Enhancing Resilience to Tame Stress in Older Adults
By Susan Chapman, MA, MFA, C-IAYT
Social Work Today
Vol. 23 No. 1 P. 20

Strategies for Facing Loneliness, Social Isolation, Health-Related Anxieties, and Other Stressors

As human beings, we experience stress in our lives every day. Those stressors can range from large life events, like moving or a divorce, to smaller daily occurrences, such as traffic and work deadlines. For older adults, life events unique to the aging process can compound their stressful experiences. Fortunately, there are strategies older adults can employ to enhance their resilience as they address life’s changes and challenges.

Stressors Facing Older Individuals
A psychiatry resident at the Yale School of Medicine, Zachary Harvanek, MD, PhD, says that among the stressors facing older adults are loneliness and becoming more socially isolated, especially in terms of moving away from friends or having family move away from them. “In the pandemic era, social isolation has become even more of a factor, because older adults are more vulnerable to COVID-19, and there is more social isolation because of it. Older adults also have more health-related anxieties than younger individuals, which leads to more isolation, and creates a feedback loop,” he says.

“Social isolation and loneliness cause stress in older individuals, particularly with COVID-19,” agrees Kathy Lee, PhD, LMSW, an assistant professor in the School of Social Work at The University of Texas at Arlington. “But it’s important to point out that older adults can be even more vulnerable to that because people may have lost their loved ones or may be living alone. Those things are compounded by other environmental factors, such as they’re no longer able to drive and thus have transportation issues. They may have decreased mobility, which then intensifies transportation issues. There may be more fear surrounding transportation because living in the US, especially, with many people living in rural places or suburbs, there isn’t reliable public transportation to accommodate them.”

Lori Rubenstein Fazzio, DPT, a clinical professor of yoga and health in Loyola Marymount University’s Bellarmine College of Liberal Arts, says older adults have both external and internal stressors. She notes losing friends to illness and death and financial woes, including concerns about having enough money for retirement and affording health care, as some examples. “And beyond affording health care, older adults have to navigate a health care environment that has so little time,” she says. “Older adults need advocates. As a physical therapist, I have many seniors come to me with health issues that could be supported better if there was better communication among providers. People are taking medications from different doctors, which have side effects or interactions, leading to things like poor balance. That can leave seniors very vulnerable. Doctors often don’t have enough time to sit, listen, and communicate with other providers.”

Fazzio adds that when older adults fall ill, they have an internal recognition that, oftentimes, they may not be getting better. “There are health issues that happen with aging, and many older individuals have conditions that may not improve, particularly cognitive issues,” she says. “Their ability to travel, to do the things they enjoy, they may not be able to enjoy those things anymore. Of course, another internal stress is facing death, knowing that there is less time left than they’ve lived on the planet, less time to come.”

Defining Resilience
“Just as stress is a naturally occurring phenomenon in all people, resilience occurs naturally as well,” says Roberta Greene, PhD, LCSW, a professor and endowed chair emerita in the School of Social Work at The University of Texas at Austin. “Resilience is the person’s, and the person’s system’s, response to stress. Greene says that how people get back on track after they’ve been disrupted in their lives is one way to view resilience. “It’s not heroic. There is always a certain amount of stress in people and their systems, but we don’t notice it until a critical event occurs, or a life disruption happens, that doesn’t let us respond in the way we used to,” she explains.

Greene cites an example of resilience as a typical family that reorganizes all the time. “No one notices. But if a member has a crisis, then resilience comes to the fore. That is why it’s important at times when we’re seeking help, we assume that someone has had as much stress, or the risk has become so great, that the person has decided to seek help,” Greene says. “When a person decides to seek help, my model, the Resilience-Enhancing Stress Model, suggests that the social worker will begin to help the client and the client’s system to weigh the risks and the protective factors that shield them from that risk.”

Some of the protective factors that are in place in the Resilience-Enhancing Stress Model are the family and how the family has dealt with a particular risk in the past, the individual’s neighborhood, and larger external ecosystems. “The risk is the negative, and the protective factor is the positive,” Greene explains.

“My understanding is that there are two different capacities: our physical resilience and our mental-emotional resilience,” Fazzio adds. “It’s the ability to thrive despite adversity. On one level, it is the ability to bounce back, the ability to get better. If someone is sick, is the body able to bounce back from health challenges? From the holistic perspective, despite stress challenges, is somebody able to continue on? The more resilient a person is, the more able that individual is to thrive. I see it as a continuum. The first is to bounce back or maintain a state of well-being. But someone who is really resilient is someone who is thriving, not just surviving.”

In the study, “Exploring Factors Enhancing Resilience Among Marginalized Older Adults During the COVID-19 Pandemic,” Lee and her coauthors indicated resilience as: “A ‘dyadic interdependence’ of individual and environmental factors (Aldwin & Igarashi, 2012). The ecological model of resilience includes individual (eg, individual characteristics), contextual (eg, family and friends), and sociocultural (eg, institutions or community) resources to understand how well equipped an individual is to cope with novel stress (Aldwin & Igarashi, 2012). According to this model, individual resilience involves not only individual coping strategies but also the individual’s environment, which may enable or impede individuals’ ability to apply those coping skills.”1

“So, when we say this person is more resilient or this person is less resilient, we may simply think that one person is stronger than the others, but I think it’s not just about one’s ability to bounce back. I think it’s more about they’re not just their own individual. Environmental or systematic factors are important, too, because those are the factors that can influence one’s resilience,” Lee explains.

Resilience-Enhancing Approaches
Fortunately, there are a variety of strategies older adults can use in order to enhance their resilience. For example, Greene believes narrative interviewing can be one beneficial method. “It’s the same school of thought as life review,” she explains. “Narrative therapy contributes to resilience by focusing on things that are external to the person. People are externalizing something, rather than looking at it being from within. In this model, things are seen as person and environment. Erik Erikson says that development takes place with the individual and moves through all their connections. It’s an ecological model that ripples out. For resilience work to be effective it has to have that ripple effect. Telling a story to a group creates a grand narrative for that generation.”

Not defining someone by their circumstances is another strategy that Greene recommends. “Someone who is older and has had a stroke is not the stroke. When someone is in a nursing home after having a stroke, for instance, how can he do things that can connect him to his personhood? If he has always enjoyed football, maybe he can have a ‘Monday Night Football’ group that meets with him, and he can talk about that. It all comes down to outside connection. It brings people back to their roots. We’re helping people connect with the resources that they can turn to. We move from the ‘you are anxious’ label to what you can anchor to in your society. Not only does this work for older adults but this also can work at any age.”

Acknowledging Greene’s emphasis on the importance of connection in resilience, Harvanek notes that social strategies can indeed be very beneficial. “Social support can definitely help in resilience. Conversely, the lack of social support can negatively affect it. It’s important for older adults to find groups that they can participate in, which will help decrease loneliness. Additionally, financial security has been associated with stronger resilience, housing security, having one’s basic needs met. Addressing those factors might also help improve resilience,” he says.

“There is still a lot of research to be done to improve resilience in any population, including in that of older adults,” Harvanek adds. “There is some evidence that some strategies can be helpful. Cognitive behavioral therapy, for example, can improve positive appraisal. When something happens, you can appraise it in negative distortions or in positive appraisals. You can develop a positive outlook on events that happen and find ways to spin events that happen in a positive light. That can help with resilience. And mindfulness-based techniques can help with emotions especially. Mindfulness-based techniques can be taught in many different ways.”

Fazzio agrees, adding that a valuable but sometimes overlooked component of resilience is spiritual health. “Spiritual health can give meaning and purpose to one’s life. Older adults may not choose to join support groups, but they can nurture their spiritual health through community involvement, doing volunteer work, or any other activity that builds connection and nurtures a person’s inner life. Mindful practices, such as yoga, are an important component of spiritual health. They help people to have acceptance, to age with grace, to be with the grief, to recognize that grief is a stress, and to be able to acknowledge that it’s there is very important. For older adults to be with that and to find ways to enjoy and focus on what they still do have are key to their resilience,” she says.

Finding a way to balance enjoying life while still having healthy habits is something that Fazzio sees with many of her patients. “For many of my older patients, I see some health care providers give them a list of don’ts, and they say to me, ‘I’m going to eat what I want, drink what I want, do those things because I want to enjoy what I have left.’ It comes back to listening. Having health care providers look at the senior and listen to their goals and about the value they place on their quality of life, rather than focusing solely on extending their lives, is essential,” Fazzio says.

Adult children figure prominently in helping their parents maintain or improve their quality of life. “A lot of seniors feel they have to make decisions their children are pushing them into instead of doing what makes them happy,” Fazzio explains. “If there is any way to have support in communications with family and friends, that would go far in helping seniors enjoy their lives. When there is good communication, seniors can feel that they are seen, listened to, and heard.”

Lee points out that there are informal and formal supports to help older adults cope with stress. “Informal supports are not only family members but also friends and neighbors, especially when people are aging in their own house,” she explains. “Or people can become just like family members when an older adult lives in an independent living facility or community. Therefore, setting up strong relationships with neighbors and friends as well as family is critical because they can help you bounce back from their adversity.

“Formal support is things like home- and community-based support systems that can be really helpful,” Lee continues. “Someone may be struggling with giving up their driving, but there are great support systems out there older adults can utilize—transportation programs or other volunteer-based carpool services. There is a saying that ‘knowledge is key.’ If people really are aware of existing formal support services in their community, I think those can also help strengthen their resilience.”

Something Lee and her coauthors concluded in their study was that technology was an important factor in resilience as it pertained to pandemic stressors: “Although technology was unable to replace the emotional satisfaction received from person-to-person contact, it provided older adults with access to vast resources for learning, entertainment, and physical activity.1 And just like family, friends and neighbors may be able to help with transportation, so, too, can they help older adults navigate how to utilize technology,” Lee says.

“Something I believe is important are the characteristics of a community,” Lee adds. “We want to make sure that our community is walkable and age friendly. Nowadays, there is a movement around dementia-friendly communities as well. There is even an organization committed to supporting this movement, Dementia Friendly America [dfamerica.org], a national network of communities, organizations, and individuals seeking to ensure that communities across the United States are equipped to support people living with dementia and also their caregivers. So, it’s very important that our cities and communities become more aware so that we can help our neighborhoods become more inclusive and address the needs of older adults.”

— Susan Chapman, MA, MFA, PGYT, is a Los Angeles–based freelance writer and editor.

Reference
1. Lee K, Hyun K, Mitchell J, Saha T, Oran Gibson N, Krejci C. Exploring factors enhancing resilience among marginalized older adults during the COVID-19 pandemic. J Appl Gerontol. 2022;41(3):610-618.