Resilience in Older Adults: More Than Meets the Eye: A conceptual & empirical exploration of resilience in older adults

The life expectancy of the global population is increasing rapidly. However, the increase in life expectancy has also led to an increase in the number of years older adults live with chronic morbidities. Thus, for most older adults the reality of aging includes health-related adversities such as illness, disability, and/or cognitive impairment, but also social adversities such as loneliness and loss. Recently, the focus of research has shifted somewhat from treatment of diseases and extension of life to increasing wellbeing in the years gained. Considering the reality of adversities occurring in these extra years, it is important to study how wellbeing can be maintained or achieved despite these adversities. Studying resilience, the core of which is considered to be “some form of adversity and a positive response to this adversity” can therefore play an important role in achieving this goal. In this thesis we study the construct of resilience and its application in aging research and older adult clinical practice. We aim to contribute to the conceptual clarity and applicability of resilience for aging research. To do this we explore the views of different stakeholders on the construct of resilience and apply the construct to two different cases. We incorporate the diverse array of adversities for older adults posed by the COVID-19 pandemic in our explorations of resilience. Main Research questions: 1. What is resilience in older adults? 2. How can resilience (best) be studied in older adults? 3. What is the value of resilience for aging research and older adult care practice? 4. What are the challenges to the application of resilience in aging research and older adult care practice? 5. What can we learn about improving older adult wellbeing and resilience from how older adults deal with the challenges posed by the COVID-19 pandemic? In conclusion, researchers and older adults themselves initially described resilience as a personality trait. However, both the conceptual work on resilience in older adults and the comprehensive descriptions of recovery form COVID-19 of older adults themselves revealed that (their) resilience incorporated much more than just a trait. The results of this thesis show that the mechanism of resilience is a complex, dynamic and contextual process involving factors at different levels. Factors at an environmental (social) level seem to be of great importance to resilience of older adults in the face of different stressors across different contexts. Resilience is a valuable construct for aging research due to its positive connotation, its dynamic incorporation of stressors, and its versatility. ! e dynamic role of resilience factors across the life course and the importance of environmental factors lend particular value to resilience as they suggest that resilience factors are modifiable, through intervention, for example. Future resilience research may contribute to older adult care practice through: the identification of resilience factors which represent potential targets for intervention, the development of (clinical) predictors of resilience for clinical decision making and the guiding of personalized care, and the development of individual resilience factor mapping tools for the guiding of personalized treatment plans. It is important for this future research to incorporate a valid resilience measurement method/operationalization which reflects the conceptual framework of resilience (based on consensus within the conceptual literature), and is appropriate for the goal and context in which it is applied.