Abstract
The concept of “resilience” is considered helpful in understanding how people navigate adversities typical to later life. It is also a concept of growing interest internationally in research and in social policy and (social) practice. This article employs an integrative review methodology to explore current trends in theoretical and empirical research on resilience. A total of 25 quantitative and qualitative studies from 2011 to 2020 are included in this review. Findings indicate how the reviewed studies typically define resilience from three perspectives: resource-based, outcome-based, and process-based perspectives of resilience. In the results of the same studies, the resource-based and outcome-based perspectives are elaborated upon while detailed results from a process-based perspective are lacking. Additionally, even though adversity is recognized as a key element in conceptualizing resilience, it is scarcely defined if defined at all in the reviewed studies. Further research is recommended in this article to contribute to a realistic and encouraging narrative on growing older in social policy and (social) practice.
Introduction
Later life brings with it unique challenges, including death of loved ones, decline in physical and cognitive capabilities, and decreasing mobility (Cruikshank, 2013; Gullette, 2004; Laceulle & Baars, 2014; Machielse & Hortulanus, 2013; Machielse, forthcoming). These challenges are often accompanied by injurious outcomes such as loneliness, higher dependency, decreased autonomy (Breiding & Armour, 2015), existential issues concerning meaning in life (Aydin et al., 2020; Edmondson, 2015), and increasing awareness of finitude and death (Cole et al., 2010; Dahlberg et al., 2022). Why injurious outcomes occur for some people in later life and not for others is a question of continued interest in international scientific research.
The concept of “resilience” is considered interesting in this regard as it provides insights into how people navigate adversities in a way that prevents injurious outcomes (Amaral et al., 2020; Browne-Yung et al., 2017; Hayman et al., 2017; Wild et al., 2011; Wiles et al., 2012, 2019; Wilson et al., 2020). “Resilience” is widely recognized as complex to define (Aburn et al., 2016; Windle, 2011). Based on a systematic review of 100 articles, Aburn et al. (2016) identify five key themes underpinning ranging definitions of resilience. These five key themes are: “rising above to overcome adversity, adaptation and adjustment, interlacement with everyday life, good mental health as a proxy for resilience and finally, the ability to bounce back” (p. 991).
Multiple perspectives are utilized to understand resilience. A large body of research on resilience describes resilience as a personality trait, as a representation of personal qualities allowing an individual to thrive amidst adversity (Connor & Davidson, 2003; IJntema, 2020; Windle, 2011). Other studies demonstrate that resilience is not something “magical” that some are lucky to possess but is a result of everyday choices and is accessible to all (Aburn, et al., 2016; Masten, 2014 in IJntema, 2020). Several researchers have therefore shifted focus away from resilience as a personality trait toward understanding resilience from resource-based, outcome-based, and process-based perspectives (IJntema, 2020; Infurna & Luthar, 2018).
The resource-based perspective is prominent in the literature on resilience and involves identifying core attributes of participants identified as resilient. These core attributes are identified on multiple levels, that is, individual, community, and society. Recognition of these multiple levels broadens the focus of this perspective beyond individual personality traits (Bergeman et al., 2020; Emlet et al., 2017; Hicks & Conner, 2014; Klokgieters et al., 2020; Randall, 2013; Smith-Osborne & Felderhoff, 2014; Szabó et al., 2020; Tay & Lim, 2020; Windle 2011). The resource-based perspective is popular for informing social policy and interventions aiming to strengthen resilience in individuals and communities (Infurna & Luthar, 2018). The outcome-based perspective recognises resilience as including a ‘positive outcome’ after facing ‘adversity’ or a ‘pattern of positive adaptation’ (IJntema, 2020; Infurna, 2020; Windle, 2011). This perspective differs from the resource-based perspective in its emphasis on a positive outcome, including different forms of positive adaption to adversity (Infurna, 2020; Fisher et al., 2019; IJntema, 2020; Windle, 2011). The process-based perspective approaches resilience as a phenomenon occurring through interactions within and between multiple levels that is, individual, community, and society. This is often described as “dynamic” or “fluid,” a balancing of vulnerabilities and strengths, which fluctuates over time and across the life course (Browne-Yung et al., 2017; Infurna, 2020; Infurna & Luthar, 2018; Wiles et al., 2019; Windle, 2011). The process-based perspective differs from resource-based and outcome-based perspectives as it moves beyond specific attributes and positive outcomes. It explores working mechanisms that bring the other two perspectives together, considering this can manifest itself differently due to timing and context. This is where authors differentiate between resilience and coping. Coping, while also a process-based response to adversity, does not necessarily result in a positive outcome (Lewis, 2019).
Common to all three perspectives on resilience is the inclusion of “adversity.” For example, Aburn et al. (2016) and Fisher et al. (2019) recognize inclusion of adversity in defining and understanding resilience as fundamental. Although adversity is often defined in relation to major life events or traumatic situations (Holston & Callen, 2021; Wild et al., 2011, Wiles et al., 2019), Power et al. (2019) argue that adversity need not only arise in extraordinary circumstances but can also occur in everyday life. They define adversity as particular (often extraordinary) embodied and emplaced circumstances in people’s lives that cause pain, disruption, exhaustion, disorientation, loneliness, and grief. Understood in this way, adversity may refer to mundane, everyday experiences such as feeling weaker when getting dressed, no longer being able to drive a car or having difficulties with cooking dinner (Wright St-Clair et al., 2011).
Another concept of importance in research on resilience in later life is the generic and often vaguely defined concept of “aging” (Hicks & Conner, 2014). Drawing upon the dictionary of Medicine, Nursing Allied Health (2003), Hicks and Conner (2014, p. 746) describe aging as “the gradual changes in the structure of any organism that occurs with the passage of time, that do not result from disease or other gross accidents that eventually lead to the increased probability of death as the individual grows older.” The all-inclusive nature of this definition succinctly highlights elementary changes that everyone experiences while growing older. How adaption to these changes and accompanying consequences varies per person is where the link with resilience resides.
When discussing aging, it is relevant to note the existence of a widely recognized and implicitly dichotomous discourse on growing older in Western societies. These narratives include terminologies such as “successful aging,” “healthy aging,” and “vital aging” and thereby bare an implicit focus on positive adaption (de Lange, 2021; Gullette, 2004, 2017; Hicks & Conner, 2014). Adjectives like “successful,” “healthy,” and “vital” function often as a counterweight to a negative framing of aging, which implies aging is inherently undesirable, and needs to be neutralized, countered, denied, or balanced (Laceulle, 2018). Widespread critique on “successful” aging models (Martinson & Berridge, 2015) includes stigmatization around dependence and disability (Gilleard & Higgs, 2010), a reductionist emphasis on physical and mental health (De Donder et al., 2019) at the expense of social, spiritual, and meaning dimensions of later life (Atchley, 2009), and failure to account for subjective perspectives of older people on what success entails (Carr & Weir, 2017; Dumitrache et al., 2019). Based on these critiques, several authors highlight the importance of building a discourse on aging that simultaneously embraces vulnerabilities and potentials in later life (Laceulle, 2018, p.974; Machielse, forthcoming). This review, therefore, explicitly attempts to move away from a dichotomous trend in narratives on growing older. It is not intended to contribute to an implicitly dichotomous understanding of “resilient aging.” As clarified, understanding resilience as a process has the potential to build a narrative that simultaneously embraces adversity, positive outcome, and the process of bringing these together.
This review aims to explore how the concept of resilience is currently approached and used in theoretical and empirical research from the years 2011 to 2020. An integrative review methodology was used to explore how the three perspectives described and the element of adversity are utilized in defining resilience in later life. Based on findings, it is discussed if research on the concept of “resilience in later life” supports policymakers and (social) professionals in building realistic narratives on growing older when using this concept in practice.
Methods
To provide a comprehensive picture of the complex concept of resilience, an integrative literature review was performed, combining theoretical and empirical scholarly literature, both qualitative and quantitative (Whittemore & Knafl, 2005). An integrative review involves five steps: problem identification, literature search, data evaluation, data analysis, and presentation (Whittemore & Knafl, 2005).
Step 1, problem identification is outlined in the introduction of this article. We identify a need to explore what scientific research on resilience can mean for building realistic narratives on resilience during later life. For step 2, literature search and data evaluation, search engines World Cat & Google Scholar were utilized for broad access to relevant articles. This entailed searches in databases of PubMed, Science Direct, Taylor & Francis, Oxford, Cambridge University Press, Springer, Elsevier, and SAGE. See Table 1 for the search terms and Boolean search strings used. These terms were identified by a thorough search of synonyms and related concepts to resilience and aging. At this point, the aim was to gain insight into resilience in a broad sense. During this step, duplicate articles were filtered out and texts about resilience, in general, were also read as well as those specific to resilience in aging during later life. A “snowballing technique” was employed when reading articles on resilience in general, or research on resilience done under younger age groups. Studies were discovered in reference lists of these articles referring to older age groups or aging and were therefore relevant for this review.
Search Terms (in English and in Dutch).
Texts chosen for data analysis followed narrower inclusion criteria. Literature was limited to English and Dutch languages and disciplines of gerontology, social work, and psychology. Additional inclusion criteria narrowed the search further to articles that are focused on resilience in older age groups (age 50+), are published between 2011 and 2020 and written to academic standards (peer-reviewed). English and Dutch language criteria reflect languages available to the authors, and the discipline choice reflects areas of study that actively engage with the concept of resilience in later life. The age criterium of 50+ is in line with the recommendation from AGE Platform Europe (2021). The choice for articles published between 2011 and 2020 was based on the substantial growth of research on resilience in later life in the fields of gerontology and social science in recent years. In psychology, particularly developmental psychology, research on resilience has a longer history, but the majority of this research is focused on younger age groups. It is in recent years that research on resilience amongst older age groups has also begun to grow in psychology (Amaral et al., 2020; Bourbeau, 2018; Browne-Yung et al., 2017; Wild et al., 2011; Wiles et al., 2012, 2019; Wilson et al., 2020). Furthermore, articles where resilience was only mentioned as an adjective but not specifically explored or detailed further were excluded because they did not offer additional insight into the research questions on hand.
Included texts are presented in Table 2. The selected articles are a mix of theoretical review articles and empirical articles, provide a range of insights into resilience and aging, and utilize diverse methodologies. Zhou et al. (2021), for example, carry out a scoping review and Wilson et al. (2020) execute a qualitative meta-synthesis of literature. Stephens et al. (2015) use 145 interviews in their article and Janssen et al. (2012) write based on narratives of two older women. See for an example of quantitative research the use of basic descriptive statistics and Pearson’s correlation in Fuller and Huseth-Zosel (2020).
Articles Reviewed.
For steps 3 and 4, data analysis and evaluation, included articles were read multiple times. The articles were categorized as theoretical or empirical, and further categorized thematically by the first author. Emerging categories included caregiving, frailty, capability, COVID, grandparents, HIV, mastery, migration, minority groups, models of resilience, oldest old, remote places, natural disasters, precarity, and socio-economic status. This categorization provided insight into what kind of topics research on resilience and aging currently addresses.
All articles reviewed were summarized according to author, name, journal of publication, number of participants, age (range and average), gender, definition of resilience, and connection with aging. Then all texts were analyzed regarding whether a resource, outcome, or process-based perspective is taken on resilience in the definitions and results/discussion sections of the articles. Finally, all texts were analyzed regarding how the concept of adversity was used. To execute this evaluation and analysis, color-coded tables in Microsoft Word were constructed. Although not specified in the research questions, age and gender were noted to gain insight into study populations included in reviewed studies. This was a point of interest due to the exploratory nature of this article and regarding possible areas of further research.
Step 1 involved input from all authors which took form in regular meetings to discuss the topic choice. Step 2 involved reading and selection of articles by the first author which was cross-referenced with the second and third authors who made suggestions on articles to read and authors to look up. Steps 2, 3 to 4 were led by the first author and involved several meetings between all authors. In these meetings, the first author informed the second and third authors of decisions taken. Any disagreements on choices made were discussed, and plans were collectively made for adjustments and next steps. These steps occurred over approximately 5 months. For the final step of data presentation and deciphering the implications of findings, the same procedure was followed. This process took place over approximately 2 months.
Results
Table 3 demonstrates age and gender distributions in empirical studies included. Most empirical articles focused on people aged between 65 and 85, of whom, the majority were female participants.
Age and Gender Distribution of Participants (Empirical Studies).
Range is provided in Wiles et al. (2012): age 56–92. Age distribution is provided in Stephens et al. (2015): 47% age 63–74, 41.6% age 75–84, and 11.4% age 85+. Range is provided in Aléx (2016): age 75–90. Range is provided in Gibb et al. (2018): age 61–80. Range is provided in Wiles et al. (2019): age 85–90.
Table 4 demonstrates which terms were identified as characteristic of each perspective on resilience; resource-based, outcome-based, or process-based.
Terms Identified to Represent Each Perspective.
Perspectives Used in Current Research
As demonstrated in Tables 5 and 6, findings reveal a pattern of empirical studies beginning with a general definition of resilience drawing upon the resource-based, outcome-based, and/or process-based perspectives and includes the element of adversity. Tables 5 and 6 also indicate how results from these same studies lean largely toward a resource-based and outcome-based perspective on resilience.
Inclusion of Perspectives on Resilience and Adversity in Theoretical Articles (Four Studies).
Inclusion of Perspectives on Resilience and Adversity in Empirical Articles (21 Studies).
Despite the commonality of utilizing all three perspectives and the element of adversity to define resilience, word choice remains varied per definition. By way of illustration, empirical studies by Kalomo et al. (2018, p. 606) and Kok et al. (2018, p. 844) contain elements of all three perspectives on resilience, although they are worded differently. When referring to resources, Kalomo et al. (2018) write of the “ability to achieve, endure, and sustain” and Kok et al. (2018) include “assets and resources within the individual, their life and environment facilitate this capacity for.” As for positive outcome, Kalomo et al. (2018) refer to “health and well-being”; Kok et al. (2018) refer to “adaptation and ‘bouncing back’”. When discussing process, Kalomo et al. (2018) talk of “a positive adaptive process” while Kok et al. (2018), describe “the process of effectively negotiating, adapting to, or managing.” When referring to adversity Kalomo et al. (2018) mention “adversity or under conditions of stress” while Kok et al. (2018) indicate “managing significant sources of stress or trauma.”
Adversity
Findings indicate a general trend of including the word “adversity” when defining resilience without providing a definition or an explanation for what it specifically means in terms of the study and resilience (Browne-Yung et al., 2017; Fuller & Huseth-Zosel, 2020; Hrostowski & Rehner, 2012; Miller & Brockie, 2015; Ottmann & Maragoudaki, 2015; Smith-Osborne & Felderhoff, 2014; Kalomo et al., 2018; Wiles et al., 2012; Wilson et al., 2020; Zhou et al., 2021). Table 7 provides an overview of 14 articles that define and/or specify what they mean by the word adversity.
Inclusion of Definition or Specification of Adversity.
In studies included in Table 7, it is evident that when adversity is elaborated on, the general pattern is to leave it undefined and specify “types of adversity” focused on in the study. By way of example, Amaral et al. (2020) do not define adversity in general but specify it for the purpose of their study, namely as adversity linked explicitly to “decline of a functional, cognitive and relational nature that is related to ageing” (p. 2). Exceptions to this general pattern include, Emlet et al. (2017), Amaral et al. (2020) and Hicks and Conner (2014). In Emlet et al. (2017) the definition for adversity is not provided, but clarification is given as to why not (p. 2132). In Amaral et al. (2020) adversity is defined as “the antecedent of resilience” (p.2). In Hicks and Conner (2014), adversity is defined as “referring to negative life experiences that entail challenges of coping or adaptation” and as “a necessary antecedent to resilient ageing” (p.747, p.748).
Models of Resilience
Findings show how authors operationalize findings into theoretical models and tools. Based upon an integrative review, for example, Hicks and Conner (2014) created a generic model of resilient aging. Wilson et al. (2020), via a qualitative meta-synthesis of literature examining resilience from older adults’ perspectives, created a four-factor model of resilience in older adulthood. Other authors developed models for specific target groups. For instance, Smith-Osborne and Felderhoff (2014) created their model with a focus on Veteran’s informal caregivers via a systematic literature review. Zhou et al. (2021), via a scoping review and content analysis, develop a unified model of resilience for Dementia caregiving. The empirically-based “My Positive Health” dialogue tool from Huber (2013) is similar to the work of these authors (Hicks & Conner, 2014; Smith-Osborne & Felderhoff, 2014; Wilson et al., 2020; Zhou et al., 2021). This similarity is evident in the focus on the resource-based and outcome-based perspectives on resilience in the dialogue tool (IPH, 2021b) which illustrates 6 dimensions and 42 factors that guide individuals in achieving a broader insight into their health status (Huber et al., 2011).
Discussion
Findings indicate a pattern of emphasizing resource- and outcome-based perspectives on resilience and underdevelopment of a process-based perspective. The meaning of adversity is poorly defined or elaborated, if at all, in the reviewed articles. The analyzed studies, therefore, support social policy and practice with information on resilience strengthening resources identified as helpful in obtaining positive outcomes in later life, as well as what these positive outcomes look like. They also help illustrate how resilience is influenced by factors on several levels, that is, individual, community, and society. Without deepening our knowledge on the process-based perspective and everyday adversity, however, we believe that results of current research can unintentionally forge a dichotomous narrative of “resilient aging,” that is, what resources one needs to age in a “resilient way” as evidenced by positive outcomes.
We believe that further research on everyday adversities faced in later life and their interconnection with a process-based perspective on resilience is necessary. Such research embraces adversity and potentials simultaneously as part of a process and expands on a lack of research in this area. The non-dichotomous nature of such an approach may help build a comprehensive narrative on growing older in social policy and (social) practice that challenges narratives of “successful aging,” “healthy aging,” and “vital aging.” Using philosophical theories on the concept of “authenticity,” Laceulle (2018) provides further grounds for why we recognize importance in such research. She states that authenticity can be understood as “being true to an original or being of undisputed origin” (Laceulle, 2018, p. 971), and that being true to everyday adversities and potentials in later life necessitates a nuanced and comprehensive narrative. Based on results of this review, we believe that research on everyday adversities within a process-based perspective on resilience can provide such a narrative.
We recognize this recommended research to be of further relevance to operationalization of resilience in older age and its implementation in social policies and practices. For the purpose of illustration see how My Positive Health (Huber, 2013) takes a prominent position in the National Health Policy Note 2020 to 2024 in the Netherlands (IPH, 2021a). Research on everyday adversities and their role in a process-based perspective on resilience can support application of such models while maintaining a comprehensive and relatable narrative that is not centered purely on resources and positive outcomes.
This review also identifies examples of studies contributing to a nuanced dialogue on resilience in later life. Firstly, Gibb (2018) illustrates essential influence of community and societal interactions on individual feelings of resilience and provides deeper insight into the process of how this works. Second, Dolbin-Macnab et al. (2016) elaborate on “resilient processes” in managing everyday adversity. Thirdly, Dubovská et al. (2017) explore how participants are “storying their lives” under categories of narrative analysis. Instead of focusing on these categories from a resource, outcome, or process-based perspective of resilience, the authors deepen them out as aspects of narratively constructed resilience. Additionally, Miller and Brockie (2015) share participants “lived experiences” of resilience during a flooding disaster using poetic enquiry. Finally, Stephens et al. (2015) apply the capability approach from Amartya Sen to resilience. Six domains of “functioning” were determined as important to participants in helping them achieve “values” during aging. In this article, Stephens et al. (2015) employ the traditional view of Sen, which does not advocate for a specific set of functionings or “pre-determined lists.” These articles (Dolbin-Macnab et al., 2016; Dubovská et al., 2017; Gibb, 2018; Miller & Brockie, 2015; Stephens et al., 2015) can provide inspiration for future research.
Broad inclusion criteria in this article provides insight into age categories and genders that are most and least focused on in the reviewed articles. Consider for example how the age category of 85+ is the least focused upon, and additionally, that research participants of the same studies are predominantly female. Additionally, it is interesting to note how even though the search strategy employed in this article did not restrict the review to research from western societies, research from non-western societies was scarce. Two included study comes from Africa (Dolbin-Macnab et al.,2016; Kalomo et al., 2018) and one study focuses on Sami grandmothers (Aléx, 2016). These findings on age, gender, and where research on resilience predominantly originates provide interesting directions for further research.
Limitations
This review article has several limitations. Firstly, the 25 texts included for analysis are diverse in discipline, focus, and methodologies employed. Second, the age limit of 50+ is a low age limit. This results in including articles with wide ranging methodologies and inclusion of a broad and heterogeneous group of participants. This review article does not provide further detail on quality of the included reviews and can hardly be considered representative when discussing “later life” or “aging.” Finally, articles and books from before 2011 are excluded due to this review’s aim, scope, and methodological choices. Resilience research extends far beyond 2011 (Bourbeau, 2018). This review does not regard this earlier literature on resilience as unimportant. To gain a deepened insight into the genealogy of resilience, in order to promote informed reading of this review, it is recommended to read publications and gray literature from before 2011.
Conclusion
Findings from this article suggest that a rich understanding of the process-based perspective on resilience in later life with a clear emphasis and clarification on adversity is lacking. Deepening our understanding of the process-based perspective of resilience in later life and of “everyday” adversity in this process is recommended. This can support an interpretation of growing older, acknowledging real-life vulnerabilities, and challenges involved with aging while simultaneously creating a possibility for an inspiring narrative on aging in later life.
Footnotes
Acknowledgements
The authors wish to thank those who took time to read drafts of this article. These people have provided invaluable feedback and guidance regarding content, language, and publication process.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by a (non-profit) social welfare organization in the Netherlands. The article reflects the views of the authors and does not represent the views of this social welfare organization.
