Resilience and frailty in older adults:from conceptual understanding to practical intervention

Abstract

Resilience is considered the polar opposite of frailty, in that frailty is defined as a loss of resilience reserved, and the ability of our bodily systems to repair themselves, to respond to trauma and infection, and maintain homeostasis in bodily systems. Resilience is also considered a physiological construct. This may be reflective of the reluctance to move away from considered resilience in solely physiological terms. However, recognition of non physiological frailty is increased, and so too should more importance be given to psychological resilience. However, research examining the relationship between psychological resilience and frailty is lacking. This study contains a total of six studies across five chapters. Chapter 1 evaluates current models of frailty and assessment tools and considers what tool is necessary to assess resilience. Chapter 1 also considers our conceptual understanding of resilience in the context of frailty, identifies gaps within our conceptualisations, and outlines how this research will attempt to address these issues. Chapter 2 (consisting of three studies) redefines and develops a frailty index into a holistic tool, identifying a psychosocial and environmental frailty marker and integrating them into assessment. Chapter 3 analytically considers the validity of our conceptual models of resilience in the context of frailty and determines the benefits of maintaining high levels of resilience directly on frailty, as well as frailty outcomes. Chapter 3 then proceeds to co-create an intervention designed to improve psychological resilience in older adults. Chapter 4 implements and evaluates the effectiveness of the resilience-building intervention. Finally, Chapter 5 provides a general discussion of principal findings within this thesis, and offers direction for future research.