1. Avers, Dale DPT, PhD, PT, FAPTA
  2. Resnick, Barbara PhD, RN, CRNP, FAAN, FAANP
  3. Issue Editors

Article Content

The definition of resilience has been described in a variety of ways. Although initially believed to be a personality trait, increasingly resilience is conceptualized as a dynamic concept that includes positive adaptation in the face of significant adversity,1 maintaining one's equilibrium in the face of adversity,2 a pattern of functional effectiveness indicating positive adaptation in the context of adversity,3 and the ability to bounce back from significant adversity.4 Regardless of how it is defined or conceptualized, resilience is an attribute in individuals that we recognize when you see it! Instinctively, rehabilitation professionals know a resilient individual will be easier to work with and have a better prognosis. Therapists and rehabilitation nurses value resilient qualities such as determination, a sense of purpose, being goal directed, and possessing optimism and instinctively know these qualities are important to recovery. Given the benefit of being resilient, recognizing, supporting, and/or facilitating resilience are skills that rehabilitation professionals should develop. Unfortunately, however, little work has been done to optimally evaluate resilience or implement interventions to strengthen resilience, particularly in response to the many physical challenges encountered by older adults.


The aim of this issue of Topics in Geriatric Rehabilitation is to explore the concept of resiliency and provide examples of resiliency's importance to rehabilitation. Resilience is especially significant for geriatric rehabilitation, as it is resilience that helps older individuals fight back from physical challenges such as a hip fracture, stroke, or spinal stenosis and adapt to the many age-related physical changes that occur. Interestingly, adversity is necessary to develop resilience. For this reason, interventions should be geared toward strengthening resilience. In contrast, individuals who are not resilient and not exposed to interventions to strengthen resilience may languish, exemplifying the "failure to thrive" syndrome, be prone to illness, and even be labeled "unmotivated" by rehabilitation professionals.


The first 2 articles in this issue lay a foundation for understanding resilience within the rehabilitation framework. In the first article, Resnick describes resiliency as a dynamic concept that can be influenced through psychological, social, and physiological factors. She summarizes what is known about the topic and how it is measured and suggests rehabilitation connections. Guccione writes about a theoretical framework for resiliency in rehabilitation, suggesting ways resiliency is important to rehabilitation, how it might be fostered, and further areas of exploration of this important yet little studied topic. He couches his discussion within the concept of quality of life, a concept not always considered by rehabilitation providers, and suggests that quality of life may be influenced through changes in self-efficacy and resilience.


In the next 6 articles, an interdisciplinary group of practitioners provide examples of how resilience is important to older adults. Matchar and Gwyther discuss their work in supporting resilience in a group of older adults with early-stage Alzheimer disease and their caregivers. These individuals were exposed to an 8-week education and support group. Following the intervention, the participants were reevaulated and it was noted that resilience was promoted by the social network that occurred during the education and support group activities. This experience also enhanced the relationship between the patient with Alzheimer disease and his or her caregiver.


Wells provides some insight into the interface between psychological resilience and physical resilience. She suggests an assessment of psychological resilience to better understand the problem-solving skills and attitudes of the individual and to provide a gateway to influence many attributes of resilience. Assessing physical resilience through physical performance measures may also provide information on the patient's physical abilities and reserve and thus help the therapist develop the optimal plan of care.


Klinedinst and Resnick share a unique program designed to overcome the barriers of mildly depressed or cognitively impaired older adults who reside in a continuing care retirement community. Using a function-focused care philosophy that encourages older adults to engage in function and physical activity at their highest level throughout their routine daytime activities, individuals were matched to volunteer activities that were feasible and of interest to the individual. The resulting effects were an improvement in a sense of purpose, self-efficacy, and self-esteem, all important attributes of resilience. Physical activity increased as time spent in the volunteer activity increased. The authors discuss the challenges of implementing the program, ways to overcome these challenges, and the benefits that can be experienced by residents as well as caregivers.


Mlinac, Lees, Stamm, Saint, and Mulligan describe their research on using clinical judgment to measure older adults' resiliency. The older adults were part of an ongoing study of maintaining newly acquired health behaviors of exercising and/or consuming fruit and vegetables. The authors compared a self-report of resilience using the Resilience Scale with a health behavior coach's rating of resilience at regular intervals for 4 years. Regardless of the ability to maintain healthy behaviors, individuals rated themselves as relatively high on the Resilience Scale. However, coaches assessed resilience on how well participants maintained healthy behaviors in the face of stressors such as falls, hospitalizations, family difficulties, and so on. The researchers noted that their definition of resilience was not consistent with how the participants viewed their own resilience. This study serves as an important reminder for rehabilitation providers to carefully consider an individual's perception of his or her own resilience rather than imposing an external assessment.


Michael's discussion of enhancing poststroke resilience reminds us of the importance of physical resilience in stroke recovery. Specifically, this involves having adequate reserve and health to combat the inflammatory response and physical deconditioning that occurs with stroke. Michael suggests that promoting resilience may help in the necessary adjustments and adaptations that recovery from stroke requires. In this article, many strategies are suggested to enhance resilience such as preserving hope, maintaining optimism, and managing fatigue to improve energy and vigor. Many of these are already used in rehabilitation. However, recognizing that these strategies can promote an individual's resilience may positively influence the patient's adjustment and adaptations and facilitate a more successful rehabilitative outcome.


In the last article, Cohen and Krajewski propose an interdisciplinary approach to resilience and encourage research in the development of interventions to strengthen resilience. These authors propose using interdisciplinary methods to build resilience and thus build the individual's ability to adapt and thrive. Targeting specific mental and physical health challenges, building functional effectiveness, reducing biopsychosocial risk factors, and mobilizing protective risk factors are suggested as ways in which to build resilience. The exemplary collection of articles focused on resilience in this issue extends our understanding of resilience within the rehabilitation setting. Recognizing the complexity of resilience and its many factors can help us promote, encourage, and support resilience as perceived by the individual following whatever challenge the individual is experiencing. Resilience is increasingly being recognized as a powerful attribute contributing to the success of rehabilitation following adversity. Our challenge in rehabilitation is to strengthen resilience and help individuals achieve their highest level of functional recovery and physical activity.


-Dale Avers, DPT, PhD, PT, FAPTA


Barbara Resnick, PhD, RN, CRNP, FAAN, FAANP


Issue Editors




1. Luthar S, Cicchetti D, Becker B. The construct of resilience: a critical evaluation and guidelines for future work. Child Dev. 2000;71(3):543-562. Cited by: Matchar BG, Gwyther LP. Resilience in early-stage dementia: lessons learned from early-stage Alzheimer education and support groups. Top Geriatr Rehabil. 2014;30:170-175. [Context Link]


2. Mlinac M, Lees F, Stamm K, Saint J, Mulligan J. Maintaining late life behaviors: comparing clinician rating and self-reported resilience. Top Geriatr Rehabil. 2014;30:188-194. [Context Link]


3. Cohen D, Krajewski A. Interdisciplinary geriatric resilience interventions: an urgent research priority. Top Geriatr Rehabil. 2014;30:199-206. [Context Link]


4. Resnick B, Gwyther L, Roberto KA, eds. Resilience in Aging: Concepts, Research, and Outcomes. New York, NY: Springer Science and Business Media LLC; 2011. [Context Link]