEASURES

Those living alone with no social contacts in the last few days were considered socially isolated. Latent class analysis was performed to identify profiles of socially isolated older adults based on: age, sex, polypharmacy, use of home care, use of a walking aid, recall of current year/month, anxiety level (scale 0-10), and need for follow-up from a healthcare provider.

RESULTS

Three-hundred and eighty (380) older adults identified as socially isolated were analyzed, of whom 75.5 % were female and 56.6 % were over 85. Three classes were identified: Class 1 ("physically frail older females") had the highest proportion of polypharmacy, walking aid, and home care use. Class 2 ("anxious, relatively younger males") were predominantly males who used the least home care but had the highest anxiety levels. Class 3 ("seemingly well older females") had the highest proportion of females, lowest proportion of polypharmacy, lowest anxiety level, and none used a walking aid. Recall of current year/month was similar across the three classes.

CONCLUSIONS

This study found heterogeneity among socially isolated older adults during the first wave of the COVID-19 pandemic with varying levels of physical and mental health. Our findings may contribute to the development of targeted interventions to support this vulnerable population during and after the pandemic.

Loneliness, ageism, and mental health: The buffering role of resilience in seniors

Introduction

Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.

Aim

To assess the potential mediator role of resilience between the effects of ageism and loneliness on PD in seniors.

Methods

A sample of 349 Portuguese seniors aged 60 years and over was collected through an online survey and during the COVID-19 pandemic period. Seniors completed the Kessler Psychological Distress Scale (K6), the Short-Form of UCLA Loneliness Scale (USL-6), the Ambivalent Ageism Scale (AAS) and the Connor-Davidson Resilience Scale (CD-RISC-10). A mediation analysis model was developed with resilience as a mediating variable.

Results

There were moderate to high levels of PD and moderate levels of ageism, loneliness and resilience. Resilience fully mediated the effect of ageism on PD and partially mediated the effect of loneliness on PD.

Conclusions

Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.

Gender and Psychosocial Differences in Psychological Resilience among a Community of Older Adults during the COVID-19 Pandemic

The study aimed at exploring gender and additional sociodemographic differences in psychological resilience, as well as the association between resilience and psychological distress in older adults, during the first lockdown in Italy, due to the COVID-19 pandemic. Participants attended an online survey during the first lockdown in May 2020. Psychological distress was assessed through the Depression Anxiety Stress Scale-21, the Resilience Scale (RS) was administered to evaluate psychological resilience, and sociodemographic variables were also collected. The study involved 108 community older adults (mean age 70.02 ± 3.5 years). Comparisons revealed that women reported significantly lower total scores of RS (p = 0.027), as well as lower levels of resilience-related domains, namely Meaningfulness (p = 0.049), Self-Reliance (p = 0.011), Perseverance (p = 0.035), and Existential Aloneness (p = 0.014), compared to men. Significantly higher RS scores were found in older adults being involved in a relationship, compared to those not involved in relationships (p = 0.026), and in older adults with children (p = 0.015), compared to those without offspring, suggesting the importance for older adults of not dealing alone with such a dramatic and stressful event, such as the pandemic. Negative correlations were found between psychological resilience and stress, depression, and anxiety. Linear regressions revealed that lower RS total scores, as well as lower scores in the majority of the RS scales, were associated with greater levels of stress, greater levels of anxiety, and greater levels of depressive symptoms. This study suggested that older women might appear more vulnerable in facing the pandemic, compared to men; having not lived alone through the lockdown period might also be considered as a factor of resilience for older adults.

Psychometric Evaluation of the Making it CLEAR Questionnaire: A Resilience Measure for Older Adults

Background and Objectives

Previous efforts to develop a resilience measure for older adults have largely failed to consider the environmental influences on their resilience, and have primarily concentrated on the resilience of community-dwelling older adults. Our objective was to validate a new multidimensional measure of resilience, the Making it CLEAR (MiC) questionnaire, for use with older adults at the point of discharge from hospital.

Research Design and Methods

This study tested the structure, validity, and reliability of the MiC questionnaire. The questionnaire consists of 34 items, which assess the “individual determinants of resilience” (IDoR) and the “environmental determinants of resilience” (EDoR) across 2 subscales. 416 adults aged 66–102 years participated. Exploratory factor analysis, item analysis, and linear regression were undertaken.

Results

The IDoR subscale contained six factors which were labeled “Self-efficacy,” “Values,” “Interpersonal skills,” “Life orientation,” “Self-care ability,” and “Process skills.” The EDoR subscale contained five factors related to “Person–environment fit,” “Friends,” “Material assets,” “Habits,” and “Family.” Both subscales demonstrated acceptable convergent validity and internal consistency, while individual items showed acceptable levels of discrimination and difficulty.

Discussion and Implications

The study provides evidence supporting the validity and quality of the MiC questionnaire. The results suggest that the MiC questionnaire could be used to identify the resilience needs of older adults at the point of hospital discharge. However, future research should identify which items of the MiC questionnaire are associated with hospital readmission, in order to develop an easily applicable screening tool for clinical practice.