Psychiatric Quarterly

, Volume 68, Issue 3, pp 189–219 | Cite as

Successful Coping, Adaptation and Resilience in the Elderly: An Interpretation of Epidemiologic Data

  • Jeffrey R. Foster


The elderly are often thought to suffer inevitable declines in functional abilities due to normal aging and concomitant diseases (acute and chronic). This view may be true for many aspects of physical health. However, an abundance of evidence suggests that mental health diverges from physical health in that Coping, Adaptation and Resilience (CAR) functions are surprisingly well-preserved throughout most of the life span. The normal “anatomy” and “physiology” of the CAR construct is described. It's robust relationship with the abnormalities of DSM-IV geriatric mental disorders is illustrated. Opportunities for new approaches to treatment are noted. These insights from the elderly are applicable to all age groups.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Goldberger L, Breznitz S (Eds): Handbook of Stress: Theoretical and Clinical Aspects (2nded); New York; The Free Press, 1993Google Scholar
  2. 2.
    Carpenter BN (Ed.): Personal Coping: Theory, Research and Application; Westport, CT; Praeger; 1992Google Scholar
  3. 3.
    Cummings EM, Greene AL, Karraker KH: Life-span Developmental Psychology: Perspectives on Stress and Coping; Hillsdale, NJ; Lawrence Erlbaum Associates; 1991Google Scholar
  4. 4.
    Bargh JA, Barndollar K: Automaticity in Action: The unconscious as repository of chronic goals and actions. In Gollwitzer PM and Bargh JA (Eds.); The Psychology of Action: Linking Cognition and Motivation to Behavior. New York; The Guilford Press; 1996Google Scholar
  5. 5.
    Folkman S: Making the case for coping. In Carpenter BN (Ed.): Personal Coping: Theory, Research and Application; Westport, CT; Praeger; 1992Google Scholar
  6. 6.
    Foster JR, Cataldo JK: Protection from clinical depression in medical longterm care facilities: evidence for psychologic adaptation in cognitively intact patients. International Journal of Geriatric Psychiatry 9: 115-125, 1994 [see Table 2]Google Scholar
  7. 7.
    Lin KM, Poland RE, Nakasaki G (Eds.): Psychopharmacology and Psychobiology of Ethnicity. Washington DC; American Psychiatric Press, Inc.; 1993Google Scholar
  8. 8.
    Gornick ME, Eggers PW, Reilly TW et al.: Effects of race and income on mortality and use of services among Medicare beneficiaries. The New England Journal of Medicine 335: 791-799, 1996PubMedGoogle Scholar
  9. 9.
    Krause, N: Neighborhood deterioration and self-rated health in later life. Psychology and Aging 11: 342-352, 1996PubMedGoogle Scholar
  10. 10.
    Smider NA, Exxex MJ, Ryff CD: Adaptation to community relocation: the interactive influence of psychological resources and contextual factors. Psychology and Aging 11: 362-372, 1996PubMedGoogle Scholar
  11. 11.
    Vaughan E: Individual and cultural differences in adaptation to environmental risks. American Psychologist 48: 673-680, 1993Google Scholar
  12. 12.
    Sodowsky GR, Lai EWM, Plake BS: Moderating effects of sociocultural variables on acculturation attitudes of Hispanics and Asian Americans. Journal of Counseling & Development 70:194-204, 1991Google Scholar
  13. 13.
    El-Sheikh M, Klaczynski PA: Cultural variability in stress and control. Journal of Cross-Cultural Psychology 24: 81-98, 1993Google Scholar
  14. 14.
    Negy C: Coping and culture: a research note on Diaz-Guerrero's theory. Psychological Reports 76: 680-682, 1995PubMedGoogle Scholar
  15. 15.
    Diaz-Guerrero R: Comments on coping and culture. Psychological Reports 76: 1322, 1995Google Scholar
  16. 16.
    Kendler KS, Kessler RC, Walters EE, et al.: Stressful life events, genetic liability, and onset of an episode of major depression in women. American Journal of Psychiatry 152: 833-842, 1995PubMedGoogle Scholar
  17. 17.
    Ebstein RP, Novick O, Umansky R, et al: Dopamine D4 receptor (D4DR) exon III polymorphism associated with the human personality trait of novelty seeking. Nature Genetics 12: 78-80, 1996PubMedGoogle Scholar
  18. 18.
    Benjamin J, Li L, Patterson C et al.: Population and familial association between the D4 dopamine receptor gene and measures of novelty seeking. Nature Genetics 12: 81-84, 1996PubMedGoogle Scholar
  19. 19.
    Tooby J, Cosmides L: On the universality of human nature and the uniqueness of the individual: the role of genetics and adaptation. Journal of Personality 58: 17-67, 1990PubMedGoogle Scholar
  20. 20.
    Buss DM: Evolutionary personality psychology. Annual Review of Psychology 42: 459-491, 1991PubMedGoogle Scholar
  21. 21.
    O'Connell WE: The adaptive functions of wit and humor. Journal of Abnormal and Social Psychology 61: 263-270, 1960PubMedGoogle Scholar
  22. 22.
    Huyck MH, Duchon J: Over the miles: coping, communicating, and commiserating through age-theme greeting cards. In Humor and Aging. Nahemow L, McCluskey-Fawcett DA, McGhee PE (Eds.); New York; Academic Press, Inc.; 1986Google Scholar
  23. 23.
    Fry WF: Humor, physiology, and the aging process. In Humor and Aging. Nahemow L, McCluskey-Fawcett DA, McGhee PE (Eds.); New York; Academic Press, Inc.; 1986Google Scholar
  24. 24.
    Yoder MA, Haude RH: Sense of humor and longevity: older adults' self-ratings compared with ratings for deceased siblings. Psychological Reports 76: 945-946, 1995PubMedGoogle Scholar
  25. 25.
    Auerbach SM: Temporal factors in stress and coping: intervention implications. In Carpenter BN (Ed.): Personal Coping: Theory, Research and Application; Westport, CT; Praeger; 1992Google Scholar
  26. 26.
    Park C, Cohen LH: Religious beliefs and practices and the coping process. In Carpenter BN (Ed.): Personal Coping: Theory, Research and Application; Westport, CT; Praeger; 1992Google Scholar
  27. 27.
    Koenig HG, Cohen HJ, Blazer DG et al.: Religious coping and depression among elderly, hospitalized medically ill men. American Journal of Psychiatry 149: 1693-1700, 1992PubMedGoogle Scholar
  28. 28.
    Hobfoll SE, Dunahoo CA, Monnier J: Conservation of resources and traumatic stress. In Traumatic Stress: From Theory to Practice; Freedy JR and Hobfoll SE (Eds.); New York; Plenum Press; 1995Google Scholar
  29. 29.
    Schaefer JA, Moos RH: Life crises and personal growth. In Personal Coping: Theory, Research, and Application. Carpenter BN (Ed.); Westport, CT; Praeger; 1992Google Scholar
  30. 30.
    Rowe JW, Kahn RL: Human aging: usual and successful. Science 237: 143-149, 1987PubMedGoogle Scholar
  31. 31.
    Seeman, TE: Successful aging: reconceptualizing the aging process from a more positive perspective. Facts and Research in Gerontology, 1994 (pages 61-73)Google Scholar
  32. 32.
    Costa PT, Metter EJ, McCrae RR: Personality stability and its contribution to successful aging. Journal of Geriatric Psychiatry 27: 41-59, 1994Google Scholar
  33. 33.
    Jones CJ, Meredith W: Patterns of personality change across the life span. Psychology and Aging 11: 57-65, 1996PubMedGoogle Scholar
  34. 34.
    Diehl M, Coyle N, Labouvie-Vief G: Age and sex differences in strategies of coping and defense across the life span. Psychology and Aging 11: 127-139, 1996PubMedGoogle Scholar
  35. 35.
    Vaillant GE, Vaillant CO: Natural history of male psychological health, XII: a 45-year study of predictors of successful aging at age 65. American Journal of Psychiatry 147: 31-37, 1990PubMedGoogle Scholar
  36. 36.
    Verhaeghen P, Marcoen A, Goossens L: Facts and fiction about memory aging: a quantitative integration of research findings. Journal of Gerontology: Psychological Sciences 48: P157-P171, 1993Google Scholar
  37. 37.
    Light, LL: Memory and aging: four hypotheses in search of data. Annual Review of Psychology 42: 333-376, 1991PubMedGoogle Scholar
  38. 38.
    Schaie KW: The course of adult intellectual development. American Psychologist 49: 304-313, 1994PubMedGoogle Scholar
  39. 39.
    Shrout PE: The NIMH Epidemiologic Catchment Area Program: broken promises and dashed hopes? International Journal of Methods in Psychiatric Research 4: 113-122, 1994Google Scholar
  40. 40.
    Costa PT, Zonderman AB, McCrae RR: Personality, defense, coping and adaptation in older adulthood: In Life-Span Developmental Psychology: Perspectives on Stress and Coping. Cummings EM, Greene AL, Karraker KH (Eds.); Hillsdale, New Jersey; Lawrence Erlbaum Associates; 1991Google Scholar
  41. 41.
    Hughes DC, Blazer DG, George LK: Age differences in life events: a multivariate controlled analysis. International Journal of Aging and Human Development 27: 207-220, 1988PubMedGoogle Scholar
  42. 42.
    Hughes DC, George LK, Blazer DG: Age differences in life event qualities: multivariate controlled analyses. Journal of Community Psychology 16: 161-173, 1988Google Scholar
  43. 43.
    Aldwin CM, Sutton KJ, Chiara G, Spiro A: Age differences in stress, coping and appraisal: findings from the Normative Aging Study. Journal of Gerontology: Psychological Sciences 51B: P179–P188, 1996Google Scholar
  44. 44.
    Frank E, Tu XM, Anderson B, et al.: Effects of positive and negative life events on time to depression onset: an analysis of additivity and timing. Psychological Medicine 26: 613-626, 1996PubMedGoogle Scholar
  45. 45.
    Heikkinin MD, Lonnqvist JK: Recent life events in elderly suicide: a nationwide study in Finland. International Psychogeriatrics 7: 287-300, 1995PubMedGoogle Scholar
  46. 46.
    Blazer D, Hughes D, George LK: Stressful life events and the onset of a generalized anxiety syndrome. American Journal of Psychiatry 144: 1178-1183, 1987PubMedGoogle Scholar
  47. 47.
    Bremner JD, Southwick SM, Charney DS: Etiological factors in the development of posttraumatic stress disorder. In Does Stress Cause Psychiatric Illness?; Mazure CM (Ed.); Washington, DC; American Psychiatric Press; 1995Google Scholar
  48. 48.
    Samuels JF, Nestadt G, Romanoski AJ, et al.: DSM-III personality disorders in the community. American Journal of Psychiatry 151: 1055-1062, 1994PubMedGoogle Scholar
  49. 49.
    Norris FH, Murrell SA: Transitory impact of life-event stress on psychological symptoms in older adults. Journal of Health and Social Behavior 28: 197-211, 1987PubMedGoogle Scholar
  50. 50.
    Green BL, Gleser GC, Lindy JD: Age-related reactions to the Buffalo Creek dam collapse. In Aging and Posttraumatic Stress Disorder; Ruskin PE and Talbott JA (Eds.); Washington DC; American Psychiatric Press, Inc.; 1996Google Scholar
  51. 51.
    Kark JD, Goldman S, Epstein L: Iraqi missile attacks on Israel: the association of mortality with a life-threatening stressor. Journal of the American Medical Association 273: 1208-1210, 1995PubMedGoogle Scholar
  52. 52.
    Leor J, Poole WK, Kloner RA: Sudden cardiac death triggered by an earthquake. New England Journal of Medicine 334: 413-419, 1996PubMedGoogle Scholar
  53. 53.
    Schulz R, Visintainer P, Williamson GM: Psychiatric and physical morbidity effects of caregiving. Journal of Gerontology: Psychological Sciences 45: P181–191, 1990Google Scholar
  54. 54.
    Schulz R, Tompkins CA, Wood D, Decker S: The social psychology of caregiving: physical and psychological costs of providing support to the disabled. Journal of Applied Social Psychology 17: 401-428, 1987Google Scholar
  55. 55.
    Schulz R, Tompkins CA, Rau MT: A longitudinal study of the psychosocial impact of stroke on primary support persons. Psychology and Aging 3: 131-141, 1988PubMedGoogle Scholar
  56. 56.
    Schulz R, Williamson GM, Morycz RK, Biegel DE: Costs and benefits of providing care to Alzheimer's patients. In Helping and Being Helped: Naturalistic Studies; Spacapan S, Oskamp S (Eds.); Newbury Park, CA; Sage Publications; 1992Google Scholar
  57. 57.
    George LK, Gwyther LP: Caregiver well-being: a multidimensional examination of family caregivers of demented adults. The Gerontologist 26: 253-259, 1986PubMedGoogle Scholar
  58. 58.
    Clipp EC, George LK: Psychotropic drug use among caregivers of patients with dementia. Journal of the American Geriatrics Society 38: 227-235, 1977Google Scholar
  59. 59.
    Pruchno RA, Potashnik SL: Caregiving spouses: physical and mental health in perspective. Journal of the American Geriatrics Society 37: 697-705, 1989PubMedGoogle Scholar
  60. 60.
    Anthony-Bergstone CR, Zarit SH, Gatz M: Symptoms of psychological distress among caregivers of dementia patients. Psychology and Aging 3: 245-248, 1988PubMedGoogle Scholar
  61. 61.
    Fitting M, Rabins P, Lucas MJ, Eastham J: Caregivers for dementia patients: a comparison of husbands and wives. The Gerontologist 26: 248-252, 1986PubMedGoogle Scholar
  62. 62.
    Russo J, Vitaliano PP, Brewer DD et al.: Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's Disease and matched controls: a diathesis-stress model of psychopathology. Journal of Abnormal Psychology 104: 197-204, 1993Google Scholar
  63. 63.
    Foster JR, Cataldo JK, Boksay IJE: Incidence of depression in a medical long-term care facility. International Journal of Geriatric Psychiatry 6: 13-20, 1991Google Scholar
  64. 64.
    Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; American Psychiatric Association; Washington, DC; 1994Google Scholar
  65. 65.
    Foster RP, Moskowitz M, Javier RA (Eds.): Reaching Across Boundaries of Culture and Class: Widening the Scope of Psychotherapy. Northvale, NJ; Jason Aronson Inc.; 1996Google Scholar
  66. 66.
    Hobfoll SE: Conservation of resources: a new attempt at conceptualizing stress. American Psychologist 44: 513-524, 1989PubMedGoogle Scholar
  67. 67.
    Hobfoll SE, Lilly RS: Resource conservation as a strategy for community psychology. Journal of Community Psychology 21:128-148, 1993Google Scholar
  68. 68.
    Folkman S, Chesney M, McKusick L et al.: Translating coping theory into an intervention. In The Social Context of Coping; Eckenrode J (Ed.); New York; Plenum Press; 1991Google Scholar
  69. 69.
    Eaton WW, Kramer M, Anthony JC et al.: The incidence of specific DIS/DSM-III mental disorders: data from the NIMH Epidemiologic Catchment Area Program. Acta Psychiatrica Scandinavia 79: 163-178, 1989Google Scholar
  70. 70.
    Meyers J, Weissman MM, Tischler GL et al.: Six-month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry 41: 959-967, 1984PubMedGoogle Scholar
  71. 71.
    Burke KC, Burke JD, Regier DA, Rae DS: Age at onset of selected mental disorders in five community populations. Archives of General Psychiatry 47: 511-518, 1990PubMedGoogle Scholar
  72. 72.
    Weissman MM, Leaf PJ, Bruce ML, Florio L: The epidemiology of dysthymia in five communities: rates, risks, comorbidity, and treatment. American Journal of Psychiatry 145: 815-819. 1988PubMedGoogle Scholar
  73. 73.
    Glint AJ, Cook JM, Rabins PV: Why is panic disorder less frequent in late life? American Journal of Geriatric Psychiatry 4: 96-109, 1996Google Scholar
  74. 74.
    Fields RB: Severe stress and the elderly: are older adults at increased risk for posttraumatic stress disorder? In Aging and Posttraumatic Stress Disorder; Ruskin PE and Talbott JA (Eds.); Washington DC; American Psychiatric Press, Inc.; 1996Google Scholar
  75. 75.
    Cohen BJ, Nestadt G, Samuels JF, et al.: Personality disorder in later life: a community study. British Journal of Psychiatry 165: 493-499, 1994PubMedGoogle Scholar
  76. 76.
    Cosford P, Arnold E: Eating disorders in later life: a review. International Journal of Geriatric Psychiatry 7: 491-498, 1992Google Scholar
  77. 77.
    Burke KC, Burke JD, Regier DA, Rae DS: Age at onset of selected mental disorders in five community populations. Archives of General Psychiatry 47: 511-518, 1990PubMedGoogle Scholar
  78. 78.
    Coleman P, Aubin A, Robinson M, et al.: Predictors of depressive symptoms and low self-esteem in a follow-up study of elderly people over 10 years. International Journal of Geriatric Psychiatry 8: 343-349, 1993Google Scholar
  79. 79.
    Diagnosis and treatment of depression in late life: NIH Consensus Development Panel on Depression in Late Life. Journal of the American Medical Association 268:1018-1024, 1992Google Scholar
  80. 80.
    Weissman MM, Bland RC, Canino GJ et al.: Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association 276: 293-299, 1996PubMedGoogle Scholar
  81. 81.
    Meador KG, Koenig HG, Hughes DC et al.: Religious affiliation and major depression. Hospital and Community Psychiatry 43: 1204-1208, 1992PubMedGoogle Scholar
  82. 82.
    Gallo JJ, Royall DR, Anthony JC: Risk factors for the onset of depression in middle age and later life. Social Psychiatry and Psychiatric Epidemiology 28: 101-108, 1993PubMedGoogle Scholar
  83. 83.
    Eaton WW, Anthony JC, Mandel W, Garrison R: Occupations and the prevalence of major depressive disorder. Journal of Occupational Medicine 32: 1079-1087, 1990PubMedGoogle Scholar
  84. 84.
    Green BH, Copeland JRM, Dewey ME, et al.: Risk factors for depression in elderly people: a prospective study. Acta Psychiatrica Scandinavica 86: 213-217, 1992PubMedGoogle Scholar
  85. 85.
    Lewinsohn PM, Alexander C: Learned resourcefulness and depression. In Learned Resourcefulness: on coping skills, self-control, and adaptive behavior. Rosenbaum M (Ed.); New York; Springer Publishing Company; 1990Google Scholar
  86. 86.
    Parmelee PA, Katz IR, Lawton MP: Incidence of depression in long-term care settings. Journal of Gerontology: Medical Sciences 47:M189-M196, 1992Google Scholar
  87. 87.
    van Ojen R, Hooijer C, Jonker C et al.: Late-life depressive disorder in the community, early onset and the decrease of vulnerability with increasing age. Journal of Affective Disorders 33: 159-166, 1995PubMedGoogle Scholar
  88. 88.
    Glassman AH: Cigarette smoking: implications for psychiatric illness. American Journal of Psychiatry 150: 546-553, 1993PubMedGoogle Scholar
  89. 89.
    Prigerson HG, Frank E, Reynolds CF, et al.: Protective psychosocial factors in depression among spousally bereaved elders. American Journal of Geriatric Psychiatry 1: 296-309, 1993Google Scholar
  90. 90.
    Moscicki EK: Epidemiology of suicide. International Psychogeriatrics 7: 137-148, 1995PubMedGoogle Scholar
  91. 91.
    Mortimer J: Alzheimer's disease and senile dementia: prevalence and incidence. In Alzheimer's Disease. Reisberg B (Ed.); New York; The Free Press; 1983Google Scholar
  92. 92.
    Brayne C: The EURODEM collaborative re-analysis of case-control studies of Alzheimer's disease: implications for public health. International Journal of Epidemiology 20:S68-S71, 1991PubMedGoogle Scholar
  93. 93.
    Corder EH, Saunders AM, Strittmatter WJ, et al.: Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer's disease in late onset families. Science 261: 921-923, 1993PubMedGoogle Scholar
  94. 94.
    Petersen RC, Smith GE, Ivnik RJ et al.: Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. Journal of the American Medical Association 273: 1274-1278, 1995PubMedGoogle Scholar
  95. 95.
    Myers RH, Schaefer EJ, Wilson, PWF et al.: Apolipoprotein E e4 association with dementia in a population-based study: the Framingham study. Neurology 673-677, 1996Google Scholar
  96. 96.
    Snowdon DA, Kemper SJ, Mortimer JA, et al.: Linguistic ability in early life and cognitive function and Alzheimer's Disease in late life. Journal of the American Medical Association 275: 528-532, 1996PubMedGoogle Scholar

Copyright information

© Human Sciences Press, Inc. 1997

Authors and Affiliations

  • Jeffrey R. Foster
    • 1
  1. 1.Department of PsychiatryNew York University Medical CenterNew York

Personalised recommendations