A Systematic Review and Correlational Meta-Analysis of Factors Associated With Resilience of Normally Aging, Community-Living Older Adults.

BACKGROUND AND OBJECTIVES: Global policy emphasizes the need to promote healthy aging through supporting inclusivity, safety, and functional independence. Research indicates that efforts to enhance resilience can contribute to meeting these objectives. We employed a meta-analytical approach to examine evidence on resilience in community-living older adults. RESEARCH DESIGN AND METHODS: We searched electronic databases until January 13, 2020 for observational studies investigating factors associated with resilience in this population. Articles had to provide quantitative data based on standardized assessment and include samples where mean participants' age and lower 95% confidence interval were more than 55 years. We included 49 studies reported in 43 articles and completed 38 independent meta-analyses, 27 for personal and 11 for contextual factors associated with resilience. RESULTS: A range of personal and contextual factors were significantly associated with resilience, with effects sizes predominantly small to moderate (0.1 < r < 0.49). Factors reflecting psychological and physical well-being and access to/quality of social support were associated with higher resilience. Factors indicative of poorer psychological well-being and social challenges were associated with lower resilience. Longitudinal evidence was limited. The level of between-study heterogeneity was substantial to considerable. Where relevant analysis was possible, the identified publication bias was also considerable. DISCUSSION AND IMPLICATIONS: The quality of the available evidence, as well as issues related to measurement of resilience, indicates the need for further work relative to its conceptualization and assessment. The presented findings have important clinical implications, particularly within the context of the coronavirus disease 2019 impact on resilience in older adults.

Psychometric Evaluation of the Making it CLEAR Questionnaire: A Resilience Measure for Older Adults.

BACKGROUND AND OBJECTIVES: Previous efforts to develop a resilience measure for older adults have largely failed to consider the environmental influences on their resilience, and have primarily concentrated on the resilience of community-dwelling older adults. Our objective was to validate a new multidimensional measure of resilience, the Making it CLEAR (MiC) questionnaire, for use with older adults at the point of discharge from hospital. RESEARCH DESIGN AND METHODS: This study tested the structure, validity, and reliability of the MiC questionnaire. The questionnaire consists of 34 items, which assess the "individual determinants of resilience" (IDoR) and the "environmental determinants of resilience" (EDoR) across 2 subscales. 416 adults aged 66-102 years participated. Exploratory factor analysis, item analysis, and linear regression were undertaken. RESULTS: The IDoR subscale contained six factors which were labeled "Self-efficacy," "Values," "Interpersonal skills," "Life orientation," "Self-care ability," and "Process skills." The EDoR subscale contained five factors related to "Person-environment fit," "Friends," "Material assets," "Habits," and "Family." Both subscales demonstrated acceptable convergent validity and internal consistency, while individual items showed acceptable levels of discrimination and difficulty. DISCUSSION AND IMPLICATIONS: The study provides evidence supporting the validity and quality of the MiC questionnaire. The results suggest that the MiC questionnaire could be used to identify the resilience needs of older adults at the point of hospital discharge. However, future research should identify which items of the MiC questionnaire are associated with hospital readmission, in order to develop an easily applicable screening tool for clinical practice.

Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. METHODS: Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. RESULTS: 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. CONCLUSION: There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.

Assessment of need and practice for assistive technology and telecare for people with dementia-The ATTILA (Assistive Technology and Telecare to maintain Independent Living At home for people with dementia) trial.

INTRODUCTION: The objective of this study was to define current assistive technology and telecare (ATT) practice for people with dementia living at home. METHODS: This is a randomized controlled trial (N = 495) of ATT assessment and ATT installation intervention, compared with control (restricted ATT package). ATT assessment and installation data were collected. Qualitative work identified value networks delivering ATT, established an ATT assessment standard. RESULTS: ATT was delivered by public and not-for-profit telecare networks. ATT assessments showed 52% fidelity to the ATT assessment standard. Areas of assessment most frequently leading to identifying ATT need were daily activities (93%), memory (89%), and problem-solving (83%). ATT needs and recommendations were weakly correlated (τ = 0.242; P < .000), with ATT recommendations and installations moderately correlated (τ = -0.470; P < .000). Half (53%) of recommended technology was not installed. Safety concerns motivated 38% of installations. DISCUSSION: Assessment recommendations were routinely disregarded at the point of installation. ATT was commonly recommended for safety and seldom for supporting leisure.