Open Access Open Access  Restricted Access Subscription or Fee Access

An exploration of the concept and operationalization of resilience in medicine

Lisa M.C. van Hoogstraten, Sanne M.W. Gijzel, René Melis

Abstract


Rationale: Resilience is a relatively new concept in medicine and, more specifically, it is new in geriatrics. It suits the new definition of health as introduced by Machteld Huber. However, resilience still needs a suitable, operationalizable definition for the field of geriatrics, given that it is still an emerging theme in medicine.

Resilience in different disciplines: Investigation of the concept of resilience in mechanics, ecology, psychology and sociology shows that resilience is mostly considered as a dynamic, multidimensional and scalable concept. As such it may also apply to the field of medicine and potentially also to the field of geriatrics. However, the idea of resilience is still evolving. Therefore, time is needed to develop a common understanding of the concept. When this understanding is enhanced, operationalization is of great importance. Current operationalization in these disciplines varies from questionnaires to establish (static) characteristics defining a state that is prognostic for the resilience to be shown when perturbated to stress-tests, to mathematical indicators which evaluate the dynamic response or behavior of the system to (standardized) perturbations.

Discussion: All measurements for operationalization are indicators of resilience and do therefore not directly measure resilience (if this is indeed possible). In addition, there is not only one concept of resilience. Resilience can be considered objectively as a systems characteristic, or subjectively, for example by gestalt. These different approaches cause a gap between the concepts and different operationalizations, which makes it difficult to operationalize the (general) concept of resilience.

Implications and recommendations: Over time, resilience can potentially be measured by the use of new measurements, longitudinal data and wearables. For implementation in the clinic, validation of the measures is key. In addition, qualitative research on how the elderly experience, or would describe, resilience is recommended, in order to gain a better understanding about the concept. Then, there can be thought of intervening in resilience, especially in patients who face transition to another state of health.


Keywords


Adversity, care of the elderly, definitions, flourishing, frailty geriatric medicine, measurement, operationalization, person-centered healthcare, recovery, rehabilitation, resilience, stressors, whole system approaches

Full Text:

PDF

References


Gijzel, S.M.W., van de Leemput, I.A., Scheffer, M., Roppolo, M., Olde Rikkert, M.G.M. & Melis, R.J.F. (2017). Dynamical Resilience Indicators in Time Series of Self-Rated Health Correspond to Frailty Levels in Older Adults. Journals of Gerontology Series A Biological Sciences and Medical Sciences 72 (7) 991-996.

Beard, J., Officer, A. & Cassels, A. (2015). World report on ageing and health [Internet]. Geneva; 2015. Available at: http://www.who.int/ageing/publications/world-report-2015/en/.

Dictionary D co. (based on the RH. Dictionairy - resilience [Internet]. Available at: http://www.dictionary.com/browse/resilience.

Dictionaries EOL. Resilience [Internet]. Available at: https://en.oxforddictionaries.com/definition/resilience

Huber, M., Knottnerus, J.A., Green, L., Horst, H., van der Jadad, A.R., Kromhout, D., Leonard, B., Lorig, K., Loureiro, M.I., van der Meer, J.W., Schnabel, P., Smith, R., van Weel, C. & Smid, H. (2011). How should we define health? British Medical Journal 343, d4163.

Radboudumc. (2017). Academic transfer - Job Radboudumc (university medical center). Available at: https://www.academictransfer.com/employer/UMCR/vacancy/43295/lang/en/.

Whitson, H.E., Duan-Porter, W., Schmader, K.E., Morey, M.C., Cohen, H.J. & Colon-Emeric, C.S. (2016). Physical Resilience in Older Adults: Systematic Review and Development of an Emerging Construct. Journals of Gerontology Series A Biological Sciences and Medical Sciences 71 (4) 489-495.

Trefois, C. (2015). Critical transitions in chronic disease: transferring concepts from ecology to systems medicine. Current Opinion in Biotechnology 34, 48-55.

Tredgold, T. (2009) XXXVII. On the transverse strength and resilience of timber. Philosophical Magazine 51 (239) 214-216.

Wikipedia. Resilience (materials science). Available at: https://en.wikipedia.org/wiki/Resilience.

Holling, C.S. (1973). Resilience and Stability of Ecological Systems. Annual Review of Ecology and Systematics 4 (1) 1-23.

Brand, F.S. & Jax, K. (2007). Focusing the Meaning(s) of Resilience: Resilience as a Descriptive Concept and a Boundary Object. Ecology and Society 12 (1) 23.

Carpenter, S., Walker, B., Anderies, J.M. & Abel, N. (2001). From Metaphor to Measurement: Resilience of What to What? Ecosystems 4 (8) 765-781.

Holling, C.S. (1996). Engineering resilience versus ecological resilience. In: Engineering within ecological constraints. Schulze, P., (Ed.), pp. 31-44. Washington DC: National Academy, Washington DC.

Scheffer, M., Bascompte, J., Brock, W.A., Brovkin, V., Carpenter, S.R., Dakos, V., Held, H., van Nes, E.H., Rietkerk, M. & Sugihara, G. (2009). Early-warning signals for critical transitions. Nature 461 (7260) 53-59.

Leipold, B. & Greve, W. (2009). Resilience A Conceptual Bridge Between Coping and Development. European Psychologist Vol.14, pp. 40-50. Oxford: Hogrefe Publishing.

Bonanno, G.A. (2005). Resilience in the Face of Potential Trauma. Current Directions in Psychological Science 14 (3) 135-138.

Hildon, Z., Smith, G., Netuveli, G. & Blane, D. (2008). Understanding adversity and resilience at older ages. Sociology of Health & Illness 30 (5) 726-740.

de Terte, I., Stephens, C. & Huddleston, L. (2014). The development of a three part model of psychological resilience. Stress and Health 30 (5) 416-424.

van de Leemput, I.A., Wichers, M., Cramer, A.O.J., Borsboom, D., Tuerlinckx, F., Kuppens, P., et al. (2014). Critical slowing down as early warning for the onset and termination of depression. Proceedings of the National Academy of Sciences of the United States of America 111 (1) 87-92.

Csikszentmihalyi, M. & Larson, R. (2014). Validity and Reliability of the Experience-Sampling Method BT - Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi, pp. 35-54. Dordrecht: Springer.

Plough, A., Fielding, J.E., Chandra, A., Williams, M., Eisenman, D., Wells, K.B., Law, G.Y., Foggleman, S. & Magaña, A. (2013). Building Community Disaster Resilience: Perspectives From a Large Urban County Department of Public Health. American Journal of Public Health 103 (7) 1190-1197.

Links, J.M., Schwartz, B.S., Lin, S., Kanarek, N., Mitrani-Reiser, J., Sell, T.K., et al. (2017). COPEWELL: A Conceptual Framework and System Dynamics Model for Predicting Community Functioning and Resilience After Disasters. Disaster Medicine and Public Health Preparedness 1-11. doi: 10.1017/dmp.2017.39.

Villagra, P. & Quintana, C. (2017). Disaster Governance for Community Resilience in Coastal Towns: Chilean Case Studies. International Journal of Environmental Research and Public Health 14 (9) pii.E1063.

Chandra, A., Acosta, J., Howard, S., Uscher-Pines, L., Williams, M., Yeung, D., Garnett, J. & Meredith, L.S. (2011). Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security. Rand Health Quarterly 1 (1) 6.

Norris, F.H., Stevens, S.P., Pfefferbaum, B., Wyche, K.F. & Pfefferbaum, R.L. (2008). Community resilience as a metaphor, theory, set of capacities, and strategy for disaster readiness. American Journal of Community Psychology 41 (1-2) 127-150.

Castleden, M., McKee, M., Murray, V. & Leonardi, G. (2011). Resilience thinking in health protection. Journal of Public Health 33 (3) 369-377.

Nuwayhid, I., Zurayk, H., Yamout, R. & Cortas, C.S. (2011). Summer 2006 war on Lebanon: a lesson in community resilience. Global Public Health 6 (5) 505-519.

Ostadtaghizadeh, A., Ardalan, A., Paton, D., Jabbari, H. & Khankeh, H.R. (2016). Community disaster resilience: a systematic review on assessment models and tools. PLoS Currents 7, pii: ecurrents.dis.f224ef8efbdfcf1d508dd0de4d8210ed.

Quagliariello, M. (2009). Stress-testing the Banking System : Methodologies and Applications. Leiden: Cambridge University Press.

EBA. Risk analysis and data - EU-wide stress testing. Available at: http://www.eba.europa.eu/risk-analysis-and-data/eu-wide-stress-testing

NOS. 550 miljoen in fonds wederopbouw Sint-Maarten. Available at: https://nos.nl/artikel/2202148-550-miljoen-in-fonds-wederopbouw-sint-maarten.html

Olde Rikkert, M.G.M., Dakos, V., Buchman, T.G., de Boer, R., Glass, L., Cramer, A.O.J., Levin, S., van Nes, E., Sugihara, G., Ferrari, M.D., Tolner, E.A., van de Leemput, I., Lagro, J., Melis, R. & Scheffer, M. (2016). Slowing Down of Recovery as Generic Risk Marker for Acute Severity Transitions in Chronic Diseases. Critical Care Medicine 44 (3) 601-606.

Olde Rikkert, M.G.M., Melis, R.J.F., Claassen, J.A.H.R. & Ferrari, M.D., Lagro, J., Tolner, E.A. & Scheffer, M. (2015). MS. Waarschuwingssignalen voor acute verergering van chronische ziekten. Nederlands Tijdschrift voor Geneeskunde 159.

Kuh, D., Ben-Shlomo, Y., Lynch, J., Hallqvist, J. & Power, C. (2003). Life course epidemiology. Journal of Epidemiology and Community Health 57 (10) 778-783.

Jain, S., Sprengel, M., Berry, K., Ives, J. & Jonas, W. (2014). The tapestry of resilience: An emerging picture. Interface Focus 4 (5) 20140057.

DuRant, S.E., Arciniega, M.L., Bauer, C.M. & Romero, L.M. (2016). A test of reactive scope: Reducing reactive scope causes delayed wound healing. General Comparative Endocrinology 236 (Supplement C) 115-120.

Romero, L.M., Dickens, M.J. & Cyr, N.E. (2009). The reactive scope model - A new model integrating homeostasis, allostasis, and stress. Hormones and Behavior 55 (3) 375-389.

Hadley, E.C., Kuchel, G.A. & Newman, A.B. (2017). Report: NIA Workshop on Measures of Physiologic Resiliencies in Human Aging. Journals of Gerontology Series A Biological Sciences and Medical Sciences 72 (7) 980-990.

Folke, C., Carpenter, S., Walker, B., Scheffer, M., Chapin, T. & Rockström, J. (2010). Resilience Thinking: Integrating Resilience, Adaptability and Transformability. Ecology and Society 15 (4) 20.

Resnick, B., Galik, E., Dorsey, S., Scheve, A. & Gutkin, S. (2011). Reliability and validity testing of the physical resilience measure. Gerontologist 51 (5) 643-652.

Mumby, P., Chollett, I., Bozec, Y-M. & Wolff, N. (2014). Ecological resilience, robustness and vulnerability: How do these concepts benefit ecosystem management? Current Opinion in Environmental Sustainability 7, 22-27.

Whitson, H.E., Purser, J.L. & Cohen, H.J. (2007). Frailty thy name is ... Phrailty? Journals of Gerontology Series A Biological Sciences and Medical Sciences 62 (7) 728-730.

Baltes, M.M. & Lang, F.R. (1997). Everyday functioning and successful aging: the impact of resources. Psychology and Aging 12 (3) 433-443.

Baltes, P.B. & Baltes, M.M. (1990). Successful Aging: Perspectives from the Behavioral Sciences [Internet]. European Network on Longitudinal Studies on Individual Development. Cambridge: Cambridge University Press.

Hardy, S.E., Concato, J. & Gill, T.M. (2004). Resilience of community-dwelling older persons. Journal of the American Geriatric Society 52 (2) 257-262.

Wagnild, G. (2009). A review of the Resilience Scale. Journal of Nursing Measurement 17 (2) 105-113.

Schumacher, J., Leppert, K., Gunzelmann, T., Strauß, B. & Brähler, E. (2004). Die Resilienzskala – Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personmerkmal. Klin Psychol Psychiatr und Psychother. Available from: http://www.mentalhealthpromotion.net/resources/resilienzskala2.pdf

Kocalevent, R-D., Zenger, M., Heinen, I., Dwinger, S., Decker, O. & Brähler, E. (2015). Resilience in the General Population: Standardization of the Resilience Scale (RS-11). PLoS One 10 (11) e0140322.

Lagro, J., Schoon, Y., Heerts, I., Meel-van den Abeelen, A.S.S., Schalk, B., Wieling, W., Olde Rikkert, M.G. & Classen, J.A. (2014). Impaired systolic blood pressure recovery directly after standing predicts mortality in older falls clinic patients. Journals of Gerontology Series A Biological Science and Medical Sciences 69 (4) 471-478.

Wagnild, G.M. & Young, H.M. (1993). Development and psychometric evaluation of the Resilience Scale. Journal of Nursing Measures 1 (2) 165-178.

Hyde, M., Wiggins, R.D., Higgs, P. & Blane, D.B. (2003). A measure of quality of life in early old age: the theory, development and properties of a needs satisfaction model (CASP-19). Aging and Mental Health 7 (3) 186-194.

Varadhan, R., Seplaki, C.L., Xue, Q.L., Bandeen-Roche, K. & Fried, L.P. (2008). Stimulus-response paradigm for characterizing the loss of resilience in homeostatic regulation associated with frailty. Mechanisms of Ageing and Development 129 (11) 666-670.

Meeks, S., Van Haitsma, K., Mast, B.T., Arnold, S., Streim, J.E., Sephton, S., Smith, P.J., Kleban, M. & Rovine, M. (2016). Psychological and social resources relate to biomarkers of allostasis in newly admitted nursing home residents. Aging & Mental Health 20 (1) 88-99.

Berg, C.J., Haardorfer, R., McBride, C.M., Kilaru, V., Ressler, K.J., Wingo, A.P., Saba, N.F., Payne, J.B. & Smith, A. (2017). Resilience and biomarkers of health risk in Black smokers and nonsmokers. Health Psychology 36 (11) 1047-1058.

Coast, J., Smith, R.D. & Lorgelly, P. (2008). Welfarism, extra-welfarism and capability: the spread of ideas in health economics. Social Science & Medicine 67 (7) 1190-1198.

Sen, A. (1993). Capability and well-being. In: The quality of life. Nussbaum, M.C., (Ed.). Oxford: Clarendon Press.

Nussbaum, M.C. (2011). Creating capabilities - The human development approach.Cambridge, Massachussets, and London, England: The Belknap press of Harvard University Press.

Sen, A. (2004). Capabilities, Lists, and Public Reason: Continuing the Conversation. Feminist Economics 10 (3) 77-80.




DOI: http://dx.doi.org/10.5750/ejpch.v6i4.1537

Refbacks

  • There are currently no refbacks.