Resilience Factors: How May They Promote Healthy Aging?

PURPOSE: Decreased participation and dissatisfaction with quality of life (QoL) in older adults has been attributed to cognitive and physical decline. However, it is hypothesized that resilience factors, such as sense of hope and emotional status, may relate to positive engagement in life and QoL in older adults. This study aimed to investigate differences in sense of hope, emotional status, participation, and QoL between independent and dependent older adults and among elders with different levels of cognitive function.

METHOD: This study was cross-sectional and used a convenience sample of older adults living in the community in the United States. Participants were classified as either independent (no major medical neurological or psychiatric conditions, living in their homes or in a senior adult independent or semi-independent residence) or dependent (living in a nursing home or at home under the care of a personal caregiver). Cognitive function was classified on the basis of Montreal Cognitive Assessment (MoCA) scores as intact cognition, minimal cognitive decline, and moderate cognitive impairment. Seventy-eight adults aged >75 were recruited; 39 (51.3% male, 48.7% female) were independent in their daily function and 39 (20.5% male, 79.5% female) were dependent.

Demographic information was gathered using a questionnaire. Participation was measured using the Reintegration to Normal Living Index, well-being and quality of life using the Personal Wellbeing Index–Adult, hope using the Integrative Hope Scale, and cognitive and emotional functions using the MoCA and the Patient Health Questionnaire. Multivariate analysis of variance was used to examine differences between independent and dependent participants and among participants with varied levels of cognitive function.

RESULTS: A significant main effect was found for group (independent vs. dependent), F(6, 67) = 15.4, p < .001, and cognitive level, F(12, 134) = 2.11, p < .05, with no significant interaction effect. Significant between-subjects effects were found between the independent and dependent groups in participation, F(1, 72) = 38.93, p < .001; well-being and QoL, F(1, 72) = 9.13, p < .01; and sense of hope, F(1, 72) = 8.34, p < .01. A trend for significance was noted for emotional status, F(1, 72) = 3.34, p = .07.

A significant between-subjects effect was found in sense of hope between groups with intact cognition, minimal cognitive decline, and moderate cognitive impairment, F(2, 72) = 4.11, p < .05. A separate independent t test revealed a significant difference between the independent and dependent groups in cognitive function, t(76) = 3.91, p < .001. The independent group showed minimal cognitive decline (M = 24, SD = 3.4), whereas the dependent group showed moderate cognitive decline (M = 20, SD = 5.25).

CONCLUSION: Independent older adults were found to participate more, feel more satisfied with their lives, and possess a higher sense of hope than their dependent counterparts. Dependent older adults reported feeling more depressed and less hopeful. Those exhibiting a cognitive decline were less hopeful.

IMPACT STATEMENT: Occupational therapy practitioners serving the older adult population may consider developing a framework for preventive care and aging in place that incorporates early identification of social–emotional status, including sense of hope, while screening for a decrease in level of function. Early identification of individuals at risk for functional decline, depression, and loss of hope may allow for the development of programmatic efforts focused on promoting factors such as hope and emotional status, leading to higher QoL in the older adult population.

References

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