The resilience of older adults receiving hospital care: Validation of the Making it CLEAR questionnaire, and an exploration of protective and vulnerability factors
Background ‘Resilience’ is the process by which individuals adapt to and manage adversity. Through the identification of older adults who may struggle to ‘adapt well’ following health difficulties, resilience research may support health improvement. As resilience is influenced by an individual’s personal characteristics, resources, and physical and social environment, resilience measures that comprehensively capture resilience are important. Furthermore, due to the contextual nature of resilience, research findings should not be generalised across populations who experience unique adversities. Despite this, most resilience measures used with older adults assess resilience at the individual level, and current resilience research has largely recruited community-dwelling older adults, preventing the findings from being generalised to those receiving hospital care. The Making it CLEAR (Community Living, Enablement and Resilience) (MiC) questionnaire was designed to measure the individual and environmental determinants of an older adult’s resilience. This work focuses on assessing its validity with a population of older adults receiving inpatient care and uses the data to investigate the protective and vulnerability factors of this population. Methods The study analyses data collected from older adults recruited during acute hospital admission across three Medicine of the Elderly wards. Exploratory factor analysis and item analysis was used to assess the validity of the MiC questionnaire, while item response analysis identified the key ‘resilience needs’ of the population. Regression analyses identified the protective and vulnerability factors of the sample and investigated the mediatory effect of self-efficacy on the relationship between frailty and resilience. Results Exploratory factor analyses and item analysis demonstrated acceptable construct validity, internal consistency, discriminant validity, and item difficulty for each subscale of the MiC questionnaire. Multiple regression analysis found that gender, marital state, perceived physical and mental health, and receipt of a daily care package predicted individual determinants of resilience. Religion, frailty status, perceived physical and mental health, and visual impairment predicted environmental determinants of resilience. Self-efficacy was found to mediate the relationship between frailty and resilience; and low self-efficacy, poor person-environment fit, and a lack of social support from friends were identified as the most common resilience needs. Conclusion The results demonstrate that the MiC questionnaire is a valid measure of both the individual and environmental determinants of resilience of older adults during hospital admission, thus supporting the use of the MiC questionnaire with this population. In addition, the regression analyses suggest potential characteristics of older adults with low resilience, while the identified resilience needs are suggested as potential priorities for targeted intervention.