Understanding adversity and resilience at older ages

Authors


Address for correspondence: Zoe Hildon, CORE Clinical Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB e-mail: z.hildon@ucl.ac.uk

Abstract

This mixed-methods study looks at the relationship between adversity and resilience. It examines the dynamics of protection in a sub-sample of the Boyd Orr cohort that are aged between 70 and 80 years of age (n = 139). We used a questionnaire and activity diaries to gather a range of quantitative data, and interviews using lifegrids to explore past and present experiences of adversity. Sampling of 32 individuals was based on resilient and vulnerable outcomes (16 cases respectively), measured quantitatively as good or poor quality of life (CASP-19) in the presence of one or more adversities such as ill health or stress. The analysis explored adversity and protection in relationships, retirement, and health. Participants with resilient outcomes drew upon social and individual resources in the face of adversity, in particular resources that stabilised life change by providing continuity. These included: constructing narratives that reinterpreted past adversity in light of recent ones; maintaining social roles and activities that had previously brought pleasure or a sense of mastery; relying on tried and tested coping strategies; support from close ongoing relationships. Participants with vulnerable outcomes, however, described more severe adversities, suggesting that resilience is also dependent on the degree and impact of this experience.

Introduction

Research on resilience has concentrated on understanding the reasons why some people are able to overcome adversity in their life, whilst others succumb to disadvantages or difficult life events. Traditionally, such research has focused on children and adolescents identifying those who succeed despite risk and the resources that have enabled them to do so (Werner and Smith 1977, Garmezy 1985, 1993, Werner 1990, Masten 1999). Few studies have considered how older people might achieve such resilience (Rowe and Kahn 2000).

Historically resilience has been conceived of as a probabilistic concept (Schoon 2006), meaning that resilience can be seen to reflect the reduced odds of people doing well in the face of obstacles or the difficulty in overcoming hardship. As such, resilience has been measured by identifying positive outcomes despite exposure to adversity (Masten 2001). These outcomes can then be contrasted with vulnerability, where adversity leads to poor outcomes. Consequently, the study of resilience has predominantly used a quantitative approach, with few studies exploring experiences of resilience from a personal perspective.

The present paper addresses these gaps in the literature by examining resilience at older ages and focusing on individual as well as group experiences of managing adversity. We also aim to examine the relationship between resilience and adversity and to gain a wider understanding of the role of past and present life experiences and social context in the maintenance and practice of resilience in old age. To achieve these aims we use quantitative data to measure resilience and vulnerability and explore these groups using mainly qualitative data.

Quantitative methods were used in order to build on existing research into resilience and because they were judged to be effective in defining what was meant by both the concepts of resilience and vulnerability. Incorporating qualitative methods allowed us to address the theoretical concern that research into old age should aim to explore successful ageing as a ‘multi-dimensional human construction’ (Ryff 1989: 35). Using this approach captures the idea that personal accounts, thoughts, feelings and emotions are as relevant to understanding old age as quantitative descriptions and predictions. For these reasons, and to help ensure the robustness of our conclusions, we use mixed methods and compare qualitative and quantitative findings wherever possible.

We begin by situating our study within the resilience and gerontological research traditions and by describing the population sample and methods of analysis. Adversity and protection in resilient and vulnerable outcomes are examined in relation to (1) social relationships in old age and the consequences of bereavement or the ill health of a loved one; (2) the role of employment, specifically leaving the work place (retirement) and ways that this was conceived and experienced; (3) experiences of chronic or limiting illness and associated mental health. The final section concludes and discusses the strengths and weaknesses of the study and practical applications of our findings.

Previous research on resilience

Research into resilience initially concentrated on the psychological and physical characteristics thought to be protective in the face of adversity. Richardson (2002) describes these early studies as the first wave of research on resilience, which focused on understanding resilience as a range of individual attributes or as a trait (Jacelon 1997, Richardson 2002).

Researchers subsequently started to view resilience as determined not only by personal characteristics but also by the wider social experiences of that person (Flach 1980, 1988) or as a process (Rutter 1987, Jacelon 1997). This second wave of research began to examine the possibility that resilience could be learnt and practised (Richardson 2002). For example, Gilgun (1999) found that resilient people had experienced multiple risks over their lives giving them a set of skills to deal with current adversities. These people were able to draw on social and individual resources to manage adversity, relying for instance on supportive adult relationships which, Gilgun argued, mitigated daily stress.

Gilgun also emphasised the theoretical point that ‘how people interpreted events was pivotal to how they responded’ (1999: 42) which highlights the need to understand the meaning and experience of adversity in order to fully explore resilience. The second wave of research on resilience, therefore, saw an emerging focus on context and the concept of adversity and its relationship to resilience. It seems, however, that the detail of what is meant by adversity has largely been ignored or under-reported in the measuring and theory of resilience.

There are three key questions thrown up by this second wave of research: (1) how is adversity defined? (2) how can the impact of adversity be better understood? (3) how might adversity be transformed into more benign experiences? These three questions are explored in relation to successful ageing and resilience at older ages within this paper.

Ageing and resilience

Successful ageing has been understood mainly as the staving off of ill health; with, for example, Rowe and Kahn (1998) arguing that greater longevity has resulted in fewer rather than more years of illness and disability. Yet, among those over 60 years of age, the proportion with serious illness or disability is high, and rises with increasing age (Martin, Meltzer and Elliot 1988, Kind et al. 1998, Lloyd-Sherlock 2000). Successful ageing, conceived as remaining healthier for longer, does not take into account the fact that most people will not sustain a disease-free old age, and overlooks self-assessed criteria for successful ageing (Bowling and Dieppe 2005).

The present study defines resilience as flourishing despite adversity. This definition avoids equating successful ageing with health and points to the relationship between the individual and their social context as crucial to understanding resilience. Furthermore, since having a good or poor quality of life is not interchangeable with having good or poor health (Higgs et al. 2003) the notion of quality of life is particularly relevant for gaining a better understanding of the diversity of experiences in old age. This concept not only allows us to identify resilience and vulnerability but also means that the range and possible impacts of health-related and psycho-social adversities can be explored.

Population sample and methods of analysis

Participants, aged between 70 and 80 years old, were selected from a sub-sample of the Boyd Orr cohort. Further details of the cohort can be found in Blane (2005). The present reported analyses use current and lifecourse data from this sub-sample. The lifecourse data were collected retrospectively by lifegrid in 1997–8 from a stratified random sample of the Boyd Orr cohort (Blane et al. 1999). The lifegrids recorded key life events across three domains which included family life and relationships, residential addresses and moves, and changes in occupations (Berney and Blane 2003). Figure 1 illustrates a typical lifegrid.

Figure 1.

Figure 1 An example of a typical lifegrid; personal information has been changed to preserve anonymity

These lifegrids were used during follow-up home interviews in 2004–5 to identify and explore experiences of adversity in interviewees’ lives. The current data were collected during these interviews in 2004–5. These data, outlined below, include a measure of quality of life (CASP-19); details of recent adversities and the limitations they might impose; activity diaries exploring social participation; a coping index and personal accounts of ways of handling tough times at different points in life.

Attrition due to death, lost contact and withdrawal from the study reduced the 294 respondents in 1997–8 to 139 with full data in 2004–5, from whom were drawn the subjects of the present mixed-methods analysis. Selection criteria were based on quantitative information which designated participants as having either vulnerable or resilient outcomes. In order to identify resilience (flourishing despite adversity) and vulnerability (not flourishing despite adversity) only subjects with recent exposure to adversity were chosen. These measures and sampling methods are discussed in detail below.

Quality of life was measured using the CASP-19 scale, which captures this concept in terms of control, autonomy, self-realisation and pleasure (Higgs et al. 2003). This scale was developed (Hyde et al. 2003) and validated from research based on the same sub-sample of the Boyd Orr cohort (Wiggins et al. 2004). Resilience and vulnerability were identified as at least one reported adversity and high or low CASP-19 scores (on or above and below its median value).

The adversities used to determine resilient and vulnerable outcomes were: reporting a negative life event such as the death of a loved one; having a limiting-longstanding illness; reporting change in various domains over the last five years (deteriorating health, having more stress, or worsening life circumstances). All adversities were validated as such (based on n = 139), which meant that they were associated with a statistically significant reduction in CASP-19 scores and showed a gradient for reduction in CASP-19 scores when they were compounded. This suggests that these measures of adversity have independent effects and are worse when accumulated.

The present analysis examines 32 interviews in relation to resilient and vulnerable outcomes, with 16 cases for each outcome. To ensure that a range of experiences was considered the 32 cases were selected from a sampling grid which further divided CASP-19 scores into tertiles within the two groups (either side of the median). These six tiles were then crosscut by the number of adversities experienced (between 1–2, 3–4 and 5). The aim of this sampling grid was to mirror the range of exposures and CASP-19 scores in the resilient and vulnerable groups. In practice this was not always possible, because we had fewer cases in the resilient group. The grid also reflects the finding that participants with vulnerable outcomes tended to report more adversities than the participants in the resilient group (see Figure 2).

Figure 2.

Figure 2 The sampling grid which shows the data selected for inclusion in analysis; based on quantitative data including CASP-19 scores and reported exposure to adversity

The resilient and vulnerable outcome groups were similar socio-demographically, in terms of sex, age, car ownership, adequacy of income, education, social class (based on registrar general classification) and housing tenure (see Table 1). Consequently, it is reasonable to compare resilient and vulnerable groups without too much concern that socio-demographic factors are biasing experiences of health-related and psycho-social adversity.

Table 1. Number of cases by socio-demographic information of both resilient and vulnerable outcome groups
 Resilient N = 16Vulnerable N = 16
  • *

    National Key Learning target level 4 or above (undergraduate degree, postgraduate degree, National Vocational Training levels 4 and 5, Higher National Diploma, Higher National Certificate, certain professional qualifications).

Female 8 9
Under 75 9 8
Car owner or access1212
More or enough income for needs1213
Vocational or higher education* 6 5
Non-manual occupation 7 8
Owner-occupier1214

In the qualitative part of the study the interviews were semi-structured and took place in the participant's home. Interviewees were invited to talk about current and past adversities and how they dealt with them. The lifegrids served to personalise the interviews giving a blueprint of individual life trajectories and acted as a tool to encourage reminiscence and to facilitate the asking of difficult questions.

The interviews were transcribed for analysis. We analysed the narratives using a framework approach (Ritchie and Lewis 2003) that broke down the lives of participants into the experience of different adversities and how people handled these adversities during old age in comparison to their younger days. We first explored each transcript systematically examining the social and/or psychological ways of coping, identified by interviewees. Secondly, we examined the range of views and experiences of adversity to identify any ‘hidden’ or implicit ways that adversity might be overcome. Initial analysis of resilient and vulnerable groups was carried out ‘blind’ as to which group was which. All the authors undertook a series of discussions about emerging themes to resolve discrepancies and reach a consensus on the meaning of the texts. Text segments were then extracted accordingly, based on these emerging themes.

The questionnaire data that were used to complement the qualitative interviews were also based on the 32 selected participants. The questionnaire data include an index of coping styles over time. Participants were asked to indicate particular strategies that they used in the present and in the past (during their thirties) when an event had hit them really hard; for example, learning to live with the problem or seeking information. In addition, the questionnaire data included a measure of the degree to which activities of daily living (being able to climb stairs or cut toenails for example) were limited.

A seven-day activities diary was also compiled. The data collected gave a broad overview of daily activities during the week prior to the home visit and identified the activities which the participants would engage in over a typical week. The purpose of the diary was to gain insight into the role of routine and daily social context in enabling resilience and good quality of life.

A content analysis of activity diaries was carried out to systematically process the entries into content categories; this was done using an explicit set of rules to inform coding (Krippendorff 1980, Weber 1990). Coding for the frequency of routine and non-routine activities reported in the morning and early afternoon, and in the late afternoon and evenings, over a seven-day period was undertaken. Three main categories were identified based on routine and non-routine activities. These were contact with social networks, for example, socialising with family and friends, social capital such as volunteer work, and spending time alone in the home doing, for instance, DIY or housework. Social characteristics and the nature of daily activities and interactions were then compared for resilient and vulnerable groups.

All quantitative analysis was carried out using statistical software packages (SPSS and Excel) and included: validating potential adversities using a t-test for equality of means and exploring the cumulative effects of adversity on mean CASP-19 scores; identifying resilient and vulnerable groups; comparing data from both groups (including stability in coping styles, frequencies of the activities of daily living and limitations caused by ill health) using cross tabulation.

In reporting our findings, pseudonyms are used for participants and all other identifiers changed. Since many participants preferred the use of ‘Mr’ or ‘Mrs’ followed by their surname as a way of being addressed we have used this style in reporting the words of participants. Furthermore, the analysis of interview data is reported alongside complementary quantitative data extracted from the questionnaire and diaries.

The Results

Relationships

Studies show that a common realisation in facing life events is recognising the availability of help and people who can be relied upon (Thompson 1985, Calhoun and Tedeschi 1990, Harvey and Miller 2000). In our data, Social networks and support gained through relationships were important in accounts belonging to both resilient and vulnerable outcome groups.

For example, both groups commonly spoke about being able to rely on friends, family and neighbours for socialising and for emotional and sometimes practical support in the face of adversity – including bereavement and when a close relative or friend became ill. On the other hand, the differences in accounts of experiences of this kind between groups hinged largely on the impact of bereavement or the consequences of the health problems of loved ones.

In bereavement, the impact of loss appeared dependent on the degree of structure the deceased had brought to the lives of those who were left behind. For example, the participants with vulnerable outcomes described the loss of relationships which were forged around routine. In these instances feelings of loss were expressed as chronic since shared habits and the ongoing structure of daily life was altered. This produced constant reminders of bereavement, even though in most cases strong social networks were available to provide support. As the following experience suggests:

She [the participant's wife] was to me, my life. It was hard – very, very hard [when she died]. It was my wife who was my main structure of my life. She was the one that sort of really changed everything completely and utterly; even though my daughter is unbelievable, running backwards and forwards. My son is always popping his nose in. The pair of them are brilliant really. My social life, Masonic speaking, is wonderful, you never lose that camaraderie . . . they were absolutely wonderful when my wife died (Mr Hamilton, 76).

In their well-known study, Elder and Rockwell (1979) view the death of a spouse in particular as the highest level of life change. In our data this was the case for those who had shared rigid daily routines with their spouse. Even several years after the death of a loved one some people with vulnerable outcomes reported not being able to recover, and it seems that their quality of life was still being affected.

Where loved ones were ill or disabled the negative impact of this was described as much greater for the participants who were primary carers. In these instances the daily routines of the carer were tied to the needs of the people they were looking after, leaving little scope for autonomy. Routines were rigidly set and mobility difficult, which curtailed prospects of socialising and travel, even though the opportunities were available. In such instances, all participants had vulnerable outcomes and while emotional support and social contact was often available, the practical support that would enable greater autonomy, was lacking. As the experience of this participant suggests:

I suppose, during the month we see probably half a dozen different friends . . . my sister phones every Sunday . . . There are things I could do if I wasn't tied to this house and a disabled wife. I can't go off for a couple of days or something like that, because my responsibility is here (Mr Crompton, 76).

Likewise, reporting greater autonomy and flexibility tended to be particular to those with resilient outcomes. For example, in the activities diaries those with resilient outcomes reported almost twice as much engagement in leisure or household activities which took place alone (30% of the resilient group) than those in the vulnerable outcome category (17% of activities). And, although both groups reported roughly the same amount of weekly contact with family and friends (24% for those with vulnerable outcomes compared to 20% for those with resilient ones), participants in the vulnerable outcome category were more likely to report routine contact (61% of contact for those with vulnerable outcomes was routine, compared to 42% in the resilient group).

The participants in the resilient group were also more likely to talk about their bereavement in the context of wider experiences. Integrating the event into a personal narrative seemed to help make sense of the loss and appeared to buffer against the impact of bereavement. As the experience of this interviewee illustrates:

Now that simply knocked me for six [the death of a son, the previous year]. I miss having a son. I mean she [my ex-wife] had two miscarriages, before he was born and we found that they were both boys. That's added to the – it's a wound that will not heal. They are the same kind of wound if you like, and they just all caught up that little bit, and it were so difficult (Mr Mitchell, 72).

In this instance, past associations seem at first to compound grieving but the use of the past tense also suggests that Mr Mitchell had dealt with his grief. By constructing a narrative around the event he no longer seemed overwhelmed or distressed by it in his day-to-day life, although the loss itself was still painful. This particular strategy, specific to those with resilient outcomes, seemed to help transform adversity into a more benign experience for some participants. Perhaps this was because understanding the event as part of a story gave it meaning and helped to create some distance between emotions and daily living.

Supportive emotional and social networks were talked about in both outcome groups, for example the importance of camaraderie and having people to talk to. Yet in the face of some adversities, such as the bereavement of a partner who had been a significant part of the main structure of their daily life, this support was not always enough to buffer against the effects of the disruption caused by adversity. This chronic sense of loss was particular to those who had vulnerable outcomes. Besides showing greater autonomy and flexibility in daily activities, those with resilient outcomes also gave narrative accounts of adversity in which they were able to reformulate past events to help make sense of newer ones. This appeared to help interviewees to come to terms with grief.

Leaving employment

Leaving employment or retiring was experienced in a range of ways by participants. There was no real consensus on what retirement meant. However, many people pinpointed 60 or 65 as their retirement age, but some people spoke of retirement as the day they or their spouse stopped paid employment. Although most of these experiences were not current at interview, they were vividly remembered and recounted.

A clear pattern was associated with those classified with resilient or vulnerable outcomes. For instance, negative experiences in retirement were often linked with sudden exits from the labour market, and were at times met with periods of excessive drinking, depression and boredom. Concurrently, the opportunity for a gradual release from working life was rarely available for those in the vulnerable outcome group. Interestingly, it was only those with vulnerable outcomes who spoke about retirement as an adversity. The main reason given for this was because routines had been interrupted, as this participant illustrates:

I can remember that way back because I felt it was a great loss [leaving work] in my life. Not being able to get up in the morning to a regular routine and so on. But talking about my routine it was because of the long hours that I used to do, it was a great loss to me. In fact I felt quite depressed. I was really miserable for the first 18 months, and I'd thought actually I'd quite enjoy it, but I couldn't adjust somehow to the gap that the work left (Mr Crompton, 76).

In time, however the disruptions brought about by retirement were often well managed, by establishing new routines and rituals, and for those who missed their working lives by finding ways to continue fulfilling their capacities in voluntary or part-time work. Keeping up activities that people enjoyed, were good at, and in some sense defined their identities – which was often emphasised by the use of ‘I always’– was a recurring theme, particularly for those with resilient outcomes.

The ‘I always’ turn of phrase was also far more common to this outcome group. For example, it was often included in narrative accounts that reinterpreted past adversity in light of new ones. However, it also featured in some interviews given by participants in the vulnerable group. Specifically when talking about recovering from adversity as Mr Crompton goes on to demonstrate:

You can't just go on being depressed [after retirement]. You've got to take up some new interests sort of thing. What I did actually, I took on more committee work with the school. I took it on as chairman of the publications and publicity committee which had always held a particular interest to me because when I was working that was part of my job anyway.

In contrast, a gradual and positive retirement process was common for those in the resilient outcome group. This was either because their workplace allowed flexible retirement or because businesses were family owned which enhanced control over the retirement process, as the experience of Mr Smith shows:

This is why I didn't retire on the following day when I was 65. Because I'm quite happy at work you see. I was working for my son. After I'd retired if it came two o’clock I'd say well, I've had enough, I'm going home! [laughter]. And that went on for a while. I was working while I wanted to work. And as soon as I found I didn't want to work I said, ‘no’. It wasn't a conscious decision to retire. I was in the position to be able to do that without hindering anybody (Mr Smith, 70).

Negative experiences in retirement were rare in the resilient outcome group, unless retirement had been precipitated by ill health. In instances where health or work-related stress were reported, retirement was seen as a means of recovery. Retirement was therefore protective when it helped relieve health or stress-related adversity and for those participants who were able to have a gradual labour-market exit or had planned their leisure time post retirement.

In contrast, where the opportunity to continue work was suddenly and prematurely revoked it was common to experience retirement as difficult. Young and Schuler (1991) describe this conflict in relation to freedom, and echo our findings, arguing that, although retirement can offer greater choices or freedom from the constraints of working life, many of the retired people they interviewed ‘were aware of being deprived of the freedom to work’ (1991: 20).

Having control over the retirement process was a major theme for those with resilient outcomes. Workers who were self-employed or had the skills to become consultants or freelance workers had control over the last stages of their career and when they retired. These factors allowed participants to leave work gradually and enabled them to maintain a sense of purpose and identity. Maintaining a sense of constancy in the face of changing work-life circumstances appears to transform the potentially adverse experience of retirement or losing employment into a positive or benign experience.

Health

Ill health or declining health has been shown to reduce the quality of life of older people particularly when it results in physical impairment or functional limitation (Netuveli et al. 2006, 2005). Both groups reported limiting-longstanding illnesses; seven people in the resilient outcome group compared to 10 in the vulnerable group. As we shall see, however, those with vulnerable outcomes described their experiences as far more limiting. Moreover, analysis of limitations in activities of daily living showed that these problems were more prevalent, by over a third, among those with vulnerable outcomes.

The health problems reported by the participants with vulnerable outcomes were less easily managed through medication and emotionally than those reported by people with resilient outcomes. For instance, those in the vulnerable group reported suffering from the effects of: cancer, under-active thyroid, amputation of nose and palette, double mastectomy, urinary incontinence, recent stoma operation, a recent stroke, severe back pain caused by a crumbling disc, Cushing's disease as well as frequently reporting high blood pressure and arthritis. In contrast those in the resilient outcome group commonly reported: arthritis, high blood pressure, diabetes and asthma.

Internal ways of coping with ill health and other adversities were described in similar terms by resilient and vulnerable participants. For many people, effective coping was seen as being able to accept and assess problems subsequently trying to find solutions. Solutions included thinking positively, being unafraid of asking for information and help and facing up to setbacks and then moving on as quickly as possible. These ways of managing adversities, coupled with being able to rely on friends and family for advice, was common to both groups.

Some of the participants in the vulnerable group talked instead about health problems compounding, which they associated with old age and life being harder than when they were younger, as this interviewee commented:

Yes I've changed, with my husband's death it was about five years before I nearly got my head above the water, I was just about to start really living again when I had the double mastectomy, and that knocked me back again. Coz I'm older now, this is the thing . . . I've got this and that wrong with me now, you know high blood pressure and arthritis and you know heart trouble and all this carry on. I've not bounced back the way I used to do (Mrs Bosworth, 79).

For those in the vulnerable group, like Mrs Bosworth, who talked about not being able to bounce back or an inability to recover from setbacks this was seen as interchangeable with having more and ongoing adversity. The interviewees who expressed this feeling also found it hard to pinpoint any specific ways of dealing with these difficult times. Also, on the whole no interviewees in the vulnerable group felt they were able to rely on the same strategies as in younger days. Most of these participants spoke about their ability to manage difficult times declining.

In some cases the participants with vulnerable outcomes spoke of having to give up past hobbies, pleasures and outings due to ill health:

It's because I can't walk. If my legs would go, I would enjoy myself very much (Mrs Henson, 73).

Lack of involvement in group events or gatherings in the community was also reflected in the activities diaries. Participating in social events such as bingo or activity clubs (sport or craft for example) was reported twice as often for those with resilient outcomes as for those with vulnerable ones. On the other hand, half of these events were routine for both groups. These routines seemed to facilitate attendance and add to the pleasure of the experience, since participants in both groups talked about looking forward to the event several days before actually attending.

Participants with resilient outcomes rarely talked about health-related limitations. For the few in the resilient group for whom ill health and the constraints it had imposed were of central concern, health problems were understood as part of a wider set of experiences than their diagnosis suggested:

Four or five years before I finished work I had my skull split open, I got hold of the bale but being under pressure when it come off the rack, it all come down and split my skull open. And when at a fun fair an older boy hung me upside down for quite some time, and waved goodbye. I was only about 20 at the time, and after that I was disorientated and couldn't walk properly like I was absolutely drunk, you know, rolling about – bit of problems with my head since then (Mr Samuel, 75).

In this instance the participant had wanted to carry on working, but talked about having to take early retirement because of ‘spells’ and memory loss, and the apparent misdiagnoses of the onset of Alzheimer's.

Bury (1982), argues that the biographical disruptions that result from chronic illness unfold in three stages: the first is ‘the what's going on stage?’ that involves apprising changed bodily functioning; the second includes a ‘profound disruption to explanatory systems’ (1982: 169) so that one's biography and self-concept is fundamentally re-thought; and lastly, comes the mobilising of resources so that the altered situation can be faced.

Mr Samuel's account of experiences in his twenties shows how his biography was reinterpreted to include an explanation for the disruption of his current retirement plans. By doing so, his health problems were recast as part of a consistent narrative which reflects his past experiences and identity, and consequently are not seen as new at all. While this understanding of health outcomes may be inconsistent with conventional medical evaluation, it seemed to have helped this participant achieve resilience since he also described how his condition had dramatically improved.

The notion of maintaining a degree of continuity in identity was also reflected in the resilient outcome group by the common assertion that ways of managing health concerns or adversity generally had not changed a great deal. For example, another participant who also had had to come to terms with retiring early due to ill health said simply of the way he got through tough times:

It's always been my family and, it's always been my friends. I think really, I'm the type of person that doesn't let problems get on top of me (Mr Mitchell, 72).

One participant in the resilient group who described health limitation and consistency in coping strategies also added by way of explanation:

I did cope. I've always been different. I think I saw so much as a little girl that I thought ‘I'm not going to be like that’ (Mrs Rose, 75).

The finding that ways of dealing with adversity among participants with resilient outcomes was more likely to be understood as established and maintained over time was reinforced by quantitative analysis. This complementary analysis looked at how people reported handling events which had hit them hard now compared to their thirties. Results showed that those with resilient outcomes were more than twice as likely to report stability in a range of coping styles, than those with vulnerable outcomes.

Ill health was more limiting to the present everyday life of those participants with vulnerable outcomes, and their health complaints were more likely to be multiple and their symptoms more severe compared to the resilient group. As such, the health problems experienced by the vulnerable group were commonly described as emotionally draining. They were also seen to curtail social life outside the home and group activities which otherwise would have been pleasurable. However, a few participants in the resilient group did describe severe symptoms of ill health in the recent past and currently. For these individuals the sense of continuity gained from relying on the same ways of handling adversity and by contextualising adversity in light of past events seemed to help them come to terms with, or even improve, their conditions.

Discussion

How is adversity defined?

Themes from our data that defined adversity centred on limited circumstances and opportunities brought about by physical, mental or social losses. In our data these were talked about in relation to the death or illness of a loved one, one's own ill health and circumstances in retirement.

How can its impact be better understood?

Overall, past and present adversities were described either in terms of disruptions to expected life trajectories or changes in the structure of people's lives. Rigidly set routines and lack of autonomy in routine, or flexibility in daily life seemed crucial in determining the greater impact of adversity. Although routine at times appeared to play a protective role, by structuring daily activities and facilitating social participation and pleasures, it also undoubtedly contributed to the chronic experience of adversity when it was lost.

It was clear from qualitative and quantitative data that those participants with vulnerable outcomes experienced greater and more compounding losses or adversity than those with resilient outcomes. For instance, the participants in the vulnerable group described a chronic sense of adversity in relation to caring and bereavement; had fewer opportunities and less control in the last stages of their careers; and perhaps initially had less motivation and help to work out a gradual retirement plan. They tended to describe and report more multiple, and more emotionally severe and physically limiting health concerns than the participants with resilient outcomes.

How might adversity be transformed into more benign experiences?

It was also clear from our data that certain resources, principally having access to social networks that can be relied upon and having effective coping strategies, were important to both groups. Examples would include having friends to talk problems through with in times of need and the ability not to dwell on setbacks. Yet, it appears unlikely that for our interviewees such resources are in themselves features of resilience, since those participants with better outcomes were far more likely to emphasise stability in the ways of handling adversity than those with worse outcomes.

In fact our findings suggest that processes that offered stability in the face of change in combination with social support and positive coping styles were integral to transforming potentially ongoing adversity into more neutral experiences. These were often talked about using the ‘I always’ turn of phrase, and included: relying on tried and tested ways of handling stress; finding ways to continue in roles and activities that had formerly brought pleasure or a sense of mastery; and retaining continuity of identity through narrative.

Conclusion

Giddens (1991) argues that it is the capacity for maintaining consistency in one's life story that is integral to one's sense of identity:

Self identity is not a discursive trait, or even a collection of traits, possessed by the individual. It is the self as reflexively understood by the person in terms of his or her biography . . . A person's identity is not to be found in behaviour nor – important though it is – in the reaction of others, but in the capacity to keep a particular narrative going. The individual's biography, if she is to maintain regular interaction with others in the day-to-day world, cannot be wholly fictive. It must continually integrate events which occur in the external world, and sort them into the ongoing ‘story’ about the self (1991: 53–54).

Our data indicate that the process of constructing and reinterpreting past events in the light of more recent ones was essential to developing resilience. This is because it not only allowed people to retain a sense of identity but also seemed to clarify the meaning of adverse experiences. This process appears to create a genuine acceptance and distance between the emotional weight of adversity and day-to-day life. Furthermore, in line with Bury's (1982) assertion that adapting to biographical disruptions means fundamentally reinterpreting one's own biography and self-concept, this process also seemed to help people readjust their expectations to changing circumstances. The use of the lifegrid in encouraging reminiscence in the age group we were interviewing was therefore fundamental to this research. This approach also enabled us to begin untangling how present perception of past and current adversity might contribute to resilience.

Despite the advantages of our approach we were limited by the small numbers available from comparative quantitative data. Similarly, in our qualitative analysis the data did not reach saturation point, or the point where no new information was being given. In addition, our sample population was mostly affluent and educated. Further research might explore resilience with participants who are more socially and economically disadvantaged and test our findings using a larger and more diverse sample.

The mixed-methods approach we developed, however, allowed us to complement qualitative themes with quantitative data on coping, social participation/contact and adversity. This comparative approach showed strong, consistent patterns, i.e. the quantitative data supported the qualitative findings. They also delivered clear criteria that can be used to inform intervention aimed at enabling resilience and improving the quality of life of older people.

For example, the compounding of adversity and changes in rigid or set routines can be understood by health practitioners, family and friends as likely to increase vulnerability. In addition, health professionals will have a better understanding as to the role of narrative in enabling resilience in the face of adversity. This process may be encouraged through life review or reminiscence therapy (Bohlmeijer, Smit and Cuijpers 2003) which prompts people to talk about their life stories, and has been identified as an effective component of old age palliative care (Paice 2002).

Our findings also suggest that practical help to alleviate the limiting effects of caring for a disabled person and of ill health – thereby promoting greater autonomy and flexibility – is significant in achieving resilience. And making retirement a gradual process available to those who want it may help to circumvent the vulnerability that can accompany sudden exits from the labour market.

It is clear from our research that social context can play a significant part in fostering resilience and reducing adversity. Social institutions and their practices can encourage resilience, by enabling individuals to retain a sense of stability in their life and a coherent identity in the face of inevitable life changes. How society and social policy can be improved to foster resilience and reduce adversity is a rich focus for future research and debate.

Acknowledgements

The funding for this project was obtained through British Economic and Social Research Council grant L326253061 that forms part of the Capability and Resilience Network. We gratefully acknowledge the Boyd Orr respondents for their continued participation and commitment and thank Justin Smith and Michael Hildon for their comments.

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