Why do some people cope well but others don’t? Resilience and vision impairment in older people

Some people fare better than others when faced with adversity; they appear to be more ‘resilient’. There are around two million people with a vision impairment in the UK, the majority of whom are aged over 60.  This number is expected to increase to 2.25 million within 10 years, primarily due to population ageing. Vision impairment has negative impacts upon wellbeing and quality of life, mental health and social participation. However, these impacts are highly variable across the vision impaired population. The relationship between severity of vision impairment and the impact upon wellbeing is not simple; there is a range of individual and social-environmental influencing factors, including physical and mental health and personality traits. Among older people with vision impairment there is often also considerable physical and emotional co-morbidity, compounding and complicating the challenges they face. We considered how the concept of resilience might be applied in the context of vision impairment, in order to better understand how this complex range of factors operate to influence individual well-being.

Highlights

  • 3 longitudinal in-depth case studies of vision impaired older adults
  • A range of inter-connected and inter-dependent resources are required to facilitate resilience.
  • To enable resilience, available resources must be utilised.
  • The interconnectivity of resources means that assessment and service delivery must be holistic.
  • Resilience is not a fixed state; it can vary over time.

The concept of resilience offers a way to understand why some people fare better than others, given similar adversity. It is, however, a contested concept. Whilst some conceptualisations focus upon personality traits and neglect the influence of social and environmental factors, we used Windle’s definition of resilience which recognises individual characteristics and the social and environmental factors which influence resilience: “Resilience is the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity”.

Fig. 1. The resilience framework applied to visual impairment

Fig. 1. The resilience framework applied to visual impairment

We used two linked sets of narrative interview data from 2007 and 2010. These data were acquired through narrative interviews with people with sight loss, who were asked to provide their accounts of their experiences of sight loss and accessing support. Three qualitative case studies were analysed in detail using a social-ecological model of resilience and vision impairment (shown in figure). The social-ecological model of resilience recognises that social and environmental factors are at least as important as individual personality traits in determining resilience. This perspective makes it clear that responsibility for optimising the resilience of individuals rests as much with the society in which they live as with the individuals themselves.

Within the model a range of assets and resources are identified which influence an individual’s capacity for resilience.  A set of criteria were used to establish the extent to which each individual appeared to be resilient at each point in time. For these three individuals, the impact of their sight loss upon wellbeing and quality of life was experienced and perceived quite differently. Analysis revealed that it is not merely the presence or absence of individual, social, and community resources – but how these resources interact with each other – that influences resilience and can create a risk to wellbeing. However, to possess only some of these resources is not sufficient; there is a co-dependency between these resources which requires the presence of other resources for resilience to be achieved. Resilience is not a permanent state; individuals can become more or less resilient as their circumstances and resources change over time.  Our analysis also demonstrated that access to resources is not enough to achieve a resilient outcome; individuals have to be motivated to utilise the resources available to them.

As an analytical tool that can help us to develop an understanding of the experiences of people with vision impairment, the concept of resilience has much to offer. It enables us to identify strengths as well as weaknesses, and, from an intervention perspective, potentially to build capacity rather than focus upon a deficit approach to ageing. Resilience allows the identification of enablers as well as barriers to improving peoples’ health and wellbeing and suggests further opportunities for service providers to engage with clients, as individual’s social, economic and emotional landscapes continue to change over time.

Clare Thetford, Kate Bennett, Suzanne Hodge, Paul Knox and Jude Robinson
The University of Liverpool
Institute of Psychology, Health and Society

 

Publication

Resilience and vision impairment in older people.
Thetford C, Bennett KM, Hodge S, Knox PC, Robinson J.
J Aging Stud. 2015 Dec

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