Psychological Resilience in Long-Term Care Residents

Several individual and social factors are associated with resilience in residents of long-term care facilities who experience stressful life events, according to a study in the Netherlands.Led by Milou J. Angevaare, MD, MSc, of the Amsterdam Public Health Research Institute, researchers conducted a longitudinal cohort study using the Long-Term Care Facilities Assessment from interRAI. The assessment consists of about 250 items that cover such areas as mental and physical health, social support, and service use.The researchers identified psychological resilience in 248 individuals who had experienced major life stressors, such as severe illness or the death of a friend or relative, and 246 individuals who had experienced conflict with staff or other residents. They also sought to determine what factors were associated with resilient individuals in each category.The researchers defined a resilient outcome as the individual not having clinically meaningful mood symptoms, or having equal or fewer symptoms, at the post assessment. They measured the observer-reported findings using the Depression Rating Scale (DRS) and the residents’ self-reported mood symptoms using the Self-Reported Mood Scale. The observer-reported mood symptoms showed that 48% of those who had experienced major life stressors and 26% of those who had experienced conflict demonstrated resilience. The self-reported mood symptoms showed that 50% of the individuals who had experienced major life stressors and 51% of those who had experienced conflict demonstrated resilience. Conflict was associated with a higher DRS score, which may explain the variation between observer-reported and self-reported mood symptoms in these individuals, the researchers said.Several individual and social factors were strongly associated with resilient individuals who had experienced stressors, including “cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health.” For the individuals who had experienced conflict, the researchers found that “better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience.”The researchers emphasized that the social aspects of these factors can be encouraged in the long-term care setting, including facilitating family relationships, encouraging social activities, and increasing residents’ social contacts.The researchers also noted that “the likelihood of encountering stressors increases with age, and residents of [long-term care] specifically are increasingly likely to encounter different health, loss and social stressors.” Acknowledging the unavoidability of these stressors, the researchers emphasized the need to help residents develop strategies to cope. To target intervention efforts, further research is needed to identify the strongest factors in individuals who demonstrate resilience.