Resilience: a requirement for successful aging in all settings

Resilience: a requirement for successful aging in all settings

The importance of building resilience in older adults in communities, seniors centers, and other organizations within the active-aging industry cannot be underestimated, experts agree. Here’s how to do it

by Marilynn Larkin, MA

 

Imagine it’s your 95th birthday. You’ve been in a hospital for a month, battling a respiratory infection, but defying all odds, you are actually doing better.1 The strength that drove you to endure 27 years in prison, to finally attain freedom and to become an icon for your nation clearly is still present. Nelson Mandela is arguably one of the world’s best examples of resilience—the ability to bounce back after a challenge. It’s a quality most of us have to some degree, and experts agree it can be bolstered and reinforced in the right environments.

 

“Resilience goes hand in hand with wellness and successful aging,” says Colin Milner, founder and CEO of the International Council on Active Aging® (ICAA). “The right kinds of environments foster resilience in older adults, and we encourage ICAA members to embrace these environments in much the same way they have embraced the wellness model and the goals of successful aging.

 

“While the concept of building resilience is not new,” continues Milner, “it is increasingly urgent now, given the burgeoning number of older adults and the potential burden on healthcare systems if people are encouraged to be ‘cared for’ rather than to stay independent. Also, Boomers are looking to join communities and organizations that promote engagement and unique experiences rather than simply providing care or hospitality,”2 he states. “Resilience is an important quality
for those active settings, where taking on new challenges is often part of the appeal.”

 

Experts who have explored and helped implement resilience-building strategies for older adults agree on the need to promote resilience in all constituencies. In addition, these experts share a basic philosophy and approach for reaching that goal. Each one also brings unique perspectives to the discussion based on their experiences in the industry and/or the gerontological research community.


This article distills information provided by the interviewees about the benefits of encouraging older adults to become more resilient. It also offers insights from these experts on ways to change organizational cultures to foster resilience, and provides specific approaches that have been successful.

 


Can resilience be learned?
Intuitively, we might believe that some people, such as Nelson Mandela, are more resilient than others, and that little can be done to help those who can’t seem to respond robustly to life’s challenges. But that’s only partly true, according to our sources.


“Some people probably are genetically more resilient than others, but the genetic component is just one piece of the picture,” says Barbara Resnick, PhD, CRNP, FAAN, FAANP, professor in the Department of Organizational Systems and Adult Health at the University of Maryland School of Nursing in Baltimore. “Learned behavior also plays a role,” she notes— “and that’s where we definitely can make a difference.”


“As Aristotle said more than two thousand years ago, ‘You are what you repeatedly do,’” adds David Gobble, PhD, director of Masterpiece Living Academy, an entity established by the Florida-based successful aging initiative, Masterpiece Living, to offer expert guidance. “To me, this means that we live out our lives based on the patterns we’ve established,” Gobble continues. “People who established healthy patterns— eating right, exercising regularly, not smoking—early in life are more likely to do better later in life as a result of those patterns. The same is true of resilience,” he explains. “People who are accustomed to bouncing back from adversity will continue to do so into their 80s, 90s and beyond. However, it’s still possible to establish more healthful patterns later in life, if we can motivate people to make those changes and show them how to do it.”


According to Kay Van Norman, MS, president of the consulting firm Brilliant Aging in Bozeman, Montana, older adults are likely to be more resilient than most people—or they themselves—believe. “You don’t live to be in your 80s without having been resilient throughout your life, because you can’t live that long without having faced and come back from challenges, be they physical, emotional, financial or any other type.


“However, if resilient individuals suddenly find themselves in environments where people do everything for them, they’ll likely stop flexing that resilience muscle,” Van Norman says. “To prevent that from happening, we need to rethink how we interact with residents and members. We need to consistently support independent decision-making and autonomy, which enable people to take charge in the face of a challenge, rather than becoming a victim.”

 


Changing organizational cultures to support resilience
Allowing older adults to flex their resilience muscles often requires a change in organizational culture. This, in turn, will influence both staff expectations and the expectations of their constituencies.


“I’m putting this out as a challenge to the active-aging industry: Think differently about how you work with older adults and prioritize building resilience in your communities and organizations,” states Resnick, a member of ICAA’s Scientific Advisory Board. “Yes, this is already happening in some settings. Many others, however, are steeped in caring or catering to older adults, rather than engagement and growth.”


“It’s a conundrum,” Gobble notes. “We’re trying to create environments we believe are pleasant and appropriate for people, and in so doing, we often overserve them and make everything too easy. We also want environments that are easy for us to manage—but easy for the professional doesn’t necessarily mean growth for the resident,” he stresses. “That is our challenge to ourselves.”

 

Culture change begins with support and belief by an organization’s executive management, our interviewees agree. “Every time an executive director meets with staff, a key question needs to be, ‘How does what we’re doing or planning to do affect our growth environment and how does it support our core mission?’” Gobble observes. “Organizations with executive directors who literally state that at every formal meeting make progress, and we see change. Until that happens, all the talk about core values is just hot air.”


Creating culture change involves “training the entire staff on human potential and aging, because many people working in our industry underestimate that potential,” Gobble continues. “If someone doesn’t expect you to be able to do something and doesn’t work toward creating an environment in which you’ll be able to do that thing, then you most likely won’t do it.”


Resnick agrees. She gives this example: “When we just provide care, if individuals have a new physical challenge that affects walking—recovery from a hip replacement, for example—the tendency is to put them in a wheelchair and not make them walk any more. That approach doesn’t allow the person to build resilience.”


Staff often are too quick to accept “no” for an answer, Resnick adds. “Staff may start out by saying, ‘I’m going to work with you and help you believe you can overcome this hip fracture.’ But if someone refuses to go to therapy, there are two options—to keep working with the person, pushing every day and never giving up, or saying, ‘Okay, forget it. You’ve had your chance.’ And in some communities, it’s acceptable for caregivers to ask once and then move on to someone else,” she states. “Or for them to stop helping if an adult child says, ‘Oh, but my mother doesn’t want to do therapy,’ instead of standing up and saying that they’re working to build the parent’s resilience and recovery and success.”

 

Van Norman, a member of ICAA’s Industry Advisory Board, points out that staff often will say, “Well, these people can’t take care of themselves. They do need our help.” While that may be true, “the idea that you have to protect and support often is taken to the extreme, and bleeds into every interaction,” she observes. “That’s the time to step back, take age out of the equation and start looking at individuals only from the point of view of their particular needs, and how you might help them develop adaptive strategies for self-care. The focus needs to be on helping older adults create their own reality and take responsibility for their lives, rather than creating their reality for them.


“True, you can’t just wave a magic wand and say, ‘Okay, everyone be resilient now,’” Van Norman admits. “Organizations have to look at their environments from the ground up, and at all of their policies and procedures through the lens of resilience. When this is done, people often are surprised at how many times they have to say, ‘Well, this policy probably diminishes rather than supports resilience.’” She adds, “Yes, sometimes, things have to be done in a certain way. But many times, you can find alternatives.”


Changing cultures also requires changing the mindsets of one’s constituencies. Self-stereotyping (e.g., “I’m too old to do that”) and the learned helplessness that accompanies it (e.g., “I’ll never get to the dining room unless you wheel me there”) are reinforced in the care model. It may be difficult to convince residents of their own abilities if they are accustomed to that model. Nevertheless, says Resnick, “We need to create situations in which people say, ‘Wow! I did that.’ Because it’s only through that acknowledgement that they’ll grow and move out of the gloom and doom of ‘I can’t this, I can’t that.’”

 

 

Resilience-boosting strategies
Changing cultures and attitudes takes time, but some resilience-building strategies can be implemented right away. Resnick identifies three areas of focus:3

  • fostering attributes such as vigor, optimism and physical robustness
  • strengthening self-efficacy, self-esteem and motivation
  • improving socialization


However, she stresses that these areas are not mutually exclusive: An intervention in one area—improving physical activity, for example—can also boost a person’s self-esteem and self-efficacy, and provide opportunities for socialization.

 

Following are some resilience-boosting strategies shown to be effective in various older-adult settings:


Set realistic and attainable goals with input from the older adult. “Some older adults have a hard time setting goals so sometimes we have to push a bit— but regardless of age or condition, people can still have goals,” Resnick emphasizes. “It might be walking to the dining room or being the first one to get there. For some people, it’s just getting up the next day. Whatever it is, we need to start there and move forward.” If individuals have cognitive impairments that preclude goalsetting, speak with family members and friends and set goals based on prior life accomplishments, she advises.


Address concerns such as fear of falling or exacerbating underlying medical problems. These fears can interfere with the person’s willingness to embark on an activity or persist in it long enough to achieve feelings of selfefficacy, Resnick observes. “Sometimes, all it takes is a conversation or accompanying the person to the activity to allay anxieties.”

 

Provide opportunities for meaningful engagement. “If I’m in an environment where people do things for me all the time, where everything is set up for me and I don’t have to go through the process of figuring things out, it’s easy to feel like I’ve lost my sense of mastery,” Van Norman comments. “This loss can’t be replaced with an array of activities. We need to foster a sense of meaningful engagement—involvement in something that matters to the individual and/or to the community and society. It needs to be purpose-driven,” she adds, “whether it’s about helping one’s own ability to function or contributing to some larger cause.”


Review and remind the person about how they faced and overcame previous challenges. “By reminding people that they’ve been resilient in their life and helping them recall specific instances when they’ve shown resilience, we can help them build resilience in the here and now,” says Van Norman. “People sometimes get an idea that they’re resilient or they’re not. That’s just another form of self-stereotyping that can stand in their way and prevent them from
seeking adaptive strategies.”


Build challenges into every activity so that people have opportunities to incorporate new successes. “This runs counter to the care and hospitality models,” notes Gobble, “but we should be doing things like scheduling activities in such a way that people have to, for example, walk an extra 50 ft. to get there. By doing so, our members will simply have to rise to the challenge.”

 

Encourage social support. “Social support groups play a key role in promoting resilience, particularly in the face of an unexpected challenge, such as the loss of a loved one,” mentions Roger Landry MD, MPH, preventive medicine physician and president of Masterpiece Living, LLC. “A social support group doesn’t just take care of people or help them get through a challenge; it allows them to talk about their fears and reinforces that they don’t have to handle everything on their own.” Landry has written a book—Live Long, Die Short: A Guide to Authentic Health and Successful Aging (in press)—to educate people about what they need to be healthy and age well, including strong social engagement.4

 


Moving forward
“For the active-aging industry, the operative word increasingly is active,” observes ICAA’s Milner. “Environments that offer choices, positive challenges, growth opportunities and the idea of doing ‘with’ rather than doing ‘for’ are increasing. These same environments promote what we have come to recognize as ‘successful aging,’” he says. “Now is the time to truly embrace these resiliencebuilding, life-enhancing strategies for clients of all ages and abilities.”

 


Marilynn Larkin, MA, is an award-winning medical writer and editor, as well as an ACE-certified personal trainer, group fitness instructor and originator of Posture-cize. She is also ICAA’s Communications Director and a regular contributor to the Journal on Active Aging®.

 


References

  1. Govender, P. World pays tribute as “improving” Mandela turns 95. Reuters, July 18, 2013. Retrieved on July 20, 2013, from http://www.reuters.com/article/2013/07/18/us-mandelaimproving-idUSBRE96H04F20130718.
  2. Bortz, D. Boomers Flock to Niche Retirement Communities. US News and World Report, July 20, 2013. Retrieved on July 20, 2013, from http://money.usnews.com/money/retirement/articles/2012/04/13/boomers-flock-to-nicheretirement-communities.
  3. Resnick, B., Gwyther, L., & Roberto, K. (eds.). (2011). Resilience in Aging. New York, NY: Springer.
  4. Landry, R. (2014). Live Long, Die Short: A Guide to Authentic Health and Successful Aging (in press). Austin, TX: Greenleaf Book Group.

 

 

This article is provided courtesy of the International Council on Active Aging www.icaa.cc