Assessing Correlation between Psychological Resilience and Successful Ageing

Resilience in Elderly

Studies dealing with resilience in old age population commenced around 2000 when positive psychology, intra-individual plasticity and cognitive reserve became the focus of attention, and the first article presenting resilience in elderly was published in 1999 [8, 9].

The aim of studies has been to provide a model for resilience and bring it into practice by examination the catalyzer role of resilience in various age associated changes. They supported the idea that resilience could be a measurable psychological resource with a key role in ageing wellbeing.

Lavretsky in his book ‘resilience and ageing’ defined resilience as a process that defends against the psychological and physical disturbances caused by adversities and facilitates personal growth and coping. He adopted the Richardson theoretic model for resilience which claims that an individual starts a process to adopt mind, body and spirit to life situation. Disruption in this biopsychosocial stability could lead to either higher level of adaptation or dysfunctional adaptation [5, 10].

In a literature review, with the aim to show the concept of psychological resilience in elderly, Fonts and colleagues reviewed 52 international articles. The articles investigated a wide range of bio-psycho-social factors linked to resilience, coping strategies, quality of life and general health in elderly. Factors such as social support, having a job, spirituality, having a partner, generativity, physical health, emotional regulation, self-esteem, behavioral skills, copying strategies, life stories were considered as the precursors of resilience. They concluded that resilience persists throughout the life and they propose that coping is a kind of resistance, management and overcoming of despairing in the face of adversities. In their view an individual needs various biopsychosocial resources such as good health, positive affect, a sense of meaning, spirituality, flexibility, optimism and having an integrated social role to positively cope with adversities [11].

In another review, Kessel and colleagues explored the validity of the current conceptualization of resilience with the aim to define resilience in older people. They categorized them into quantitative (22 papers) and qualitative (20 papers) based on the methods they applied. The quantitative studies used various resilience psychometrics to rate resilience or detect association between resilience and other themes. Kessel pointed that people at their later life are able to implicate individual abilities to overcome stressful life situation. He concluded that resilience in elderly could be enhanced by providing reasonable interventions [2].

Of 94 papers that were collected in these reviews, a few investigated associations between resilience and successful ageing indices. Lamond and colleagues in San Diego used the Connor-Davidson Resilience Scale (CD- RISC) to measure resilience in community-dwelling older women. They concluded that a higher score on resilience predictors was strongly and negatively linked to cognitive complaints in older women and higher resilience score was associated with less cognitive complaint [12]. Harris, in a debate on successful aging and resilience, presented two case studies and concluded that resilience could allow people with early stage dementia to continue their lives in a meaningful way [13].

Resilience has also been defined as a pervasive and flexible personality trait that help an individual to cope well into a successful ageing. Resilience has been characterized by five main features: Equanimity (balanced perception of life); meaningfulness (sense of purpose); perseverance (ability to keep going); existtional aloneness (acceptance of one’s life); self-resilience (belief in one’s capacity).

In this regard resilient individual experience less depression when they migrate, do not succumb to illness, having more self-confidence, are more optimism, able to cope persistently with misfortune [14, 15, 16].

Successful Ageing

Successful ageing has been defined as mental, physical and spiritual vigour, into middle age and further years. successful ageing has also been considered as freedom from disease and disability in the way that people can live independently in later life. As the population is growing and more people live longer, there is increasing curiosity to detect the determinants that help people live longer with better health and quality of life. Factors such as absence of disease, staying physically active, more social engagement have been introduced as indicators of successful ageing [17, 18, 19, 20]. So, successful ageing is a multidimensional biopsychosocial concept refers to low risk of illness, higher physical and mental function and more social engagement, life satisfaction and productivity [21, 22, 23].

Having a good mental health has also been considered as a component of successful ageing. Some Factors related to resilience such as adaptability, wisdom, optimism, are also potential predictor of successful ageing. And optimistic people as a prototype of resilient individual has been associated with longer life, seeking medical help and caring of himself which are indicators of successful ageing [16, 24].

In prior studies characteristics such as physical activity, positive attitude, and enjoy the life have been considered as indicators of successful ageing. In their study Wagnild and colleague’s life satisfaction, self-care activities measured as variables related to successful ageing [3].

The main question is whether and how resilience correlated to successful ageing. People who are aging successfully report better health, more social involvement, good mental health which are factors related to resilience. While it is not known that resilience as a cause and effect of successful ageing but it appears they are interrelated. According to Rowe and Kahn study resilience will facilitate successful ageing [25].

Good mental is a fundamental factor for both resilience and successful ageing. And incorporate information on mental health has been suggested to be considered in definition of successful ageing and negative emotional experience like depression seems to be negatively related to successful ageing [26, 27]. Result from cognitive studies strongly supported the intellectual functioning with longevity and successful ageing [28]. Some emotional state and personality has been reported as predictor of successful ageing and neuroticism negatively associated with ageing successfully. Likewise positive emotional state, xtroversion have been reported as predictors of successful ageing [29].

While successful ageing is an arguing core concept in gerontology but definition has been widely argued. In conclusion; health condition, good physical activity, high cognitive performance, positive emotions, and social involvement are the most criteria accepted as indicators of successful ageing [30].

Logic for Study

Given that resilience represents complex psycho-social behaviors, it could potentially correlate with other gerontology concepts like successful ageing. It is thought that resilience could impact on health status, and high level of resilience is protective against both mental and physical health [31]. It is possible that long term health benefits are influenced by resilience and vice versa. Rak proposed a clinical usage for resilience intervention model that explores resilience qualities in individuals and nurture them [7].

There is certain logic to investigate the correlation between resilience scale and indicators of successful ageing. While there has been great trend toward studying resilience in the elderly over two recent decades, the association between resilience and aspects of successful ageing in the old age population has not adequately investigated. Resilience in old age depends on emotional and cognitive reserve, and there is an assumption that resilience increases in old age and builds up a successful adaptation to adversities [32]. We designed this study to examine the relationship between resilience score assessed by a valid resilience instrument factors that are considered as indicators for successful ageing. The question is whether resilience score is a predictor for SA in people aged over 65.

Expected Outcomes, Significance or Rationale

Considering that resilience may be both influenced by and itself impact biological, psychological, and social factors, an individual measure of this construct may well be associated with factors identified as determinants of successful ageing. Indeed, we hypothesize that resilience score will be associated both with indices of successful ageing in elderly, cross-sectional and longitudinally. The results of this study would have potential utility in both clinical practices and research, especially if, as is being investigated in other studies, resilience could be taught.

Measures

Resilience is measured by Connor-Davidson resilience scale (CD-RISC) [31]. Cognitive functioning is measured by Mini mental status examination (MMSE). The MMSE is a quantitative assessment of cognitive function. It gives a brief assessment of the person’s orientation, recall ability, memory, and language ability [32, 33]. Audio Recorded Cognitive Screen (ARCS) was uses as a screening cognitive measure. ARCS is administered through headphones via an audio device, and subjects respond by writing their answers in a booklet for later scoring [34, 35, 36]. MAC-Q is a self-report questionnaire of five questions meeting diagnostic criteria for age-associated memory impairment (AAMI [37].

Informant questionnaire(IQ-Code) and the Participant Questionnaire on Cognitive Decline in the Elderly (PQCode) ask specific questions about memory complaints form the informant and participants separately [38]. Depression anxiety and stress scale (DASS) were used to score emotional related symptoms. The DASS21 is a set of three self-report scales measuring negative emotional states such as depression, anxiety and stress [39]. Depressive symptoms were specifically measured by using CES-D [40]. Moreover, data were collected by using SDS (Severe Depressive symptoms) and melancholia items are considered as indicator for depressive symptoms as well. These two survey instruments asked participants how they feel in different circumstances in their current life.

To check the level of physical activity the FAQ was used. The Functional Activities Questionnaire is a 10 item instrument that asks the participant if they have any difficulty or need help with specific tasks [41]. The number of medical conditions reported by the participants; collected in health assessment clinics; were considered as indicators of physical health in the participants.

Data Aanalyses

Spss version 23 was used to analyses data.to show normal distribution of resilience score was confirmed by using Kolmgreve -Sminnove test and Q-Q plot chart. Independent t-test and one way analyses were used to compare means of resilience score among categorical variables. The correlation between numeral variables was assessed by using Pearson correlation coefficient and Eta was employed to assess correlation between categorical variables like history of treatment for depression. In the next step we used multiple regression analyses to check the predictability of various items for resilience score. Sociodemographic of sample size is presented in table 1.

Initial analyses showed that resilience sore and scores measured mental health related factors such as DASS, CES-D, melancholia score, DASS depression and Anxiety subscales were negatively correlated. Eta analyses showed higher resilience score among people without history of treatment for depression than individuals who had history of treatment for depression (p= 0.004).

Table1: Sociodemographics of sample study.

Correlation analyses between resilience score and items related to cognitive performance revealed that variables such as IQ-code score, PQ-Code Score, MAC-Q, ARCS were negatively correlated and people with higher resilient score reported lower cognitive complaint by both participant and informant. Further analyses also showed that the level of physical activity was positively correlated with resilience score.

To check another determinant of successful ageing the relation between resilience score and the number of medical condition reported by the participant was examined There was a negative correlation between number of medical conditions and resilience score(p=0.013). People with more resilient suffering from lower physical illnesses.

To check the predictability of mental health related indicators for resilience, emotional and cognitive variables including DASS, DASS Anxiety, DASS Depression, CES-D, Melancholia, were entered into stepwise regression model. The results showed that depressive symptoms were predictor for lower resilience (Table 3).

*α = 0.05 Table 3: Multiple regression analyses for depression.

Furthermore the scores of measures assessed cognitive complaints and performance including IQ-Code, PQ-Code, MAC-Q, ACRCS were entered into stepwise regression model and the results showed that resilience was a predictor for lower cognitive complaint (Table 4).

*α = 0.05 Table 4: Multiple regression analyses for cognitive measures.