Gill Windle

What is resilience? A review and concept analysis

The complexities of defining what appears to be the relatively simple concept of resilience are widely recognized. This paper analyses the concept of resilience from a range of disciplinary perspectives and clarifies a definition in order to inform research, policy and practice. The work takes a life course approach to resilience, examining evidence derived from research across the lifespan. It incorporates the methods of systematic review, concept analysis and consultation through face-to-face meetings. The synthesis of methodological approaches enables a clear identification of the antecedents, defining attributes and consequences of resilience, validated with stakeholder partners. Through this process, resilience is defined as the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity. Across the life course, the experience of resilience will vary. A large proportion of resilience research is routed within the discipline of developmental psychology, and has mainly been developed with children and adolescents. A major contribution to resilience research could be made through more multi-disciplinary studies that examine the dynamics of resilience across the lifespan, its role in healthy ageing and in managing loss, such as changes in cognitive functioning.

Is exercise effective in promoting mental well-being in older age? A systematic review.

Background: Promoting the mental well-being of older people has been neglected. Aim: To examine the clinical and cost-effectiveness of exercise and physical activity interventions on mental well-being in people aged 65+. Design: Systematic review, meta-analysis, economic model. Methods: Reports published in English, identified by searching 25 databases, 11 websites and references lists of systematic reviews. Eligible studies were those with a comparison or control group or offering qualitative evidence; exercise and physical activity interventions for people aged 65 and above living at home, in the community, in supported housing or in residential care homes; including outcome measures of mental well-being, not simply measures of depression or anxiety. Low-quality studies were excluded from the data synthesis. Results: An overall effect of exercise on mental well-being was found (standardised effect size = 0.27; CI = 0.14–0.40). The included interventions were designed for older people, targeted those who are sedentary and delivered in a community setting, primarily through a group-based approach led by trained leaders. As a minimum, the evidence would suggest two exercise sessions per week, each of 45 min duration. There is some indication that exercise can also improve the mental well-being of frail elders. Economic evidence indicated incremental cost-effectiveness ratios (compared with minimal intervention) of £7300 and £12,100 per quality adjusted life year gained for community-based walking and exercise programmes, respectively. Conclusions: Mental well-being in later life is modifiable through exercise and physical activity. To generalise the findings, there is a need for more evidence of effectiveness from older people in the UK.

Examination of a theoretical model of psychological resilience in older age.

Objective: This article integrates a number of theoretical perspectives and examines the concept of psychological resilience in older age. Drawing on the literature it is hypothesised that an overarching construct–resilience–accounts for the functioning of a number of psychological resources (self-esteem, personal competence and control). Method: The factorial validity of the resources as indicators of resilience is tested using confirmatory factor analysis. The analyses focus on previously unexplored survey data drawn from a representative sample of people aged between 50 and 90 in England, Wales and Scotland (N = 1847). Results: The results find a common factor (a higher-order model) provides the best explanation of the relationships between the resources, demonstrating an important first account for developing further work on this concept. Conclusion: Exploring what might form the basis of resilience from a psychological perspective enables a deeper understanding of why some individuals can remain positive in difficult circumstances, particularly some of the challenges of ageing.

Variations in subjective wellbeing: the mediating role of a psychological resource

This study examines the mediating role of psychological resources on life satisfaction, an indicator of subjective wellbeing. The evidence identifies several life events and changing circumstances that can be potentially detrimental to the wellbeing of older adults. Based on the literature, a theoretical model was developed with the hypothesis that adaptation to potentially adverse events draws on psychological resources central to the self. The study participants were a random sample of 423 community-dwelling people aged 70 years and over. All respondents were interviewed in their own homes using a structured schedule. Quantitative data were obtained on age, gender, social support, marital status, physical functioning, bodily pain, loneliness, isolation and housing difficulties. Subjective well-being was assessed by the life satisfaction index, and the psychological mediator was conceptualised as a measure of environmental mastery. The first round of analyses found that variations in well-being were associated with housing difficulties, isolation, loneliness, physical functioning, pain, support networks and marital status. The full model established perfect mediation by environmental mastery occurred for the variables housing problems and physical functioning, and partial mediation occurred for the variable loneliness – supporting the original hypothesis. The results add to the evidence from an increasing number of studies that demonstrates how psychological resources underlie the processes of adaptation to the changing situations that accompany increasing age and prevent negative outcomes.

A short measure of quality of life in older age: The performance of the brief Older People's Quality of Life questionnaire (OPQOL-brief)

Promoting quality of life in older age is an internationally recognized priority, requiring valid measurement. We present a short version of the established Older Peoples Quality of Life questionnaire (OPQOL-brief). The full OPQOL-35 was original in being developed from the perspectives of older people, assessed conceptually, and validated with a population sample using gold-standard psychometric assessment. The OPQOL-brief was also developed by asking older people to prioritize the most important items from the OPQOL-35, next assessed psychometrically with a population sample, and also statistically against the discarded 22 items. The aim was to assess the psychometric properties of the short, 13-item version of the OPQOL (OPQOL-brief), and to compare the performance of included and discarded items. The method was a national population survey of people aged 65+ living at home. The measures were OPQOL-brief, WHOQOL-QOL and CASP-19. The OPQOL-brief was found to be a highly reliable and valid, short measure of quality of life in older age. The OPQOL-brief is of value in assessment of interventions where a rigorously tested, short measure is required. The grounded development of the instrument is consistent with international policy emphasis on user involvement in shaping policy and research.

Mood, eating behaviour and attention

BACKGROUND Obesity is a growing health problem, but most people find dieting unsuccessful. Three studies examine possible reasons for the difficulty and the extent to which dieting-related reductions in cognitive function are associated with mood and well-being. METHOD In Study One, 49 female dieters were compared with a control group of 31 matched non-dieters on measures of well-being, mood, eating behaviour (Dutch Eating Behaviour Questionnaire), and attention. Study Two examined two measures of restraint to examine why previous studies find high restrainers are prone to react to emotion. Study Three experimentally manipulated mood using music and the standard Velten Induction Procedure to examine attention in restrainers and emotional eaters. RESULTS Dieting was found to be associated with deficits in sustained attention. This finding was further supported by the demonstration of a significant impairment in performance following a negative mood induction in high emotional eaters whereas high restrainers were relatively unaffected by the mood challenge. CONCLUSIONS We suggest that different aspects of eating behaviour have dissociable effects on cognitive-affective function. Trait tendencies to restrained eating are associated with attentional deficits, but are not further affected by mood disruption. It is the long-term tendency to eat when emotional that combines with current emotional state to trigger cognitive deficits.

Measuring the quality of life and well-being of people with dementia: A review of observational measures

The dynamic nature of psychosocial interventions implies that trying to measure their effects using standardised clinical trial measures may not capture their full effects. Rich and valuable data during the sessions may be missed by using standard quality of life questionnaires. This paper compares observational measures in the context of recording the well-being of a person with dementia during and outside of a visual arts intervention. A literature search was conducted using systematic principles of searching, screening and retrieval to identify peer-reviewed English language evaluations of research projects using observational measures with people with dementia. Psychometric properties, strengths and weaknesses of 11 observational tools are reviewed in order to identify the most appropriate one for evaluating a visual art intervention for people with dementia. This review supports the Greater Cincinnati Chapter Well-Being Observation Tool as an appropriate measure to evaluate a visual art programme for people with dementia. The results of this review will help researchers plan projects to show the full range of effects for people with dementia for taking part in art sessions.

Caring Relationships: How to Promote Resilience in Challenging Times

This chapter examines the potential for resilience within the context of caring relationships, mainly from the perspective of the adult carer. They may be caring for children, spouses or parents with a range of complex problems, such as health or behavioural issues. We will examine the contexts of care provision, exploring what contributes to, or eases the challenge of care provision across the life course. In doing so, we will identify the factors that build resilience for the caregiver in the face of significant challenges.

Lifestyle Matters for maintenance of health and wellbeing in people aged 65 years and over: study protocol for a randomised controlled trial

BackgroundHealthy, active ageing is strongly associated with good mental wellbeing which in turn helps to prevent mental illness. However, more investment has been made into research into interventions to prevent mental illness than into those designed to improve mental wellbeing. This applied research programme will provide high quality evidence for an intervention designed to improve and sustain mental wellbeing in older adults.Methods/DesignThis study was a multi-centre, pragmatic, two-arm, parallel group, individually randomised controlled trial to determine the population benefit of an occupational therapy based intervention for community living people aged 65 years or older. Participants (n = 268) will be identified in one city in the North of England and in North Wales through GP mail-outs, signposting by local authority, primary care staff and voluntary sector organisations and through community engagement. Participants will be randomised to one of two treatment arms: an intervention (Lifestyle Matters programme); or control (routine access to health and social care). All participants will be assessed at baseline, 6 and 24 months post-randomisation. The primary outcome, which is a person reported outcome, is the SF-36 Mental Health dimension at six months post randomisation. Secondary outcome measures have been selected to measure psychosocial, physical and mental health outcomes. They include other dimensions of the SF36, EQ-5D-3L, Brief Resilience Scale, General Perceived Self Efficacy Scale, PHQ-9, de Jong Gierveld Loneliness Scale, Health and Social Care Resource Use and the wellbeing question of the Integrated Household Survey 2011. A cost effectiveness analysis will investigate the incremental cost per Quality Adjusted Life Years (QALYs) of the Lifestyle Matters intervention compared with treatment as usual.DiscussionThe questions being posed through this research are important given the increasing numbers of older people, pressure on the public purse and the associated need to support good health in the extended lifespan. The proposed trial will determine the clinical and cost effectiveness of the intervention delivered in a UK context. The results will support commissioners and providers with decisions about implementation.Trial registrationCurrent Controlled Trials ISRCTN67209155

Exercise, physical activity and mental well-being in later life

Exercise and physical activity are thought to be among the most important lifestyle factors for the maintenance of health and prevention of premature disease and mortality. Yet sedentary lifestyles are common. Many people avoid exercise, and have done so across their lifespan. Exercise and physical activity are also considered important for positive psychological functioning; however, this has received limited research attention. This mini-review discusses the effects of exercise and physical activity on mental health and well-being in later life. It draws on international peer reviewed research, summarized in systematic reviews and/or meta-anlaysis, and presents the key findings. Systematic reviews and meta-analyses generally confirm the importance of exercise for mental well-being; however, there is a lack of good quality research. The review discusses some of the barriers to exercise, and identifies strategies that may facilitate uptake and adherence in later life. Limitations in the current evidence are discussed. Based on the current evidence, it is recommended that health practitioners should encourage exercise or physical activity of low to moderate intensity, and leisure time activity such as walking, especially at retirement. Future intervention research would benefit by focusing on people who have not self-selected into studies so as to understand the causal direction, and include theory driven approaches to behaviour change.