Integrating stable and modifiable aspects of resilience into healthy aging

Of the many challenges in life course epidemiology is unpacking the complex interrelationships between stable and modifiable attributes across a lifetime of unique experiences and exposures that impact the health and wellbeing of older adults. Examining the developmental progression at the beginning of the life span, infants go through a fairly predictable series of milestone as they age, e.g. object permanence at 5–8 months walking at 12 months. Although there a variety of factors that impact fetal development, e.g., maternal nutrition, once a baby is born you can reasonably map out the trajectory of these developmental milestones with a relatively high level of certainty, due in part the relative homogeneity of the experiences that infants will have had during their short lives (when compared to older adults). Nearer to the end of the life span, there is a remarkable heterogeneity of health and wellbeing outcomes and there are no analogous developmental milestones of decline. This heterogeneity is both fascinating and frustrating to study because there are so many factors to take into account in order to identify causal relationships between exposures and outcomes. Gene-environment interactions obviously have a considerable impact on these outcomes, but also psychological attributes that are relatively stable, such as personality, and those that are more modifiable, such as affect.

As I’ve previously written about in the OIPA blog, resilience is a complex process that exists both as a trait and as a dynamic process. The concept of resilience focuses on the ability to ‘bounce back’ or to deal with challenges in a way that is better than expected given the degree of adversity experienced. The stable form of resilience, i.e., trait resilience, has been conceptualized as a pattern of different levels of the big-five personality traits that are associated with greater capacity to deal with adversity.

The “big five” personality traits consist of conscientiousness, agreeableness, neuroticism, openness, and extraversion. Conscientiousness refers to the tendency to be careful, thorough, responsible, organized, and scrupulous. Agreeableness refers to the tendency to be good-natured, compliant, modest, gentle, and cooperative. Neuroticism refers to the tendency to be anxious, depressed, angry, and insecure. Openness refers to the tendency to be intellectual, imaginative, sensitive, and open-minded. Extraversion refers to the tendency to be sociable, talkative, assertive, and active. Individuals may have high or low levels of each of these different components and the interrelationships of these five aspects of personality have important implications for resilience. Three broad categories of personality have been described as they relate to resilience as being over-controlled, under-controlled, or resilient. For individuals that are under-controlled they have low levels of conscientiousness and agreeableness, for over-controlled individuals they have high levels of neuroticism and low levels of extraversion, resilient individuals are high on extraversion and conscientiousness and low on neuroticism. These have important implications for how individuals deal with adversity and predisposes individuals to being more or less resilient as they age. With that said, although there are aspects of resilience that are stable, individuals can foster greater resilience through the invoking of resilience resources. Previously studies have suggested that there are various socioeconomic and lifestyle behaviors that can foster greater resilience, and that social support is an important component of resilience.

The relationship between stable and modifiable aspects of resilience over the life course have important implications for health and wellbeing. Knowing that an individual has a personality type that lends itself to poorer outcomes in the face of adversity, it may be possible to foster aspects of lifestyle or in developing resilience resources that facilitate better adversity-related outcomes. Fostering greater levels of resilience in individuals has been linked to successful aging, lower depression, and longevity; therefore, this may be an important target for intervention.

Not all interventions are created equal and different approaches work better (or worse) for different people. The field of precision medicine developed around the concept of rejecting a “one-size-fits-all” model of medicine and moving towards individualized approaches to (amongst other aspects of medicine) the treatment of illness and development of interventions. As I’ve previously written about on this blog, the burgeoning field of precision mental health takes a stakeholder-informed approach to the examination and identification of interventions for greater mental health amongst older adults. Using this approach, it is hoped that there can be a greater alignment of research objectives with the priorities of stakeholder, leading to the fostering of greater health and wellbeing outcomes. This approach can also be extended to the integration of aspects of one’s personality into the coordination of appropriate interventions. For example, my colleagues and I demonstrated a relationship between older adults with a larger social network demonstrating higher levels of wellbeing when experiencing greater adversity in one’s physical functioning than those with smaller networks. The results from this study are derived from a sample of older adults randomly selected from the population, providing a general idea of what factors are associated with resilience in the broader population of older adults. If we look at individuals’ personal preferences for the implementation an intervention that expands one’s social network, individuals with higher levels of the personality trait extraversion, would likely respond better to a broader social network than those who demonstrate higher levels of introversion. This targeted approach that considers the individual’s preferences, personality traits, and attitudes towards different treatments underpins the precision medicine model, which may provide better outcomes from interventions throughout the life course. In the medical field we are seeing marked changes in the provision of preventative medicine using this ‘precision’ approach, which is also making inroads into industry where preventative medicine institutes, such as The Harper Institute, are developing tailored health-tracking platforms and corresponding precision intervention targets for companies’ employees. As I’ve previously written about in this blog , the implications of mid-life adversity and work-related stress have negative long-term implications for older adults.

Every older adult has a lifetime of unique experiences and exposures that have shaped who they are as a person, what their quality of life is like, and their levels of health and happiness. Disentangling all these contributing factors in order to foster more positive aging trajectories is a monumental challenge, but it is hoped that by looking at the interrelationships between individuals’ stable and modifiable characteristics, perhaps we help foster greater resilience and healthier aging.

About the Author

Theodore D Cosco joined the Oxford Institute of Population Ageing in 2016 as a Research Fellow. Dr. Cosco is a Chartered Psychologist (British Psychological Society) trained in applied social research methods (MSc 2011, Trinity College Dublin) and epidemiology (PhD 2015, University of Cambridge), and Assistant Professor of Mental Health and Aging in the Department of Gerontology, Simon Fraser University. His research interests include resilience, mental health, and the interface between technology and healthy ageing.