Resiliency in the Elderly

Resiliency in the Elderly 2 America is growing old fast. Approximately 10% of our country is currently 60 years or older and by 2050 nearly a fourth of our citizens will be elderly (Kaplan et al., 2008). This presents a specific category of Americans with unique challenges. In a comprehensive review of research from 1978 through 2005, it was determined that only one third of the elderly are considered to be successful agers (Kaplan et al., 2008). This means two thirds of our elderly are struggling with the aging process. Society is obligated to address the needs associated with this struggling group that will assist them in living healthy well-adjusted lives. It is in everyone’s best interest to facilitate their independence and allow them to continue to contribute to society in a productive way rather than become a burden that requires limited resources to manage. Understanding risk factors and protective mechanisms used by elderly individuals that have achieved successful aging can help design preventative practices that will enable similar beneficial outcomes. It is well established that genetics play a part in longevity. However, only about one third of living an extended life can be attributed to heredity and the rest is up to the individual (Parker-Pope, 2005). Obviously, eating right, proper exercise, and avoiding unhealthy habits like tobacco and excessive alcohol use have a role in physical health. It is commonly accepted that a healthy lifestyle will enable the body to sustain itself and increase the length of an individual’s life. Although these are important aspects of extending life, by themselves they do not explain why some people maintain full function of their faculties and report a high level of satisfaction in their lives while others seem to give up and merely mark time and wait for the end to come. While these modified lifestyles are related to longevity, socioeconomic status has just as much influence and cannot be ignored. Different research has independently identified particular qualities that appear to have a distinguishable impact on the ability to age gracefully
Resiliency in the Elderly 3 and well-adjusted. Much of the research has common threads that interlink these qualities and create a basic pattern of successful strategies for producing resilient older citizens. I have explored eight different authors research and will illustrate how all sources reaffirm the fundamental qualities of stress management, strong social contacts, self efficacy, and sense of control as key factors for resiliency in the elderly. The first article I examined was entitled The Secrets of Successful Aging: What Science Tells Us, by Tara Parker-Pope. In this secondary research, she states managing stress at any age is important but especially so for the elderly (2005). She points out that stress accelerates the aging process and as we get older it takes longer to shut down this stress response causing even more negative effects on our bodies. Furthermore, she comments handling stress appropriately decreases a person’s allostatic load which is a means of measuring the negative effects of stress has on the body and its organs (Parker-Pope, 2005). Quoted in Parker-Pope’s article, Bruce McEwen, a neuroendrocrinologist and expert on allostatic load has concluded that lower levels of stress or proper coping skills for stress allows a person to feel more in control of their own life (2005). A sense of control in one’s life is a key issue to successful aging. It is linked to self efficacy and self esteem. If you feel you are in control then you are more confident and self assured. Parker-Pope comments successful agers feel more in control of their surroundings and daily lives. She offers Dr. Sapolsky’s nursing-home study to validate this observation. In this study one group of residents were given more responsibility for meals, social activities, and other aspects of their lives while another group was closely controlled. The results revealed the group with more control over their lives were happier and had a significantly lower death rate of nearly half that of the controlled group (Parker-Pope, 2005). Resiliency in the Elderly 4
In addition, Tara Parker-Pope noted strong social contacts increase the likelihood of an extended well-adjusted life. She mentions the results from the MacArthur Foundation study where 4,000 older people were evaluated for mental and physical functions (2005). In this study, the frequency of support from family and friends was an excellent indicator for how a person would deal with aging. Those who had the greatest interactions with others were more likely to “get out more, keep moving, and actually improve with age”(Parker-Pope, 2005). The second literature source I reviewed was Prevalence and Factors Associated With Thriving in Older Adulthood: A 10-YearPopulation-Based Study. This study particularly looked at the maintenance of healthy well-adjusted senior citizens over a 10 year period rather than a cross-sectional representation at a given point. Researchers documented a direct correlation between having a positive outlook on life with less psychological stress and increased coherence to increasing the quality of life and ability to thrive in old age (Kaplan et al., 2008). They credited social and behavioral factors as important components in obtaining a well-adjusted status. Other significant factors in their particular study revealed income and education played important roles for successful aging. A dramatic contrast to commonly held beliefs was discovered in their study in respect to physical activity and body mass index (BMI). It has been generally assumed that proper exercise and weight control help facilitate a healthier lifestyle which enables a longer life. However, this particular study found no association between physical activity and BMI and the ability to thrive (Kaplan et al., 2008). This further strengthens the idea that positive social contacts, stress management, self efficacy, and a sense of control have valuable implications to a variety of older individuals. The next primary research study I looked at was Structural Relationships Between Social Activities and Longitudinal Trajectories of Depression Among Older Adults.
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Depression is an important indicator of well-being and as such investigating it can help determine successful aging strategies (Hong et al., 2009). This study found that social support and self-rated health perception are can accurately predict the occurrences of depression. The more socially active an elderly individual was presented less depressive episodes and increased satisfaction of life in general. Social activities such as religious services, volunteering, sporting events, and movies were among the most successful activities in defeating depression. Even talking on the phone with family and friends produced beneficial protective effects suggesting the social contact is paramount to successful aging (Hong et al., 2009). However, what appeared even more significant than the actual activities were the self-perceptions of what the individuals thought about their own involvements. If an elderly person believed that they adequately participated in enough activities, they experienced less or no depression in comparison to someone who believed they weren’t as active as they could or should be. This supports self efficacy and a sense of control over one’s own well-being. As noted in the previous literature, religious activities appear to have a buffering effect and promote positive effects on depression and the aging process. I investigated additional information on this particular emphasis and discovered a paper by Dong Pil Yoon and O. Lee entitled The Impact of Religiousness/Spirituality, Social Support, Life Satisfaction, and Depression Among Diverse Minority Elderly. Although the paper addressed minorities, the information can be used to understand how important these aspects are to elderly individuals regardless of their cultural background. Author Yoon reports higher levels of life satisfaction were recorded when strong religious and spiritual affiliations were present (Yoon & Lee, 2007). He acknowledges the cultural differences associated with diverse minorities but is still able to draw definitive conclusions about the preventative effects any religious belief has against depression regardless of the originating denomination. The belief itself is the
Resiliency in the Elderly 6 distinguishing factor. Furthermore, Yoon reports strong social support networks decrease depression and increase life satisfaction. This source corroborates what Hong and his associates documented in their research. My continued research led me to an article that I found quite interesting by Professor Sue Ronaldson entitled Terminally Old. She contends that aging is similar to a terminal illness like cancer in that both have limited time left and quality of life can be disrupted (1998). She suggests successful palliative care strategies in addressing elderly citizen’s needs specifically spiritual and existential can increase their quality of life. She noted as social contacts decrease because older people have out lived most of their friends and family, spirituality becomes more important. Life is about the here and now. It is the reality of controlling what you can and managing stress levels by accepting what you can’t. In addition, Ronaldson cites relationships and belonging as well as self-worth and meaning as import aspects that require attention in successful aging. The sixth article I reviewed was Well-Being Among Older Adults on Different Continents by Toni Antonucci, Corann Okorodudu, and Hiroko Akiyama which summarizes the commitment efforts dedicated to addressing aging and age related issues (2002). They cite independence, participation, care, self-fulfillment, and dignity of older persons as fundamental goals for the United Nation’s World Assembly on Ageing (Antonucci et al., 2002). This report illustrated the world wide recognition of social support for the elderly. In a specific study conducted by Lang and Schütze exploring parent-child relationships in the very old, it was revealed that a child’s emotional support was more important than instrumental support to aged parents (Antonucci et al., 2002). In another study reported to this assembly by Sugisawa and associates, the more social connections a person had decreased depressive

Resiliency in the Elderly 7 episodes, thus contributing to a greater level of satisfaction of life (Antonucci et al., 2002). Although slight variations exist from one country or cultural context to the another such as availability of a spouse or number of children, overall social contact was determined to have substantial impact on well-adjusted aging.
The seventh source that I consulted in my research was Self-serving appraisal as a cognitive coping strategy to deal with age-related limitations: An empirical study with elderly adults in real-life stressful situation by Rudi De Raedt and I. Pontjaert-Kristofferson. They noted in a study using a fitness-to drive program and other diagnostic tests, individuals who either over-estimated their perceived ability to master the driving test or correctly estimated their performance also reported less depression on an accompanying Mini Mental State Exam (De Raedt & Pontjaert-Kristofferson, 2006). Self-confidence and efficacy gave them a greater sense of control which in turn had a positive effect on the driving test. Those who expected to do poorly likewise recorded higher depression ratings indicating uncertainty and lack of self efficacy regardless of what their actual driving tests revealed. In other words, they could have passed the driving test just as well as those who over-estimated their performance but tests supported that their overall attitude about their performance was associated with negative impressions about themselves and this was linked to their emotional outlook on life in general.
The final article I explored was Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities. In this article authors Celso, Ebener, and Burkhead conducted a study to determine if the use of humor as a coping strategy was useful in dealing with diminished health and life satisfaction in assisted living residents. The studied showed the relationship between humor and life satisfaction was weak at best. In reference to health, it indicated emotional health had a strong connection to humor coping.
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They reported that humor has been shown to reduce levels of anxiety reported by elderly and can be a valuable tool for both physical and psychological well-being (2003). Furthermore, it helps manage stress levels by providing amusing distractions for the adverse situations. It was noted that assisted living residents use humor as a way to interact with other residents and increase social contact (Celso et al., 2003). However, not everyone enjoys the same kind of humor or appreciates it at the same time.
In addition, it corroborated what other studies have shown that health status and life satisfaction were directed linked. Since emotional health is a component of overall health, this probably accounts of the weak association to life satisfaction. Although it promoted social contact and successful stress management, it was not a particularly protective factor for health status or life satisfaction but rather was useful as just one form of a coping skill which may not necessarily work as well for all individuals. As mentioned at the beginning of this paper, all the articles I reviewed contain common themes consistent throughout. Some with emphasis in different areas but all aimed at addressing coping skills and strategies necessary to promote successful aging in the elderly. Great effort has gone into research studies designed to determine the most effective practices for achieving a well adjusted elderly population. The literature supports stress management, strong social contacts, self efficacy, and sense of control as the most successful strategies currently identified for successful aging. Personally, I have witnessed how these qualities greatly complement an elderly person’s life. Likewise, I have seen adverse effects from lacking these qualities. I have been an in-home care giver to an elderly person and worked at an assisted living facility. In the course of my employment I have seen both ends of the spectrum: both the well-adjusted and the maladjusted older individuals. I have seen a 97 year old women shuffle down to the dining
Resiliency in the Elderly 9 hall every day and participate in weekly bingo sessions rather than sit in her room and vegetate. As restrictive as her mobility is, she still manages to remain as fairly active. She maintains a healthy outlook on life and enjoys a good joke and a hardly laugh. All of her family is gone and many of her friends have died but she continues to make new friends and cultivate new social contacts. She insists on handling as many of her own affairs as possible as a way to maintain a sense of control.
Similar to the 97 year old woman, my grandmother is 75 years old and looks forward to celebrating her 50th wedding anniversary in Hawaii. Her husband has been diagnosed with lung cancer and his prognosis is not good. She realizes that this might not happen. However, as she says “if the good Lord is willing and we are both still here in two years, I will be basking on the sandy beaches of Hawaii.” She has a plan and has not given up. When faced with unexpected troublesome circumstances she does not resist the situation but rather goes with the flow. I remember missing a turn on a congested freeway and getting quite lost in an unfamiliar part of a large city with her as a passenger. My mother way driving and was quite upset about the whole predicament. My grandmother calmly said “Here we go again, on another adventure.” She chose to enjoy the experience rather that worry over what negative consequences might occur. Both the 97 year old woman at the assisted living facility and my grandmother look forward to tomorrows. They are in control of their lives and have stress under control. They have the ability to put things into their own kind of perspective. They surround themselves with positive influences and people that keep them connected to the here and now. Their eyes are always on the future and what it might hold.
In contrast to these successfully aging women, I have watched a 68 year old man give up on life and steadily decline in both physical and mental health while he just goes through the motions of living. He is resigned to dying and has no desire or motivation to go on even
Resiliency in the Elderly 10 though he does not have a terminal illness or disabling condition. He has continued to alienate and isolate himself from social contacts by sitting alone in his room. He would dwell on his misfortunes that he had experienced in life and refused to move past them. He felt like he was at the mercy of his environment and lacked any control over his circumstances. His spirit has been broken and now his body is following suit.
All three of these individuals had experienced similar trials and tragic events in their lives. My grandmother and the 97 year old women still remember the great depression. Furthermore, both women have experienced tragic losses of loved ones. Although the 97 year old woman had out lived all of her children, one death was exceptionally tragic dying in a house fire at the age of 2. This fire left the woman and the remainder of her family homeless until they could rebuild. They lived in a tent on their property.
The 68 year old man had served in some branch of service so had more than likely been involved in a war. I know he had been married but other than that I don’t know much more about him since he was not social at all. I know that the women are living on very fixed budgets. Of the three, the 68 year old man appears to have the greatest financial means. The difference between the man and the women’s aging capabilities was glaringly obvious. The women were thriving while he was stagnate and depressed. The only explanation for this discrepancy was how each one chose to address their attitude towards life. Well-adjusted aging requires a combination of successful strategies that promotes a healthy outlook on life and increases the overall satisfaction. The women had achieved this and he had not. The women exhibited good stress management, strong social contacts, adequate self efficacy, and a sense of control over their lives. They had overcome adversity and learned from their experiences. At some point the 68 year old man had slipped into a negative state and was unable to reconnect and rebuild his life.
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As America continues to grow older, it becomes more and more important to identify and foster positive strategies that enable all older individuals to reap the benefits of healthy and happy lives. Assisting the elderly to stay healthy in mind and body as long as possible will avoid the need to accommodate and care them with expensive interventions. There will always be a certain amount of care that will be necessary but minimizing or delaying a potentially devastating surge of older people on an unprepared society must be addressed.
After examining the previous literature and reviewing my personal experiences, I have come to the conclusion that the fundamental qualities of stress management, strong social contacts, self efficacy, and sense of control are basic components necessary to nurture resiliency in the elderly. Incorporating these elements into current practices will help avert an overwhelming situation for society in the future.

References
Antonucci, T. C., Okorodudu, C., & Akiyama, H. (2002). Well-being Among Older Adults on Different Continents. Journal of Social Issues, 58(4), 617-626. Retrieved April 22, 2009 from http://ezproxy.lcsc.edu:2062/ehost/detail?vid=3&hid=107&sid=5b8046d3-fb3e-419e-976e-373768587f9e%40sessionmgr108&bdata=JnNpdGU9Z Whvc3Qtb Gl2ZQ%3d%3d#db=sih&AN=8972223.

The authors conducted secondary research by compiling and summerzing the processing’s presented at the 2002 Non-Governmental Organization Forum. They reported the five topics considered and reported their findings on: Well-Being Among Older Americans; Social Support; Functional Status, Well-Being and Successful Aging; Cross-Cultural Approaches to the Study of Aging; and Research Perspectives in Aging.

Celso, B. G., Ebener, D. J., & Burkhead, E. J. (2003). Humor coping, health status, and life satisfaction among older adults residing in assisted living facilities. Aging & Mental Health,7(6), 438-445. Retrieved April 17, 2009 from http://ezproxy.lcsc.edu:2062 /ehost /detail?vid=3&hid=107&sid=5b8046d3-fb3e-419e-976e 373768587f9e% 40session mgr108&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d.

The authors use data from the Multidimensional Functional Assessment Questionaire, Coping Humor Scale, and Life Satisfaction Index A to test their hypothesis that humor coping has a direct association with life satisfaction and indirectly affects the relationship between health and life satisfaction. They did not support this hypothesis. They find that humor as a coping strategy does have an association with emotional health which was unexpected.

De Raedt, R. & Ponjakert-Kristofferson, I. (2006). Self-appraisal as cognitive coping strategy to deal with age-related limitations: An empirical study with elderly adults in real-life stressful situation. Aging & Mental Health,10(2): 195-203. Retrieved April 17, 2009 from http://ezproxy.lcsc.edu:2062/ehost/detail?vid=3&hid=107&sid=5b8046d3-fb3e-419e-976e-373768587f9e%40sessionmgr108&bdata=JnNpdGU9ZWhvc3Qtb Gl2ZQ % 3d%3d#db=sih&AN=19937412.

The authors used a fitness-to-drive evaluation, Profile of Mood States, Nottingham Extended Activities of daily living list, Mini Mental State Examination, and IQ tests to analyze the basic mechanisms of perceived control and self-protective processes. Higher estimation of performance was associated with less depression, higher self-confidence, and increased performance in accomplishing task presented.

References (Continued)

Hong, S., Hasche, L., & Bowland, S. (2009). Structural Relationships Between Social Activities and Longitudinal Trajectories of Depression Among Older Adults. The Gerontologist. 49(1), 1-11. Retrieved April 22, 2009 from http://ezproxy.lcsc.edu: 2053/pqdweb?index=1&did=1684154631&SrchMode=1&sid=4&Fmt=4&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1241310049&clientId=58535.

The authors research supported by the Longer Life Foundation used latent class analysis from Longitudinal Study on Aging II to classify social activities and a latent growth curve model to capture longitudinal changes in depression while controlling relocation, health status, insurance, and sociodemographics. Three patterns emerged across 8 activities. It was determined that social activities are important in preventing and treating depression but was dependent on self perceived levels of “enough.”

Kaplan, M. S., Huguet, N., Orpana, H., & Feeny, D. (2008). Prevalence and Factors Associated With Thriving in Older Adulthood: A 10-Year Population-Based Study. The Journals of Gerontology: Series A: Biological sciences and medical sciences. 63A(10), 1097-1105. Retrieved April 28, 2009 from http://ezproxy.lcsc. edu:2053 /pqdweb?index=18&sid=1&srchmode=1&vinst=PROD&fmt=4&startpage=-1&client id=58535&vname=PQD&RQT=309&did=1590141981&scaling=FULL&ts=1240974003&vtype=PQD&rqt=309&TS=1240974042&clientId=58535&cc=1&TS=1240974042.

The authors use data from Health Utilities Index Mark 3, a multidimensional measure of health status to examine the maintenance of exceptionally good health in old age in 2432 individuals. Four trajectories were determined over 10 years: thrivers, non-thrivers, deceased, and institutionalized. Modified lifestyles and socieconomical status the major factors for maintaining exceptionally good health.

Parker-Pope, T. (2005). Personal Journal; The Secrets of Successful Aging: What Science Tells Us. Wall Street Journal(Europe). June 24, 2005. Retrieved April 19, 2009 from http://ezproxy.lcsc.edu:2053/pqdweb?index=0&did=858340211&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1240421556&clientId=58535.

The author uses secondary research to identify beneficial methods of dealing with stress. She presents social contact, self-perception, and control over day-to-day life situations as successful strategies for elderly citing research from multiple sources including MacArthur Foundation Research on Successful Aging, Carnegie Mellon University, the Alzheimer’s Nun Study from Sisters of Notre Dame.

References (Continued)

Ronaldson, S. (1998). Terminally Old. Clinical Information Access Program. Retrieved April 27, 2009 from http://www.ciap.health.nsw.gov.au/hospolic/stvincents/1998/a04.html.

The author, a professor and Chair in Nursing for the Australian Catholic University and St. Vincent’s Healthcare Campus, uses secondary research to hypothesize that successful strategies currently practiced in palliative care can also be used for successful aging. She presents evidence from a Sacred Heart Hospice study entitled Humanistic Communication, information collected at the World Congress of Gerontology, and her own personal observations and experiences to support her hypothesis. Her findings were presented at the National Hospice and Palliative Care Association Conference for review.

Yoon, D. P. & Lee, E. O. (2007). The Impact of Religiousness/Spirituality, Social Support, Life Satisfaction, and Depression Among Minority Elderly. The Journal of Geronotological Social Work.48(3/4) 281-298. Retrieved April 21, 2009 from http://ezproxy.lcsc.edu:2048/login?url=http://proquest.umi.com/pqdweb?did=1218782061&sid=1&Fmt=7&clientId=58535&RQT=309&VName=PQD.

The authors used data collected from 215 older adults to measure the impact of spirituality, religiousness, and social support on the psychological well-being among rural elderly. Using the Brief Multidimensional Measures of Religiousness/ Spirituality, the Social Support Measurement, the Satisfaction with Life Scale, and Analysis of Variance, they determined spirituality and religiousness decreased depression and social support was directly associated with life satisfaction.

References: (Continued) Ronaldson, S. (1998). Terminally Old. Clinical Information Access Program. Retrieved April 27, 2009 from http://www.ciap.health.nsw.gov.au/hospolic/stvincents/1998/a04.html. The author, a professor and Chair in Nursing for the Australian Catholic University and St. Vincent’s Healthcare Campus, uses secondary research to hypothesize that successful strategies currently practiced in palliative care can also be used for successful aging. She presents evidence from a Sacred Heart Hospice study entitled Humanistic Communication, information collected at the World Congress of Gerontology, and her own personal observations and experiences to support her hypothesis. Her findings were presented at the National Hospice and Palliative Care Association Conference for review. Yoon, D. P. & Lee, E. O. (2007). The Impact of Religiousness/Spirituality, Social Support, Life Satisfaction, and Depression Among Minority Elderly. The Journal of Geronotological Social Work.48(3/4) 281-298. Retrieved April 21, 2009 from http://ezproxy.lcsc.edu:2048/login?url=http://proquest.umi.com/pqdweb?did=1218782061&sid=1&Fmt=7&clientId=58535&RQT=309&VName=PQD. The authors used data collected from 215 older adults to measure the impact of spirituality, religiousness, and social support on the psychological well-being among rural elderly. Using the Brief Multidimensional Measures of Religiousness/ Spirituality, the Social Support Measurement, the Satisfaction with Life Scale, and Analysis of Variance, they determined spirituality and religiousness decreased depression and social support was directly associated with life satisfaction.