A longitudinal exploration of mental health resilience, cognitive impairment and loneliness

Abstract

Objective There is a growing interest in how people living with dementia may achieve good outcomes and be resilient despite their health challenges. Understanding what might be important for resilience in this population is largely untested theory. Methods The analysis draws a subsample with cognitive impairment (N = 579) from two waves of the Cognitive Function and Ageing Studies Wales study, a nationally representative study of community‐dwelling people aged 65+ in Wales. We constructed a measure of mental health resilience (MHR) defined as no depression, no anxiety and high well‐being. Drawing on a resilience framework, we tested univariate and cumulative effects models of the factors that enable MHR, and then examined whether MHR is important for reducing loneliness over time. Results Across both waves of data 22% (n = 121) met the criteria for MHR. The cumulative effects model found the odds of MHR were greater for male gender, higher self‐esteem, greater social resources and no subjective memory complaints. Controlling for these significant predictors, MHR significantly predicted lower total and sub‐scale scores for loneliness at wave 2. Sensitivity analysis shows these effects held at lower levels of cognitive function when the Mini‐Mental State Examination score was <25, but not at <23. Conclusions This paper addresses a gap in research regarding the conceptualisation and measurement of resilience when facing cognitive impairment. Understanding what aspects of a person's life might enable good mental health despite cognitive impairment—to be resilient—could inform effective strategies for friends and families, along with health, and social policy and practice.

Maintenance of high quality of life as an indicator of resilience during COVID-19 social distancing among community-dwelling older adults in Finland

“…Adversity was defined as illness, change in marital status to single, or transition into poverty, and resilience as bouncing back to the pre-adversity mental health level after adversity. In majority of studies among older adults, resilience has been studied as positive psychosocial functioning in the context of accumulating and persisting health adversities such as decreased physical functioning or disability [ 7 , 8 ], cognitive impairment [ 9 ], and caregiver stress [ 10 ]. Diversity in operationalizing resilience stems not only from differences in research questions and study designs, but also from challenges related to capturing adaptation processes, as the timing and types of adversities vary between individuals making it challenging to construct analytical models in observational studies.…”

A systematic review and psychometric evaluation of resilience measurement scales for people living with dementia and their carers

“…The extent to which people with dementia may be unaware of difficulties or changes they are experiencing may influence reporting outcomes. Other research suggests that people with dementia who focussed less on memory problems, perhaps appearing less aware of difficulties, also reported better well-being and mood [ 92 ]. Although this effect may be interpreted as a form of positive response bias, it may also be viewed as an adaptive form of coping in some situations, focusing on strengths rather than problems [ 93 ].…”