Resilience means different things to each of us. To me it represents a persons ability to bounce back – ‘bounceback-ability‘ for want of a better term. Traditionally the modern concept of ageing doesn’t focus on bounceback-ability but more a progressive and irreversible decline towards disability, immobility and death. As many forward thinkers are arguing it’s time to focus on resilience rather illness and decline.
An article published in the BMJ last month discussed this same argument: Impact of resilience on health in older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS). This was a retrospective cohort analysis using the data from the International Mobility in Aging Study. The study is survey and biophysical in nature and involved 1506 participants from Albania, Brazil, Colombia and Canada. The primary aim was to examine if resilience is related to self-rated health.
This study was descriptive in nature and I would recommend reading the whole text to fully understand the sheer scope and nature of the study. The number of factors they analysed appears overwhelming at first but hone in on what takes your eye. It’ll take a few reads but you’ll understand what that means later!
Resilience is dynamic simply meaning we can and should focus on building our patients resilience regardless of their current heath, age or frailty. Often those that have to work the hardest benefit the most. By explaining this to our patients means we can give them the foundation to age positively and change their focus to “what I can do” not “what I can’t”. If you think about it, as a profession we do this already.
To improve a persons resilience from a physiotherapy perspective we need to improve strength, aerobic capacity and reduce social isolation. It’s time we moved away from making someone safe at home and calling it a day with their therapy. Let’s agree goals, set ambitious targets and get our patients believing in themselves again. Build up what they CAN do and not what they cannot.
Think of risky step/walking transfers as an example. We often try and make transfers safe by providing re-turns and alike. By doing this we reinforce the cannot walk attitude instead of thinking what can we do to add walking to their assets. With some robust and evidence based strength training perhaps they could transfer safely again. This works with falls, with stairs and endless lists of examples.
Next time you are assessing an older person, or person of any age, please consider their assets not deficits.