Challenges and healthy ageing: the role of resilience across the life course

1. Challenges and healthy ageing: the role of resilience across the life course 30th September 2009 Bangor University

2. ResNet: Research Questions • To what extent is resilience determined by community, individual and biological characteristics? • How can resilience best be defined and measured in order to inform research, policy and practice? • How can resilience be developed, maintained and enhanced to reduce health and social inequalities and achieve healthy ageing across the life-course? • How do life course experiences influence health and resilience?

3. ResNet: Work plan

4. Work Package 1Update Literature Review – definitions, determinants, measurement, interventions • A. (DE=resilien*) and((KW=biol*) or(KW=geog*) or(KW=community)) • B. (DE=resilien*) and((KW=Interven*) or(KW=promot*) or(KW=associat*) or(KW=determin*) or(KW=relat*) or(KW=predict*) or(KW=review) or (definition)) • Social Sciences CSA (ASSIA, Medline, PsycInfo) • Web of science (SSCI; SCI AHCI) • Greenfile • Cochrane database of systematic reviews

5. Methods (2) • Inclusion/exclusion (to be applied when screening journal abstracts) • Research papers where resilience is a key focus and/or is assessed (NOT papers that are just picking up the word in the discussion) • The population of interest is human (not animal research) • All age groups considered • Peer reviewed journal articles, priority given to systematic reviews/meta analyses • 1989 onwards • English language only • Exclude if only the title is available • Google/websites

6. Results - summary by population

7. Definitions of Resilience – Key Points from the Literature (1) • There is a consensus in the literature regarding the complexities of defining resilience • There are variations in definitions of resilience, often according to the adversity under question, which in turn identify different risk or protective factors that impact on different outcomes. • Definitions of resilience have been derived from observations in child & adolescent research which have shaped developmental theory – applied to adults and older age

8. Definitions of Resilience – Key Points from the Literature (2) Three broad areas of resilience research (Masten 2007): • 1) Developing well in the context of high cumulative risk for developmental problems (beating the odds, better than predicted development) • 2) Functioning well under currently adverse conditions (stress-resistance/coping) • 3) Recovery to normal functioning after catastrophic adversity or severe deprivation (bouncing back, normalization) • Accounts mainly for observations derived primarily from children and adolescents, does this also account for some of the observations in adults and older adults?  • In research on loss, trauma and human resilience in adults Bonnano (2004) defines resilience as an individual’s capacity to resist maladaptation in the face of risky experiences and maintain a stable equilibrirum - does 2 account for this? Is maintenance the same as functioning well? • Bonnano does not agree that recovery is the same as resilience.

9. Resilience?

10. Theoretical Framework – Bronfenbrenner’s Ecological Systems Theory of Development

11. Results – study design x population (1)

12. Results – design x population (2) • Adolescents and early adulthood – 3 papers (2 longitudinal studies, 1 qualitative) • Families – 5 papers (1 literature review of intellectual disabilities, 4 cross sectional surveys

13. Results – design x population (3)

14. Results – design x population (4)

15. Results – Study Design x Population Community/Society – 7 papers, all literature reviews, which discuss the threat of natural disasters or ‘national stressors’ at the society level such as social exclusion, economic disadvantage, social capital, violence. Other – 25 papers which did not fit in the other categories 12 literature reviews, 5 relating to biological resilience in response to stress & childhood abuse Specific populations and adversities e.g. cancer survivors, parents who were abused as children, burns

16. Results –Population x Adversity Children & Adolescents

17. Results – Population x Adversity Adolescents and early adults • 1 x risk of developing mental illness • 1 x socio-economic adversity • 1 x Families with substance abuse problems Families • 1 x review of intellectual disabilities • 2 x stress & poverty • 1 x mental illness • 1 x maternal depression

18. Results – Population x AdversityYounger Adults Brain injury • Children with developmental disabilities • Violent trauma • Poverty • Bereavement • Progressive chronic disabilities • Unemployment • Immigration • Children with cancer/chronic conditions • Family crisis • HIV/AIDS • Work stress

19. Results – Population x AdversityOlder Adults • Bereavement • Rheumatoid Arthritis • PoW • Chronic illness and racism • Terminal illness • Depression • Stress • Stroke • Multiple adversities (limiting long term illness, bereavement, stress, poor life circumstances)

20. Measurement – Key Points • Population differences in how data on resilience is obtained - adults v children • Multiple vs single indicators • Better results may be obtained if the adversity and the outcome are conceptually similar or theoretically linked • The strength of resilience • Direct, moderation, mediation

21. Interventions So far, only one primary paper of an intervention has been identified. Be a star community-based after-school program: Developing resiliency factors in high-risk preadolescent youth (Pierce et al, 1998). Designed to build resiliency to withstand pressure from peers and the community to abuse substances. This reflects the results of an earlier review by (Newman & Blackburn, 2002) who state that   • “The literature on resilience promotion, while empirically based, includes relatively few accounts of conscious and specific strategies used to promote resilience, and fewer still that have been subject to a robust evaluation using controlled trials” • Others note that more investment has been made in identifying risk/protective factors, but less on designing and testing interventions that might change negative outcomes. • Cochrane Data base of systematic reviews: Title: Psychosocial, community based interventions for promoting resilience in disadvantaged children aged 5-17 Stage: Registered Title : 10 June 2009 Last Updated: 01 July 2009 Author: Davidson, Gavin Country: UK Entity: Developmental, Psychosocial and Learning Problems Group

22. Interventions • Luthar, S. S., & Brown, P. J. (2007). • Outline a few interventions for children and their parents in the context of maltreatment, e.g. the Incredible Years, - training in parent skills, preparing children for school and parents coping with own problems. Many of these focus on attachment. • Characteristic to some of the resilience interventions is that they are implemented without the recipients having necessarily experiencing a significant adversity – they are preventative. The UK Resilience Programme: • Promoting emotional resilience in 11-13 year olds • Promoting emotional resilience amongst older people • Bernardo’s Arch Project • Interventions need to consider culture and context when studying or theorizing resilience in at risk populations (Ungar 2005) • Resilience or normal development? Luthar, S. S. & Brown, P. J. (2007). Maximizing resilience through diverse levels of inquiry: Prevailing paradigms, possibilities, and priorities for the future. Development and Psychopathology, 19(3), 931-955