SciELO - Scientific Electronic Library Online

 
vol.20 issue5The social in health: trajectory and contributions of Maria Cecilia Ferro DonnangeloPay-for-performance in health care services: a review of the best evidence available author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Ciência & Saúde Coletiva

Print version ISSN 1413-8123On-line version ISSN 1678-4561

Ciênc. saúde coletiva vol.20 no.5 Rio de Janeiro May 2015

http://dx.doi.org/10.1590/1413-81232015205.00502014 

Review

Resilience in aging: literature review

Arlete Portella  Fontes 1  

Anita Liberalesso  Neri 1  

1Programa de Pós-Graduação em Gerontologia, Faculdade de Ciências Médicas. Universidade Estadual de Campinas. Av. Tessalia Vieira de Camargo 126, Cidade Universitária. 13083-887 Campinas SP Brasil. arletepfontes@gmail.com

ABSTRACT

Psychological resilience is comprised of an adaptive functioning standard before the current and accumulated risks of life. Furthermore, it has a comprehensive range of psychological resources which are essential to overcome adversities, such as personal competences, self-beliefs and interpersonal control which interact with the social networks support. The objectives are to show the concepts of psychological resilience in elderly, relative to dominant theoretical models and the main data about psychological resilience in aging, found in an international and Brazilian review from 2007 to 2013. The descriptors "resilience, psychological resilience and aging", "resiliência e envelhecimento, velhice e velho", were used in PubMed, PsychInfo, SciELO and Pepsic databases. Fifty three international and eleven national articles were selected. The international articles were classified in four categories: psychological and social coping resources, emotional regulation before stressing experiences, successful resilience and aging and correlates, and resilience measures. The Brazilian articles were grouped in three: psychological and social resources, resilience in carers and theory review. Articles on psychological resources and on emotional regulation prevailed as key factors associated with psychological resilience in aging.

Key words: Resilience; Coping; Emotional regulation; Elderly

Introduction

In physics the term resilience is "a property by which the energy stored in a deformed body is released when elastic deformation ceases"1. Other fields, including psychopathology, also use the term to refer to the heterogeneity of coping responses utilized by children in face of major life stressors such as disease, socioeconomic difficulties, parental psychopathology and ruptures in the family unit, whereby one succumbs to such experiences, escapes unharmed or becomes stronger2. The study of resilience in the field of psychology started around 30 years ago, when development psychologists began to observe that exposure to adversities posed a likely risk for child development3. The attention given to resilience in adult life and old age was influenced by a movement known as positive psychology4 and notions such as intra-individual plasticity5 and capacity for cognitive reserve6.

Currently, the term resilience is used in various academic contexts, including the field of lifespan development, developmental stage theories focussing on adolescence, adult life and old age, recovery from traumatic events, and organizational performance7.

A bibliographical review carried out by Souza and Ceverny8 of the period 1986 to 2004 utilizing the Medline (Medical Literature Analysis and Retrieval System Online), Lilacs (Latin American and Caribbean Center on Health Sciences Information) and APA (American Psychological Association) databases and using resilience as a keyword, showed that the number of publications tripled in each five-year period. The review also shows that the number of articles addressing resilience in children and adults has increased, particularly in recent years, and that the first article dealing with resilience in the elderly was published in1999. After 1999, APA's database included themes such as religion, racism, family violence, homosexuality, and terrorism survival8. The most common research topics found on the Brazilian databases CAPES (Brazilian Federal Agency for Support and Evaluation of Graduate Education), SciELO (Scientific Electronic Library Online) and Universia (information portal of knowledge and applied research and institutional collaboration between universities and companies) are family, adolescents and children, with only five publications involving adults and five on the elderly8.

Laranjeira's9 review utilising Medline, Lilacs and the APA database PsycINFO and using the keywords adaptation, vulnerability, resilience model, the elderly and life events, found 44 articles, in which he identified four central themes: precursors to resilience, resilience and aging, the importance of protective factors, and resilience and successful ageing. In the latter, resilience was associated with a low likelihood of illness, preservation of cognitive and physical functioning and engagement with life, which are described by Rowe and Kahn10 as indicators of successful ageing.

With reference to essential psychological resources for overcoming adversity and ensuring a return to normal levels of functioning and development after stressful situations, the construct of resilience is defined as patterns of adaptation in face of biological, socioeconomic and psychological risks6 - 9 , 11 - 14. In old age, these risks include exposure to stressful life events such as death of loved ones, accidents, illness and disability, poverty, abandonment, family conflict, domestic and urban violence, chronic tension related to social roles.

Based on the above context, this article presents an updated review of articles on resilience in the elderly published in Brazil and internationally. It has a dual objective: to present the concepts associated with the predominant theoretical models in this field; to present the results of a bibliographical review of related articles published in Brazil and in international journals between 2007 and 2013.

Variations in the construct of resilience in old age

The predominant theoretical models that have formed the foundation of much of our current understanding of resilience are permeated by a classical notion of resilience as a personality trait or as a process15. As a personality trait, resilience is seen as a stable resource that enables a stable performance when it comes to resisting stress. In this sense, resilience is the tendency to respond to stress in a flexible rather than rigid manner. Based on this view, the construct of hardiness16 is as a set of traits, such as commitment, control and openness to change, which can be seen as a general disposition to resist stress. It should be noted that this individual-centred approach runs the risk of underestimating the role of variable factors which are external to the event, without offering a description of the event and how it happened. In the view of resilience as process, the construct is seen as a bridge between the coping and development processes15. An individual's level of resilience is therefore seen as being based on protective factors (internal and external) which can alter a person's response to given environmental circumstances6.

There are two basic underlying conditions of the concept of resilience as patterns of adaptation in the context of situations of risk or adversity: exposure to significant risk, and evidence of positive adaptation to threats to development11. Positive adaptation refers to successful development despite the risks: ability to deal with stress, including the capacity to minimise the effects of the stressful event; capacity for a rapid recovery from a trauma; and, in the long term, ability to contain negative responses and capacity to promote positive consequences and behaviours that enable the individual to overcome adversity17.

Thus, elderly people are considered psychologically resilient when they do not succumb to adversity, but rather exhibit the capacity for successful adaptation characterised by managing stressful events, or recuperating previous or baseline levels of objective or subjective well-being after exposure to an adverse event. In the face of adversity, the elderly are able to change its meaning, reduce the level of danger caused by stressful events, reduce their exposure to such events, reduce negative reactions, maintain positive self-esteem and self-efficacy and create opportunities to revert the effects of stress16. These actions oppose vulnerability, understood as the lack of psychological coping resources, and manage the deleterious effects of the risks and threats to adaptation, thereby enabling elderly people who possess such resources to overcome biological, socioeconomic and psychological risk factors.

As a dependent variable, resilience is understood as a product of the interaction between the nature, quantity and intensity of risk factors and personality traits. As a moderator variable, its role is to mitigate the negative effects of stressful events on adaptation18.

The field of lifespan development has adopted the concepts of plasticity and capacity for cognitive reserve, seeing resilience as the maintenance of normal development, despite the risks, and recovery from traumatic situations5 , 6.

Plasticity involves patterns of adaptation, including an increase, decrease or maintenance of the capacity for successful adaptation. In childhood, this concept can be interpreted as maturation and learning, which are driving forces of organic and behavioural changes, while in adult life and old age it can be seen as flexibility in the face of stressors. The level of biological and behavioural plasticity naturally becomes more limited in old age.

Capacity for reserve is the ability to maintain or recuperate normal levels of functioning through mobilizing latent resources. Coping responses may vary according to the context, moment in time, age, gender and culture, and depend on self-esteem and self-efficacy19. In old age, resilience depends on affective and cognitive reserves and is manifested in coping resources, emotional regulation, motivation, sense of purpose and self-efficacy. One of the assumptions of the lifespan development approach is that resilience tends to increase in old age, rather than decline, acting as a mediator to achieve successful adaptation, otherwise recognised as successful ageing5.

Resilience can also be defined as inner strength, inner growth and personal strength or power20, which are related to a strong sense of coherence, life goals (or purpose in life) and self-transcendence (capacity to extend beyond yourself, towards altruism, dedicate yourself to something, to person you love or to God21). In this sense, resilience may encompass the following aspects: feeling competent even after accepting others help; looking at the bright side of life without hiding the dark side; being active, and at the same time relaxed; be the same, even with a new appearance; and live in the present, but also in the past and the future20.

Resilience is also associated with emotional regulation in coping with adversity. The advantages of emotional regulation in old age include the following: greater adaptation of the cardiovascular and immune system; greater cognitive resources, including sense of elf-efficacy; increased ability to seek social support; increased capacity to adapt to the intensity of stressful events; greater cognitive and affective integration; more mature defence mechanisms; low neuroticism (personality trait related to symptoms of depression, anxiety and unhappiness); greater awareness; the use of proactive coping strategies; and greater satisfaction with life22 , 23.

Individual and social coping resources help the elderly to deal with critical events by attributing meaning in light of past experiences, seeking out and maintaining pleasurable activities, performing social roles, adopting coping strategies, and by mobilising social support. Such coping mechanisms promote resilience by alleviating, transforming or denying the impact of adversity24.

Another important aspect of emotional regulation is the intensity of stress. High levels of stress in the elderly accentuate and prolong negative emotional experiences and reduce cognitive flexibility25. Despite emotional regulation in the elderly being equal to or greater than that of young adults, in some cases an elderly person is unable to employ effective strategies, for example in cases such as cognitive impairment, chronic diseases, such as rheumatoid arthritis, osteoarthritis and fibromyalgia22, and loss of family members and friends, which are often associated with depression. Elderly individuals may have the same level of negative affect as young adults who do not have a chronic disease but this advantage disappears in the presence of high stress levels25.

A number of studies demonstrate that the concept of resilience encompasses a multiplicity of protective factors and adaptive processes3. Windle et al.26carried out a multi-factor analysis of psychological resilience in old age based on data from a representative sample of 1,847 individuals between the age of 50 and 90 years from England, Wales and Scotland who were subjected to an assessment of the following indicators of resilience: self-esteem, interpersonal control, and personal competence. Factorial validity was tested using confirmatory factor analysis which enables the comparison of a wide umbrella of psychological resources which are essential for overcoming adversity, including personal competence, self-esteem, self-efficacy and interpersonal control26. Despite a low correlation between the indicators of resilience and the sociopolitical dimension, a moderate correlation was observed between these indicators and other measures, suggesting that they represent a common construct26.

There has been a convergence of ideas in the literature on resilience regarding the importance of components of the self, such as self-concept, self-esteem and emotional regulation, resources provided by social and family support, and relationships with the community. This interpretation of resilience is in line with the view of resilience as a process in which environmental and individual factors interact. There is also a general acceptance by the literature of the importance of resilience for maintaining functioning, subjective well-being, sense of adjustment, motivation for activity and vital involvement, which play a central role in protecting the individual from the influence of loss, risks and threats to adaptation.

In light of these concepts, the authors carried out the literature study presented in the following pages.

Method

Two searches were carried out: one of Brazilian journals and one of international journals. The search of international journals was carried out using the PubMed and PsycINFO databases and covered the period January 2007 to August 2013, using the following keywords: resilience, psychological resilience and aging.A total of 67 articles were found, of which 53 were analysed. The following articles were excluded: those which included only young adults and made no reference to older adults; those which explored specific resilience-related themes such as post traumatic stress disorder and suicide; and a study about resilience in animals. The remaining 53 articles were analysed to identify the main investigated variables, sample characteristics and main results.

The search of Brazilian journals was undertaken using the SciELO and PePSIC (Digital Psychology Journals) databases covering the same six-year period and using the same criteria mentioned above. Keywords were resilience and ageing, resilience and old age and resilience and elderly.

The international articles were grouped into the following four categories according to focus topics of each study:

Category 1. Psychological and social coping resources: articles related to the control of external and internal stressors using self and cognitive resources and informal social support for the elderly.

Category 2. emotional regulation in face of stressful experiences:articles related to the management of physiological, emotional and behavioural aspects of stress and ratings of positive and negative valence related to internal and external pressures.

Category 3. Resilience and aspects related to successful ageing (well-being, satisfaction with life, quality of life): articles about health, activity, productivity, satisfaction and well-being as factors that promote resilience and about the successful ageing and resilience paradigms.

Category 4. Resilience measures: methodological articles about the validation of measures of resilience in adults and the elderly.

The Brazilian articles were grouped into the following three categories:

Category 1. Psychological and social coping resources (identical to the definition adopted for international articles).

Category 2. Resilience of carers of the elderly: articles related to care of the elderly.

Category 3. Theoretical reviews: articles containing bibliographical reviews.

Results

International Journals

A total of 54 articles were found on the PubMed database and 19 articles on the PsycINFO database. Six articles were found on both databases, giving a final total of 67articles, of which 53 were selected for analysis.

The yearly average number of publications in the categories psychological and social coping resources, and emotional regulation was 3.14 and 2.43 articles, respectively. Production of articles remained relatively constant after an increase in the number produced between 2007 and 2008 (increase of seven articles). An average of 7.57 articles a year was produced in the last six years and the largest production was in 2009 and 2011. The lowest production was in the resilience measures category (data not shown in tables).

The term resilience appeared in the title of 23 of the 53 international articles, while in the rest of the articles it appeared in the text. Twenty-two articles were included in Category 1. Psychological and social coping resources; 17 in Category 2. Emotional regulation; 10 in Category 3. Aspects related to successful ageing; and four in Category 4. Resilience measures. Charts 1, 2, 3 and 4 show the authors and a brief description of the objectives, sample and results of the articles by category.

In Category 1. Psychological and social coping resources (Chart 1), greater resilience was associated with good quality relationships, integration into the community, high use of coping methods to solve problems, and coping directed at development (for example, dealing with adversity in a positive manner)24. Creative engagement in social networks may have a neuroprotective effect for the elderly, including those with dementia27. In a qualitative study involving elderly people in a community in a rural area in the United States, resilience is described as being associated with a frugal lifestyle, social support and acceptance28. Social support is also associated with resilience in the elderly living in urban areas, and those affiliated to churches, members of retired people's organisations and those frequenting nutrition clinics. A study using multivariate regression analysis found an association between resilience and the desire to seek help for symptoms of depression29.

Chart 1. Category 1. Psychological and social coping resources. Review of international literature on resilience in the elderly (2007-2013). 

The relation between resilience and the impact of personal and social resources is evident in more recent studies, such as that carried out by Mertens et al.30 which found an association between high levels of resilience (defined as mastery) and physical, mental and social functioning among 361 elderly in the Netherlands aged 60 years and over, where high social support and income levels among individuals with diabetes contributed to successful ageing. A study carried out by Gooding et al.31 showed that older individuals were more resilient, especially in relation to problem solving and capacity for emotional regulation, while resilience among younger individuals was associated with the availability of social support.

Religiosity and spirituality were mentioned by five articles (four in category 1 and one in category 2), where spirituality among women was significantly associated with resilience, low income, low level of education and being married42. Spiritual and religious beliefs are used as a form of coping with suffering and are associated with better self-perceived health40. A qualitative study with 84 black women living in the United States showed that aspects of faith and spirituality, including identity and belief, religious affiliation, involvement, practices and benefits, are protective resources for coping with adversity related to homelessness36.

A study which compared 398 survivors of cancer to 796 individuals which had no history of cancer, showed that social well-being, resilience, spirituality and sense of personal growth was greater among cancer survivors, and that older individuals were more resilient than younger individuals41.

Two studies found that satisfaction with life was associated with individual and social coping resources. One study with a sample of 2,144 German men showed a strong association between resilience and satisfaction with life, presence of a partner, positive self-esteem, adequate level of income, absence of depression and living in the eastern states38. A study with 2,540 German women aged between 18 and 70 years found that satisfaction with life was associated to resilience, presence of a partner, absence of anxiety and depression, having a job, positive self-esteem, religious affiliation and being younger33.

The 17 articles involving emotional regulation (Chart 2) address daily stressors, presence of emotions and affections (positive and negative) in old age, attitudes in the face of adversity and the complexities of emotional responses.

Chart 2. Category 2. Emotional regulation in the face of stressful experiences. Review of international literature on resilience in the elderly (2007-2013). 

Old age was associated with reduced exposure to daily stressors and negative affects48 , 49 and greater emotional regulation (reduced anxiety and symptons of depression)50.

The studies show that capacity for emotional regulation varies50. Individuals who are more able to regulate their emotions are less susceptible to anxiety and depression, and are more optimistic than those who are less able. A study involving 239 individuals aged between 18 and 89 years which examined the association between daily stressors and negative affect using coherence of self-concept, age and sense of control as indicators of resilience found that younger individuals and individuals with a more incoherent self-concept (greater evidence of discrepancy between measures of self representation in different roles and situations) showed higher average negative affect51. Although individuals, especially younger individuals, showed higher negative affect in the presence of less sense of control, reactivity to stress did not differ between ages and remained the same regardless of coherence of self-concept51.

A study which investigated the relationship between daily stressors and emotional experience over the course of a week among 101 relatively healthy women aged between 63 and 93 years shows that reduced negative affect in old age is partially due to a reduction in the frequency of daily stressors48. However, the same study found that positive affect decreases with increasing age, probably because the elderly were engaged in few experiences and involved in avoiding unforeseeable situations48. Furthermore, positive events did not attenuate reactivity to daily stressors, in contrast to current literature which suggests that positive events attenuate stress. According to the authors, this occurs because the benefits of positive events exercise a significant influence over individuals who are experiencing chronic stress, which did not happen in this sample made up of healthy individuals who were not subjected to such conditions. On the other hand, illness and poor health status, especially in the early and final stages of old age may cancel out the advantages of greater affect48.

With regard to the Category resilience and successful ageing(Chart 3), the elderly describe ageing in terms of decline and coping52. Resilience is associated with a pragmatic acceptance of reality by the elderly in rural areas53 and general and daily well-being in a study involving 125 elderly widowed individuals54. In a study involving 174 individuals without dementia aged between 60 and 94 years resilience is associated with motivational skills acquired throughout life and thus considered a protective factor for cognitive impairment and psychological well-being32.

Chart 3. Category 3. Resilience and aspects related to successful ageing (well-being, satisfaction with life, quality of life). Review of international literature on resilience in the elderly (2007-2013). 

Chart 4 describes the following resilience measures: the Connor-Davidson Resilience Scale (CD-RISC)19 ; the Wagnild and Young Resilience Scale55; and the Brief Resilience Scale56.

Chart 4. Category 4. Resilience measures. Review of international literature on resilience in the elderly (2007-2013). 

Brazilian Journals

This search, using the keywords resilience and ageing, resilience and old age and resilience and the elderly, resulted in 11 studies, two of which were a review. No articles were found on the PePSIC database using the same keywords. However, when only the keyword resilience was used, four articles appeared: one of these articles was also found on the Scielo database; two were unclear as to whether the study involved the elderly, ageing or old age; and one was a theoretical review carried out during the period 2000 to 2006.Only the latter article was retained for analysis.

The Brazilian articles were grouped into the three categories described above: Category 1. Psychological and social coping resources; Category 2.Resilience of carers of the elderly; and Category 3.Theoretical reviews (see summaries inChart 5).

Chart 5. Review of Brazilian literature on resilience in the elderly (2007-2013). 

Discussion

The studies highlight the multidimensional nature of resilience, reflecting a complex interaction between individual and environmental dimensions which involves a combination of risk factors (individual, environmental and cumulative) and protective factors (personal attributes, interpersonal relations and support), and results in successful adaptation, avoidance of disorders, psychological well-being, and recovery3 , 70 - 72.

With respect to gerontology, an analysis of a group of articles shows the predominance of constructs associated with the life-span model, which views resilience as being related to development, the notion of individual plasticity, the potential for personal change, flexibility and resistance in dealing with the limitations and losses which occur throughout life5 , 6. There exists a predominance of gerontological concepts, such as successful ageing, psychological well-being, social support, satisfaction with life, and religiosity and spirituality, which are seen as being associated with resilience. The review highlights that psychological and social coping resources and emotional regulation are central components of adaptation processes.

With respect to Category 2. Emotional regulation in the face of stressful experiences, it is important to highlight that people differ in their capacity for emotional regulation - an important theoretical aspect of the construct of resilience - since resilience involves a complex interaction between the individual and his or her dispositional resources and environment supports. Thus, aspects of an individual that promote a resilient disposition such as optimism, sense of control, self-concept, and capacity for emotional regulation50 , 51, can explain differences in levels of resilience between individuals.

The literature which specifically addressed old age in relation to the process of emotional regulation as an advantage of age suggests that the elderly experience a small reduction in well-being after the age of 60, probably due to an increase in illnesses, and adopt a more accommodating posture59in the face of unavoidable interpersonal tensions and stressful situations as a complex emotional response which values the positive and negative aspects of the experience11. This capacity for emotional regulation may be associated with processes of adaptive selection which allow the elderly to save psychological, physiological, social and cognitive resources, reducing the number of bonds and cultivating only those which result in affective closeness, an increase in comfort and improvements in subjective well-being25.

The articles produced on emotional regulation during recent years (2011 to 2013) emphasise the importance of positive emotions of ageing, such as being optimistic about living to be 100 years of age67, self-acceptation, desire to live, self-control and quality relationships, for coping with diseases such as AIDS63. Furthermore, a study involving 529 individuals aged between 31 and 88 years suggests that sense of control has a mediating effect on the relation between religiosity/spirituality and well-being64. It is important to note that, although resilience is associated with the individual resources outlined here, the conceptualisation of this phenomenom requires an integrative approach in which the concept is expressed as a constelation which combines individual resources (capacities, competences, attributes), social conditions (social support, for example) and developmental problems or changes (for example, obstacles and losses)4.

Considering that resilience goes beyond self resources and encompasses resources related to social support, certain studies24 , 27 , 28 , 39 highlight the relevance of social resources, or "social capital" as Hildon calls it24 , 39, such as social support, quality of relationships and integration into the community.

Although studies on successful ageing do not always focus on resilience and its related aspects, they reveal that psychological well-being and maintaining affective and cognitive functioning are important indicators of adaptation in the face of adversity. Positive psychological functioning leads to improved neuroendocrine regulation and acts as a protective factor for physical (illness or disability) and economic and educational adversity. Strong sense of purpose of life, personal growth and positive personal relationships are associated with low cardiovascular risk, adequate levels of cholesterol and cortisol and improved glycemic control71. Greater psychological well-being and higher levels of education were identified as predictors of low levels of Interleukin 6 (IL-6), a marker of inflammation77. The importance of positive psychological functioning and well-being for psychosocial adaptation is also highlighted by Harris70who proposes that the construct of successful ageing should be substituted with that of resilience, based on two case studies of patients diagnosed with early-stage Alzheimer's taking into consideration their ageing trajectories.

An important aspect of the Brazilian literature is that the majority of articles (seven out of 11) describe psychological and social coping resources, reflecting the trend in the international literature. Furthermore, six of the articles use the Resilience Scale to assess resilience78, which is an adaptation of the Wagnild and Young Resilience Scale55.

The Brazilian articles grouped into Category 2. Resilience of carers of the elderly shows an interest in care relationships as a new topic in research involving the elderly. One of these articles found a significant association between resilience and the following factors: relationship (children and spouses exhibit a medium to high level of resilience in comparison to brothers and sisters, and brothers and sisters-in-law); use of medicines (use is greater in individuals with a low resilience score); tiredness, exhaustion and lethargy (greater in individuals with low and medium levels of resilience), medical treatment (prevalence of treatment was greater in individuals with low resilience)81.

Articles dealing with clinical practice were not found. However, it is known that one of the main objectives of clinical practice is to increase capacity for coping with adverse conditions. In this respect, methods which increase emotional resilience, such as biofeedback, relaxation, cognitive restructuring, and distraction are seen as effective strategies for strengthening skills for coping with chronic pain and promoting well-being22. Practices such as exploring life stories, individual development and personal circumstances may contribute towards increasing an individual's resilience by identifying successful past experiences which can be used promote resilience in adverse situations91.

From a methodological point of view, the use of statistical analysis is more prevalent than qualitative studies in the international literature28 , 34 , 36 , 45 , 47 , 52 , 53. The studies carried out by Hildon24 and Rosado-Medina et al.67 use both qualitative and quantitative methods. The majority of studies in Brazil used quantitative methods, reflecting the tendency of international studies.

The present literature review has certain limitations related to the scope of analysis of each article, which focussed only on the objectives, sample and main results, possibly to the detriment of other information, such as study methodology, country of origin, operational model used, and whether resilience was used as a dependent or independent variable.

Conclusion

This literature review highlights a number of important ideas of resilience. First, resilience is maintained during old age, thus providing a foundation for continuity of functioning and development through successful coping with the deleterious effects of life's risks and adversities. This is one of the principles or assumptions of the life-span paradigm and one which is repeatedly confirmed by research in this area.

The second idea is that coping is understood as the management, resistance to and recovery from the negative effects of stressors. In old age, adversities or risks may take the form of experiencing the illness and death of a loved one, illness and accidents, loss of prestige and even uncontrollable past events affecting relatives.

The third important notion is that effective coping with risks and adversity requires individual resources, such as good health, maintenance of activity, functioning, optimism, positive affect, high self-esteem, flexibility, purpose, sense of meaning, interpersonal control and religiosity/spirituality, and social resources, such as integration into the community, maintaining a social role, social involvement and the social resources offered by relationship networks. Health, vital involvement, social participation and psychological well-being are also highlighted as dependent and independent variables related to resilience.

The production of research articles on resilience in the elderly has increased in Brazil over the last two years. The resilience of family carers of ailing elderly appears to be a new line of research, possibly because this phenomenon has gained more visibility over recent years as increasing life expectancy in Brazil means that the need for care has become more palpable in clinics and families.

However, despite the increase in the number of studies, advances in theory and methodology and overlapping topics of international research, Brazilian research involving the elderly remains relatively scarce, particularly in relation to health and functioning, and suffers from a lack of measurement instruments, theoretical grounding and robust lines of long term research. It therefore repeats the tendency of research in the sphere of gerontology in the country, a new field which, despite receiving few resources from universities and research funding agencies, is growing in response to current population and social trends.

The Brazilian literature also highlighted the importance of population-based studies that encompass sociocultural and economic conditions and the interaction between lifelong biological and individual processes to determine associations with vulnerability and resilience. Despite the above, there is still a long road ahead for research in this area.

References

Ferreira BHF. Novo Dicionário Aurélio Século XXI: o dicionário da língua portuguesa. 3ª. Rio de Janeiro: Nova Fronteira; 1999. [ Links ]

Rutter M. Implications of resilience concepts for scientific understanding. Ann N Y Acad Sci 2012; 1094:1-12. [ Links ]

Smith GC, Hayslip Jr B. Resilience in adulthood and later life: What does it mean and where are we heading? In: Hayslip Junior B, Smith GC, editors. Annual Review of Gerontology and Geriatrics. Emerging perspective on resilience in adulthood and later life. New York: Springer; 2012. Vol. 32 p. 3-28. [ Links ]

Seligman ME, Csikszntmihalyi M. Positive Psychology. An Introduction. The American Psychologist 2000; 55(1):5-14. [ Links ]

Baltes PB. On the incomplete architecture of human ontogeny. Selection, optimization, and compensation as foundation of developmental theory. American Psychologist 1997; 52(4):366-380. [ Links ]

Staudinger UM, Marsike M, Baltes PB. Resilience and levels of reserve capacity in later adulthood: Perspectives from life-span theory. Development and Psychology 1993; 5:541-566. [ Links ]

Bandura A. Self-efficacy: the exercise of control. New York: W.F.Freeman; 1997. [ Links ]

Souza MTS, Ceverny CM. Revisão de literatura e análise da produção científica. Revista Interamericana de Psicologia. 2006; 40(1):119-126. [ Links ]

Laranjeira CAS. Do vulnerável ser ao resiliente envelhecer: revisão de literatura. Psicologia: teoria e pesquisa 2007; 23(3):327-332. [ Links ]

Rowe JW, Kahan RL. Usual and successfull. Science 1997; 237(4811):143-149. [ Links ]

Ong AD, Bergeman CS, Boker SM. Resilience comes of Age: Defining Features in Later Adulthood. J Pers 2009; 77(6):1777-1804. [ Links ]

Pesce RP, Assis SG, Santos N, Oliveira RVC. Risco e proteção. Em busca de um equilíbrio promotor de resi liência. Psicologia: Teoria e Pesquisa 2004; 20(2):135-143. [ Links ]

Waxtman HC, Gray JP,Padrón YN. Review of research um educational resilience. Ed: Vickie Lewelling. Santa Cruz: Center for Research Education, Diversity & Excellence, University of Califórnia, 2003. Research Report nº 11. [Cited 2007 Mar25] [about 28 p.] Avaiable from: http://www.cal.org/crede/pubs/research/RR11.pdfLinks ]

Rutter M. Resilience in the face of adversity. Protective factors and resistance to psychiatric disorders. Br J Psychiatry 1985; 147:598-611. [ Links ]

Leipold B, Greve B. Resilience. A conceptual Bridge Between Coping and Development. European Psychologist 2009; 14(1):40-50. [ Links ]

Kobasa SC, Maddi SR, Kahn S. Hardiness and health: A prospective study. J Pers Soc Psychol 1982; 42(1):168-177. [ Links ]

Hardy SE, Contato J, Gill TM. Resiliencfe of Community-Dwelling Older Persons. J Am Geriatr Soc 2004; 52(2):257-262. [ Links ]

Wagnild G. Resilience and Sucesfull Aging: Comparison Among Low and High Income Older Adults. J Gerontol Nurs 2003; 29(12):42-49. [ Links ]

Connor KM, Davidson JRT. Development of a new scale. The Connor-Davidson Resilience Scale. Depress Anxiety 2003; 18(2):76-82. [ Links ]

Nygren B, Norberg A, Lundman B. Inner Strength as Dsiclosed in Narratives of the Oldest Old. Qual Health R 2007; 17(8):1060-1073. [ Links ]

Frankl VE. Em busca de sentido: um psicólogo no campo de concentração. Porto Alegre: Sulina; 1999. [ Links ]

Davis MC, Zautra AJ, Johnson LM, Murray KE, Okvat HA. Psychosocial Stress, Emotion Regulation, and Resilience among Older Adults. In Aldwin CM, Park CL, Spiro III A, editors. Handbook of health psychology and aging. New York: The Guilford press; 2007. p. 250-262. [ Links ]

Neri AL. Teorias psicológicas do envelhecimento: percurso histórico e teorias atuais. In: Freitas EV, Py L, Cançado F, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. 2ª ed. Rio de Janeiro: Guanabara-Koogan; 2006. [ Links ]

Hildon Z, Smith G, Netuveli G, Blane D. Understanding adversity and resilience at older ages. Sociol Health Illn 2008; 30(5):726-740. [ Links ]

Charles ST, Cartensen, LL. Social and Emotional Aging. Annu Rev Psychol 2010; 61:338-409. [ Links ]

Windle G, Markland DA, Woods RT. Examination of a theoretical model of psychological resilience in older age. Aging Ment Health 2008; 12(3):285-292. [ Links ]

Mc Fadden SH, Basting AD. Healthy aging persons and their brains: promoting resilience trhrough creative engagement. Clin Geriat Med 2010; 26(1):149-161. [ Links ]

Dorfman LT, Mendez EC, Osterhaus Jk. Stress and resilience in the oral histories of rural older womem. J Women Aging 2009; 21(4):303-316. [ Links ]

Smith PR. Resilience: resistance facto for depressive sympton. J Psychiatr Ment Health Nurs 2009; 16(9):829-837. [ Links ]

Mertens VC, Bosma H, Groffen DA, van Eijk JT. Good friends, high income or resilience? What matters most for elderly patients? Eur J Public Health 2012; 22(5):666-671. [ Links ]

Gooding PA, Hurst A, Johnson J, Tarrier N. Psychological resilience in young and older adults. Int J Geriatr Psychiatry 2012; 27(3):262-267. [ Links ]

Forstmeir S, Maercker A. Motivacional reserve: lifetime motivational abilities contribute to cognitive and emotional health in old age. Psychol Aging 2008; 23(4):886-899. [ Links ]

Beutel ME, Glaesmer H, Decker O, Fischbeck S, Braehler E. Life satisfaction, distress, and resiliency across the life span of women. Menopause 2009; 16(6):1132-1138. [ Links ]

Black HK, Rubstein RL. The effect of suffering on generativity: accounts of elderly African American men. J Gerontol B Psychol Si Soc Sci 2009; 64(2):286-303. [ Links ]

Costanzo ES, Ryff CD, Singer BH. Psychosocial adjustment among cancer survivors: findings from a national survey of health and well-being. Health Psychol 2009; 28(2):147-156. [ Links ]

Washington OG, Moxley DP, Garriot L, Weinberger JP. Five dimensions of faitth and spirtuality of older African American women transitoning out of homelessness. J Relig Health 2009; 48(4):431-444. [ Links ]

Wells N. Resilience in rural community-dewlling older adults. J Rural Health 2009; 25(4):415-419. [ Links ]

Beutel ME, Glaesmer H, Wiltink J, Marian H, Brahler E. Life satisfaction, anxiety, depression and resilience across the life span of men. Aging Male 2010; 13(1):32-39. [ Links ]

Hildon Z, Montgomery SM, Blane D. Examining resilience of quality of life in the face of health - related and psychosocial adversity at older ages: What is "right" about the way we age? Gerontologist 2010; 50(1):36-47. [ Links ]

Krause N, Bastida E. Religion, suffering, and self-rated health among older Mexican Americans. J Gerontol B Psychol Sci Soc Sci 2011; 66(2):207-216. [ Links ]

Fankhauser S, Wagner B, Kramer S, Aeschback M, Pepe A, Maercker A, Forsteimeier S. The impact of social and interpersonal resources on adjustment disorder symptons in older age: Motivational variables as mediators? GerPsych: The Journal of Gerontopsychology and Geriatric Psychiatry 2010; 23(4):227-241. [ Links ]

Vahia IV, Deep CA, Palmer BW, Fellows I, Golshan S, Thompson W, Allison M, Jeste DV.Correlates of spirituality in older women. Aging Ment Health 2011; 15(1):97-102. [ Links ]

Shrira A, Palgi Y, Ben-Ezra M, Shmotkin D. Transgenerational effects of trauma in midlife: Evidence for resilience and vulnerability in offspring of Holocaust survivors. Psychol Trauma 2011; (4):394-402. [ Links ]

Sargent-Cox KA, Anstey KJ, Luszcz MA. Change in health and self-perceptions of aging over 16 years: The role of psychological resources. Health Psychology 2012; 31(4):423-432. [ Links ]

Lou VW, Ng JW. Chinese older adults' resilience to the loneliness of living alone: a qualitative study. Aging Ment Health 2012; 6(8):1030-1046. [ Links ]

Tomás JM, Sancho P, Melendez JC, Mayordomo T. Resilience and coping as predictors of general well-being in the elderly: a structural equation modeling aproach. Aging Ment Health 2012; 16(3):317-326. [ Links ]

Tummala-Narra P, Sathasivam-Rueckert N, Sundaran S. Voices of older Asian Indian immigrants: Mental health implications. Professional Psychology: Research and Practice 2013; 44(1):1-10. [ Links ]

Charles ST, Luong G, Almeida DM, Ryff C, Sturm M, Love G. Fewer ups and downs:daily stressors mediate age differences in negative affect. J Gerontol B Psychol Sci Soc Sci 2010; 65B(3):279-286. [ Links ]

Stawiski RS, Sliwinski MJ, Almeida DM, Smith JM. Reported exposure and emotional reactivity to daily stressors: the roles of adult age and global perceived stress. Psychol Aging 2008; 23(1):52-61 [ Links ]

Larcom MJ, Isaacowitz DM. Rapid emotion regulation after mood induction: age and individual differences. J Gerontol B Psychol Sci Soc Sci. 2009; 64(6):733-741. [ Links ]

Diehl M, Hay L. Risk and resilience factors in coping with daily stress in adulthood: the role of age, self-concept incoherence, and personal control. Dev Psychol 2010; 46(5):1132-1146. [ Links ]

Phoenix C, Smith B. Telling a (good?) counterstory of aginf: natural bodybuilding meets the narrative of decline. J Gerontol B Psychol Soc Sci 2011; 66(5):628-639. [ Links ]

Terril L, Gullife J. Growing older: a qualitative inquiry into the textured narratives of older rural women. J Health Psychol 2010; 15(5):707-715. [ Links ]

Hahn EA, Cichy KE, Almeida DM, Haley WE. Time use and well-being in older windows: adaptation and resilience. J Women Aging 2011; 23(2):149-159. [ Links ]

Wagnild G, Young HM. Development and psychometric evaluation of the Resilience Scale. J Nurs Meas 1993; 1(2):165-177. [ Links ]

Tomás JM, Meléndez JC, Sancho P, Mayordomo T. Adaptation and initial validation of the BRCS in an elderly Spanish sample. European Journal of Psychological Assessment 2012; 28(4):283-289. [ Links ]

Chow S-M, Hamagani F, Nesselroade JR. Age differences in dynamical emotion-cognition linkages. Psychology and Aging 2007; 22(4):765-780. [ Links ]

Ostir GV, Berges I, Ottenbacher M, Graham JE, Ottenbacher KJ. Positive emotion following a stroke. J Rehabil Med 2008; 40(6):477-481. [ Links ]

Kessler EM, Staudinger UM. Affective experience in adulthood and old age: the role of affective arousal and perceived regulation. Psychol Aging 2009; 24(2):349-362. [ Links ]

Montpetit MA, Bergeman CS, Deboeck PR, Tiberio SS, Boker SM. Resilience-as-process: negative affect, stress, and coupled dynamical systems. Psychol Aging 2010; 25(3):631-640. [ Links ]

Ong B, Fuller-Rowell T, Bonano GA. Prospective predictors of positive emotions following spousal loss. Psychology and Aging 2010; 25(3):653-660. [ Links ]

Ong AD, Zautra AJ, Reid MC. Psychological resilience predicts decreases in pain catastrophizing trough positve emotions. Psychology and Aging 2010; 25(3): 516-523. [ Links ]

Emlet CA, Tozay S, Raveis VH. "I´m not going to die from the AIDS": resilience in aging with HIV disease. Gerontologist 2011; 51(1):101-111. [ Links ]

Jackson BR, Bergeman CS. How does regiosity enhance well-bein? The role of perceived stress. Psychology of Religion and Spirituality 2011; 3(2):149-161. [ Links ]

Brassen S, Gamer M, Peters J, Gluth S, Baechel C. Don´t look back in anger! Responsiveness to missed chances in successful and nosucessful aging. Science 2012; 336(6081):612-614. [ Links ]

O'Hara R, Marcus P, Thompson WK, Flournoy J, Vahia I, Lin X, Hallmayer J, Depp C, Jeste DV. 5-HTTLPR short allele, resilience, and successful aging in older adults. Am J Geriatr Psychiatry 2012; 20(5):452-456. [ Links ]

Rosado-Medina JJ, Rodríguez-Gómez JR, Altie ri-Ramirez G. Study on resilience internal factors in a sample of Puerto Rican centenarians. Bol Asoc Me PR 2012; 104(4):17-25. [ Links ]

Deboeck P, Bergeman CS. The reservoir model: A differential equation model of psycological regulation. Psychological Methods 2013; 18(2):237-256. [ Links ]

Randall WL. The importance of being ironic: narrative openness and personal resilience in later life. Gerontologist 2013; 53(1):9-16. [ Links ]

Harris PB. Another wrinkle in the debate about successful aging: the undervalued concept of resilience and the lived experience of dementia. Int J Aging Hum 2008; 67(1):43-61. [ Links ]

Ryff CD, Friedman EM, Morozinki JÁ. Tsenkova V. Psychological Resilience in Adulthood and Later Life: Implications for Health. In: Hayslip Junior B, Smith GC, editores. Annual Review of Gerontology and Geriatrics. Emerging perspectives on resilience in adulthood and later life. New York: Springer Publishing Company; 2012. vol 32 p. 72-112. [ Links ]

Chu N, Leasure AR. Aging in America: quality of life among older vietnamese women immigrants. J Cult Divers 2010; 17(3):105-109. [ Links ]

Kleinspehn-Ammerlahn A, Kotter-Gruehn D, Smith J. Self-perceptions of aging: do subjective age and satisfaction with aging change during old age? J Gerontol B Psychol Sci Soc Sci 2008; 63(6):377-385. [ Links ]

Rothrauff TC, Cooney TM, An JS. Remembered parenting styles and adjustment in middle and late adulthood. J Gerontol B Psychol Sci Soc Sci 2009; 64(1):137-146. [ Links ]

LaCruz ME, Emeny RT, Bickel H, Cramer B, Kurz A, Bdlingmaier M, Huber D, Klug G, Peters A, Ladwig Kh. Mental Health in the aged: prevalence, covariates and related neueoendocrine, cardiovascular and inflammatory factors of successful aging. BMC Med Res Methodol 2010; 10:36. [ Links ]

Jeste DV, Savla GN, Thompson WK, Vahia IV, Glorioso DK, Martin AS, Palmer BW, Rock D, Golshan S, Kraemer HC, Depp CA. Association between older age and more successful aging: critical role of resilience and depression. Am J Psychiatry 2013; 170(2):188-196. [ Links ]

Morozink JA, Friedman EM, Coe CL, Ryff CD. Socioeconomic anda psychosocial predictors of interleukin-6 in the MIDUS national sample. Healht Psychology. [serial on the Internet] 2010 [cited 2010 fev 26]; 29(6): [about 9 p.] Avaiable from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991411/pdf/nihms246605.pdfLinks ]

Pesce RP, Assis SG, Avanci JQ, Santos NC, Malaquias JV, Carvalhaes JV. Adaptação transcultural, confiabilidade e validade da escala de resiliência. Cad Saude Publica 2005; 21(2):436-448. [ Links ]

Lamond AJ, Deep CA, Allinson M, Langer R, Reichstadt J, Moore DJ, Golshan S, Ganiats TG, Jeste IV. Measurement and predictors of resilience among community-dwelling older women. J Psychiatr Res 2008; 43(2):148-154. [ Links ]

Resnick BA, Inguito PL. The resilience Scale: psychometric properties and clinical applicability in older adults. Arch Psychiatr Nurs 2011; 25(1):11-20. [ Links ]

Gaioli CCLO, Furegato ARF, Santos JLF. Perfil de cuidadores com doença de Alzheimer associado à Resiliência. Texto contex-enferm 2012; 21(1):150-157. [ Links ]

Oliveira RM, Furegato ARF. Um casal de idosos e sua longa convivência com quatro filhos esquizofrênicos. Rev Esc Enferm USP 2012; 46(3):618-625. [ Links ]

Fortes TFR, Portuguez MW, Argimon IIL. A Resiliência em idosos e sua relação com variáveis sociodemográficas e funções cognitivas. Estud psicol (Campinas) 2009; 26(4):455-463. [ Links ]

Resende MC, Neri AL. Ajustamento psicológico e perspectiva de velhice pessoal em adultos com deficiência física. Psicologia em estudo 2009; 14(4):767-776. [ Links ]

Resende MC, Ferreira AA, Naves GG, Arantes FMS, Roldão DFM, Souza KG, Abreu SAM. Envelhecer atuando: bem-estar subjetivo, apoio social e resiliência em participantes de grupo de teatro. Fractal Rev Psicol 2010; 22(3):591-608. [ Links ]

Ferreira CL, Santos LMO, Maia EMC. Resiliência em idosos atendidos na Rede de Atenção Básica de Saúde em município do nordeste brasileiro. Rev Esc Enferm USP 2012; 46(2):328-334. [ Links ]

Rodrigues NO, Neri AL. Vulnerabilidade social, individual e programática em idosos da comunidade: dados do estudo FIBRA, Campinas, SP, Brasil. Cien Saude Colet 2012; 17(8):2129-2139. [ Links ]

Andrade FP, Muniz RM, Lange C, Scwartz E, Guanilo MEG. Perfil Sociodemográfico e Econômico dos sobreviventes ao câncer segundo o grau de resiliência. Texto Contexto Enferm 2013; 22(2):476-484. [ Links ]

Ribeiro RCHM, Santiago E, Bertolin DC, Ribeiro DF, Cesarino CB, Burdmann EA. Depressão em idosos protadores de insuficiência renal crônica em trata mento hemodialítico. Acta Paul enferm 2009; 22(Spe 1):505-508. [ Links ]

Oliveira MA, Reis VL, Zanelato LS, Neme CMB. Resi liência: análise das publicações no período de 2000 a 2006. Psicol cienc prof 2008; 28(4):754-767. [ Links ]

Lerner RM, Winer MB, Arbeit MR, Chase PA, Agans JP, Schimd KL, Warren AEA. Resilience Across the Life Span. In: Hayslip Junior B, Smith GC, editors. Annual Review of Gerontology and Geriatrics. Emerging perspectives on resilience in adulthood and later life. New York: Springer Publishing Company; 2012. V. 32. p. 274-299. [ Links ]

Received: August 10, 2013; Accepted: February 06, 2014

Collaborations AP Fontes designed the study and wrote the paper. AL Neri designed the study, wrote the paper and revised the final version of the paper.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.