What can older adults teach us about supporting mental wellbeing?
Senior citizens sit at the center of life’s oldest paradox. For many, the closer they come to death, the more their emotional wellbeing seems to increase. After a lifetime of losing loved ones, suffering defeats, and experiencing physical decline, older adults still manage to take life’s punches in stride. In fact, many report they are happier and more content than younger people.1 Resilience with aging is what gives seniors an edge. The wisdom of their experience preserves their ability to adapt and react to the changes around them.
Their unique resilience was evident during the COVID-19 pandemic, when seniors defied expectations and displayed a stronger meddle than younger generations. In a June 2020 survey, 6% of seniors reported an anxiety disorder, compared to 49% of 18- to 24-year-olds and 16% of 25- to 44-year-olds.1 While 6% of seniors experienced a depressive disorder during these early months, the younger brackets reported 52% and 14%, respectively.1
That is not to say seniors did not suffer during the pandemic. Many reported increased feelings of loneliness, but their overall mental health levels remained relatively consistent.1 As younger populations panicked and stress-baked, older adults viewed the pandemic as just 1 of many events, wars, and calamities they had already survived.
Today, the elderly population in the United States is growing and living 10 years longer than they did in 1959.2 In 2016, seniors represented 15% of the population. Well on its way to doubling by 2030 to 75 million, seniors will comprise 25% of the population by 2060.3 This is a group that has earned its wisdom with hard-fought experience. But not a lot of people know to seek their guidance. How they have adapted to the aging process speaks to their incredible resilience. And it begs the question: What can the rest of us learn from them?
What Is Resilience?
Resilience is the ability to quickly recover from stress, whether it is physical, mental, or emotional. It is a reflection of how flexible we are in adapting to problems that involve family and relationships, health, work, or finances. Resilient thinking is shaped by how we view and engage with the world, the strength of our social resources, and our ability to cope with external and internal demands. Being resilient does not mean you will not face hardships. Rather, it is a way of growing stronger because of them. In some cases, it can even create opportunities to evolve and make larger shifts in behavior.
Resilience can be observed in any area of life where failures and victories are commonplace. Losing can be a crushing experience, forcing some to give up when they are unable to see beyond the loss; however, others might see failure as a valuable teaching moment paving the way toward personal growth and improvement.
Everyone experiences challenges that hone their resilience. Like muscles, it is torn and rebuilt into something stronger. But everyone has a unique tipping point where a challenge has the potential to overwhelm their defenses and become threatening. Much of this revolves around the amount of control a person has over their stressor, as well as the potential for changing the situation.4 A person who has little control over their situation is more likely to develop learned helplessness, a resignation that future similar situations will bring the same results. On the other hand, a person who learns to be resilient from hard experiences may use it as a “stress inoculation” that can make them immune to future stressors.4
The Neurobiology of Resilience
Efforts by neuroscience to study why some people are more resilient than others have generally led to elusive answers. For example, 1 study observed brain images of people who had suffered abuse as children. The intent was to compare brain changes between those who went on to develop psychopathology as adults and those who developed resilience.5 Surprisingly, brain changes associated with maltreatment were equally noticed in both groups of people, despite whether they exhibited psychiatric symptoms. The authors speculated that there may be other molecular alterations or neurobiological changes that helped them adapt to stress.5
Resilience is thought to involve 3 main brain regions: the prefrontal cortex, hippocampus, and amygdala. Research indicates that resilient people have greater connectivity between areas of the prefrontal cortex to the areas of the brain linked to emotions. Their hippocampi and amygdalae are less stimulated.6
The prefrontal cortex is involved in decision-making and emotional control. Activity in the orbitofrontal network especially plays a role, particularly as it involves reward-related memories. One study suggested that activating this system can improve the body’s stress response and lead to greater psychological resilience.7
In the hippocampus, gray and white matter volume is larger in resilient adults, with more connectivity between the limbic system and central executive network.8
As part of the brain’s limbic system, the amygdala plays a huge role in decision-making by helping us process information and rewards, assess threats, and regulate emotions.9 It also ties emotions into certain memories. Resilience is higher when there is less connectivity between the amygdala nuclei and the ventral default-mode network.9
Resilience involves several neurotransmitters. These include norepinephrine, neuropeptide-Y, galanin, corticotropin-releasing hormone, dehydroepiandrosterone (DHEA), and dehydroepiandrosterone sulfate (DHEA-S), dopamine, serotonin, abrineurin (BDNF), and allopregnanolone (ALLO).4
Resilience does not imply a reduction in the response to stress. Rather, more of our brain is involved in adapting to it. As described in 1 article, it is an “active process that implies ongoing adaptive plasticity without external intervention.”10
Of the mice subjected to stress in 1 study, those with higher levels of resilience engaged 3 times the numbers of genes in their stress response than those with lower resilience.11 Researchers also identified a potassium channel in the Ih channel gene in the brain, which experienced increased activity in the brains of mice with higher resilience.11
In addition to neurobiology, genetics, and environment, resilience is shaped by other factors like personality, temperament, physical fitness, and social support. All of this can shape how we react to stress and whether we view it as challenging or threatening. Manageable stress can hone and improve our performance, while situations experienced as threatening may significantly impact one’s physical and mental health.
Whether our resilience level is genetically endowed or something that is learned has long been the subject of debate. It may be a mix of the 2. There is strong evidence to suggest that strategies can be employed to build the muscle of resilience.6
One study analyzed the effects of positive memory recall on a group of teens at risk of depression.6 The practice of recalling good memories resulted in lower cortisol and negative mood levels over the course of a year. By actively shifting focus away from memories of stressful events, these teens learned to actively create resilience.6
The Lifecycle of Resilience
With an inheritance range of 33% to 53%, resilience appears to be passed down the generations.12 It is strongest when nurtured at an early age and modeled by parents and caregivers.12 Because of their fragility, children exposed to higher levels of stress are more susceptible to psychiatric vulnerability, which explains why most mental illnesses are established by age 24.12 The stronger the social network and access to resources at an early age, the better children can stock up on valuable coping skills for adulthood.
When today’s senior citizens were born, they ushered in an era of unprecedented technology, global connection, and warfare. Those born in the 1920s were the first to enjoy freshly arrived cars, telephones, and movies. Many endured financial insecurities during the Great Depression, and everyone watched as Hitler drew the world into madness and World War II.
As the United States recovered, the Baby Boomer generation grew up. Born between 1946 and 1964, they would go on to become the largest living adult generation in the United States, influencing everything from the Civil Rights movement to Social Security reform.13 They witnessed the Korean and Vietnam wars, the assassination of a president, and a Cold War that hung a shadow of fear over everyday life. The fact that they have seen and experienced so much explains why 90% of seniors have experienced at least 1 traumatic event during their lives.14 It also helps to explain their impressive resilience.
To make it this far in life means seniors have accumulated a lifetime of experiences ranging from challenging to traumatic. Their ability to understand the big picture, see the silver lining, and not sweat the small stuff allows them to feel more content and less psychopathologic than other population groups.15
And yet, even with this rich experience, a senior’s resilience can become brittle. Negative perspectives and a resistance to growing old can work against them. They may become overwhelmed with loneliness and sorrow. Losing spouses and friends, seeing family members less and less, and disengaging from activities can be discouraging experiences for anyone.
What is interesting about the COVID-19 pandemic are indications that many older adults adapted to the isolation of lockdown better than expected, especially in the beginning. COVID-19 appeared and provided a good distraction. Knowing their isolation protected them against COVID-19 contributed to lower anxiety levels among seniors. Technology made it easier than ever to connect with family, strengthening important social bonds. And the confines of social distancing encouraged seniors to value and savor the social connections they did have.1
Keeping the brain engaged is key to building resilience. By seeking out new challenges and activities, seniors can take their resilience to the next level by developing wisdom.
Wisdom is more strongly associated with life satisfaction than physical health, finances, socioeconomic status, social involvement, physical environment, and age. Among older hospice patients and nursing home residents, wisdom is more connected to their sense of wellbeing than other healthier seniors.16
One way to understand wisdom is to observe it as a 3-dimensional model that incorporates cognition, reflection, and compassion. The cognitive dimension refers to a person’s need to understand the deeper truths of life, including its positive and negative aspects. The reflective dimension paves the way to this understanding by pondering events from many perspectives rather than blaming others or circumstances. The compassionate dimension brings a broad awareness of human nature and suffering that motivates people to help others with sympathy and compassion.16
The reflective dimension has an especially strong effect on a person’s wellbeing. This is what allows seniors to be more aware of their feelings and exert greater control over negative emotions, especially those that seek to blame others for their own unhappiness. In short, reflective wisdom allows people to understand and, more importantly, accept their reality.16
Ultimately, wisdom is what allows seniors to make sense of their paradox. It guides and protects them through the fear and hardship of life, comforting to the very end.
Ways to Build Resilience
What can we learn about resilience from older adults? And how can we promote resilience from an early age in our patients?
-Choose optimism. Reframe your outlook on challenging situations by actively looking for ways to see the silver lining in challenging situations.
-Develop a problem-solving attitude. Accept new challenges with the knowledge that you might fail. If—or when—you do, try to focus on bouncing back and learning from your mistakes.
-Spend time finding out what the meaning of life is for you. Focusing on your own wellbeing is key to aging gracefully. Work to actively build a positive self-image.
-Surround yourself with people who believe in you. Nurture your relationships, and work to build positive connections.
-Build confidence by challenging yourself with activities that push your comfort levels without threatening your peace of mind.
-Put your situation into perspective. Supporting and helping others through their challenges can benefit your own state of mind.
-Build a resilient body to support a resilient mind by following a healthy diet and engaging in an active lifestyle.
-Practice mindfulness through breathing, meditation, yoga, or tai chi. Mindfulness is paying attention to the present in a nonjudgmental way that involves kindness.
Every one of us will confront several challenges in our lifetime. How we choose to deal with these experiences will determine our future path and affect our sense of wellbeing.
Resilience is earned over time by exercising a lot of patience, wisdom, and experience in the face of adversity. It is important to understand your limitations—what you can and cannot accomplish—by doing the best with what you have got. The earlier we train ourselves to think this way, the richer our lives will be. Most of us have access to resilient older adults, whether they are our own relatives, our neighbors, or other people in the community. When younger and older generations share their experiences, they work together to build a better community and a better tomorrow.
Dr Parmar is a psychiatrist with Mindpath Health.
Sidebar. Assessing Resilience
There are a number of scales used to measure resilience. These include the Resilience Scale, with 25 items and 2 dimensions, and the Psychological Resilience Scale, with 3 dimensions and 19 items.
Here are some questions that can be used to assess resilience.
1. Why do you think you have lived such a long life?
2. What is your life philosophy?
3. How would you describe your relationships with your friends/family/neighbors?
4. What do you do when you face difficulties in your life?
5. What does being healthy mean to you?
6. How do you handle change in your life?
7. Are you satisfied with your life?
8. What are you proudest of?
9. Are there lessons to learn from life’s difficulties, or should we just “grin and bear it”?
10. Are there any benefits that come from stress?
Source: University of Arizona Center on Aging
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12. Tucker P. What is resilience? Psychiatric Times. 2021;38(7).
13. Fry R. Millennials overtake Baby Boomers as America’s largest generation. Pew Research Center. April 28, 2020. Accessed December 21, 2021. https://www.pewresearch.org/fact-tank/2020/04/28/millennials-overtake-baby-boomers-as-americas-largest-generation/
14. Kuwert P, Pietrzak RH, Glaesmer H. Trauma and posttraumatic stress disorder in older adults. CMAJ. 2013;185(8):685.
15. Edwards ES, Hall J, Zautra A. Resilience in aging. Elder Care: A resource for Interprofessional Providers. April 2012. Accessed December 21, 2021. https://nursingandhealth.asu.edu/sites/default/files/resilience-in-aging.pdf
16. Ardelt M, Jeste DV. Wisdom and hard times: the ameliorating effect of wisdom on the negative association between adverse life events and well-being. J Gerontol B Psychol Sci Soc Sci. 2018;73(8):1374-1383.
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18.7 cultures that celebrate aging and respect their elders. Huffpost. February 25, 2014. Accessed December 21, 2021. https://www.huffpost.com/entry/what-other-cultures-can-teach_n_4834228
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Article From: Psychiatric Times
Author: Rashmi Parmar, MD