In 2035, projections indicate that 50% of the population will be aged 65 and older, with a life expectancy reaching 100 years. This demographic shift is expected to bring a significant rise in chronic illnesses, which will often become acute and necessitate hospital readmissions. These re-admissions can expose patients to serious risks, including severe infections and psychological trauma, jeopardizing the life quality of millions of ill elderly and their families. This shift results in huge expenditures on health insurers and patients, affecting the allocation of public funding for any citizen who utilizes health services from a national public system. Table 1 illustrates the development of the population in Europe by age over time.
Eurostat base scenario, EU25(in thousands) | 2005-2050 | 2005-2010 | 2010-2030 | 2030-2050 |
Total population | -2.1%(-9642) | +1.2%(+5444) | +1.1%(+4980) | -4.3%(-20066) |
Children (0-14) | -19.4%(-14415) | -3.2%(-2391) | -8.9%(-6411) | -8.6%(-5612) |
Young people (15-24) | -25.0%(-14441) | -4.3%(-2488) | -12.3%(-6815) | -10.6%(-5139) |
Young adults (25-39) | -25.8%(-25683) | -4.1%(-4037) | -16.0%(-15271) | -8.0%(-6375) |
Adults (40-54) | -19.5%(+4538) | +4.2%(+5024) | -10.0%(+8832) | -14.1%(-9318) |
Older workers (55-64) | +8.7%(+25458) | +9.6%(+1938) | +15.5%(+22301) | -14.1%(+1219) |
Elderly people (65-79) | +44.1%(+25458) | +3.4%(+1938) | +37.4%(+22301) | +1.5%(+1219) |
Very elderly people (80+) | +180.5%(+34026) | +17.1%(+3229) | +57.1%(+12610) | +52.4%(18187) |
Table 1: The development of the EU population by age over time.
(Source: The European Commission. https://ec.europa.eu/commission/presscorner/detail/fr/memo_05_96)
What can we do to be prepared? Cultivate Resilience.
Resilience in Chronic Illness Management
Resilience, bouncing back to life despite adversity, represents a crucial shift in healthcare, moving the focus from merely acknowledging psychological trauma to actively promoting coping strategies. In managing chronic illnesses, resilience plays a key role in reducing hospital readmissions, lowering levels of depression and anxiety, and enhancing patient engagement. Resilience fosters better adherence to treatment, a stronger determination to confront illness, improved self-management skills, and an overall improvement in quality of life and recovery.
Drivers of Resilience
Building resilience in chronically ill patients relies on strengthening specific skills, including:
Self-Efficacy: Empowering patients with the belief in their ability to manage aspects of their illness independently.
Problem-Solving: Encouraging patients to develop and use practical strategies to navigate their health challenges effectively.
Emotional Regulation: Teaching techniques to manage and respond to emotions constructively, particularly in stressful health-related situations.
By prioritizing resilience-building in chronic illness care, healthcare systems can support aging populations more effectively, promoting better outcomes and fostering a healthier, more proactive approach to lifelong health challenges.
How may we promote the resilience of elders after being hospitalized in acute care?
Which conduct of clinicians has an impact on patients' trajectory from psychological trauma in acute care to resilience after discharge?
According to Aharon Antonovsky’s Salutogenic paradigm, a health-promoting framework, the focus shifts from the symptoms of illness (pathogenic paradigm) to the resources that enhance health (Salutogenesis). This paradigm emphasizes that individuals can develop and leverage personal and external resources to transform their circumstances and strengthen their ability to manage medical adversity. Salutogenics is an empowering approach, seeing people as capable of exercising control over their health and wellbeing.
A key component of Antonovsky's Salutogenic model is the sense of coherence, which is central to resilience. The sense of coherence comprises three interrelated dimensions:
Comprehensibility: The perception that the world is understandable, and information is clear and structured. When patients find their health information accessible and logical, clear and structured. it reduces confusion and helps them feel more in control.
Manageability: The belief that one has the resources—both internal and external—to cope with health-related challenges. This perception fosters motivation to apply energy and effort toward effective coping strategies. Manageability is the patient's perception that she or he has adequate resources, even when these are short, to cope with health events.
Meaningfulness: The conviction that it is worthwhile to engage with and confront health challenges, as life itself has value and purpose. When patients feel their efforts are meaningful, they’re more likely to face health challenges with resilience. Comprehensibility and manageability result in meaningfulness, which is one's perception that it is worth coping with health challenges, as life is meaningful.
The good news is that resilience is modifiable!
Clinicians play a vital role in fostering resilience among hospitalized elderly patients, enhancing their sense of coherence. By promoting an environment of understanding, support, and purposeful care, clinicians can drive resilience and improve patient outcomes in several ways:
Clear Communication: Providing structured and understandable information that enhances patients’ comprehensibility.
Resource Empowerment: Ensuring patients feel they have access to the necessary resources for effective coping, thereby strengthening manageability.
Meaning-Making Support: Helping patients find personal meaning in their recovery journey, reinforcing the importance of persevering through health challenges.
Thus, clinicians can empower even elderly patients to engage more proactively with their health, enhancing the resilience and overall quality of life of elders and reducing costs of healthcare systems and governments. The resources for building resilience in elder patients that clinicians can enhance are as follows:
Building Resilience
Enhancing resilience among elderly patients requires thoughtful, intentional communication from clinicians. Older patients who engage actively in their care experience improved health literacy, a greater sense of control, and a stronger connection with their healthcare providers, all of which contribute to their resilience. This process is supported by Antonovsky’s Salutogenic paradigm, which emphasizes focusing on health-promoting resources rather than on illness symptoms alone. Next, seven key elements of communication to build resilience in ill elders.
Health Literacy
When clinicians simplify complex medical information, encourage self-education, and maintain eye-level conversations with elderly patients, these patients experience a higher sense of manageability. Clear, face-to-face communication using simple language enhances patients’ understanding of their illnesses and empowers them to engage more fully in their treatment, reinforcing the dimension of comprehensibility.
Enhancing Perceived Control
Empowering elderly patients to feel in control of their health outcomes can significantly bolster resilience. Clinicians who help patients recognize their internal and external resources enable them to better manage stress, set recovery goals, and adopt a positive outlook. Enhanced perceived control correlates with faster recovery, fewer readmissions, and increased treatment adherence, aligning with the manageability dimension of resilience.
Proactively Communicating and Avoiding Jargon
When clinicians provide regular, jargon-free updates and take the time to clarify complex terms, they reduce patient anxiety and foster trust. In contrast, the use of medical jargon can heighten anxiety, decrease health literacy, and make patients feel isolated and disempowered, which can reinforce psychological trauma and hinder recovery. Clear, accessible language is key to helping patients feel understood and capable of facing health challenges.
Acknowledging Distress
Addressing the emotional distress of elderly patients allows clinicians to meet patient expectations and validate their experiences. This acknowledgment strengthens patients' sense of coherence, especially during hospitalization, by affirming that their challenges are understood and shared by their care team.
Enhancing Self-Efficacy
When clinicians encourage elderly patients to believe in their ability to manage their health and adapt to challenges, they foster self-efficacy. This belief that their actions can positively impact their health contributes to greater resilience, self-esteem, and determination to reach recovery goals.
Instilling Hope
Supporting patients in seeing a hopeful future by discussing the potential for improvement promotes the dimension of meaningfulness. Patients who are given a sense of purpose and encouragement are better able to process difficult emotions and become more determined to bounce back from health setbacks.
Respecting Self-Worth
Respecting and valuing patients by involving them in the care process reinforces their sense of control and makes them feel like integral partners in their healthcare journey. This respect and shared decision-making strengthen both comprehensibility and manageability, fostering resilience.
Figure 2 presents the insights from research on Key cultivators and outcomes of resilience in elders.
Conclusion: The Power of Communication in Promoting Resilience
Although clinicians may view elderly patients as passive or frail, research suggests that these patients often actively manage life’s challenges. When clinicians emphasize limitations rather than resources, they may inadvertently limit patients' engagement. Clinicians have the potential to enhance elderly patients' resilience by focusing on comprehensibility, manageability, and meaningfulness, promoting a sense of control and self-worth. By building trust and equipping elderly patients with the knowledge and confidence to manage their health, clinicians can promote medication adherence, reduce readmission rates, and improve overall satisfaction post-discharge. Adopting the dimensions of Antonovsky’s sense of coherence helps clinicians foster resilience, empowering elderly patients to approach their health challenges with strength and determination.
Additional Reading
Antonovsky, A. (1991). The structural sources of salutogenic strengths.
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social science & medicine, 36(6), 725-733.Chand, M., & Markova, G. (2019). The European Union's aging population: Challenges for human resource management. Thunderbird International Business Review, 61(3), 519-529.
Ezeamama, A. E., Elkins, J., Simpson, C., Smith, S. L., Allegra, J. C., & Miles, T. P. (2016). Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey. Quality of Life Research, 25, 1007-1015.
Gabay, G. (2015). Perceived control over health, communication and patient–physician trust. Patient education and counseling, 98(12), 1550-1557.
Gabay, G. (2019). Patient self-worth and communication barriers to Trust of Israeli Patients in acute-care physicians at public general hospitals. Qualitative health research, 29(13), 1954-1966.
Gabay, G. (2020). In the quest of resilience in elder patients: Solutogenics. In Handbook of Ethnography in Healthcare Research (pp. 301-312). Routledge.
Gabay, G., & Ornoy, H. (2024). Revisiting the hospital-issued gown in hospitalizations from a locus of control and patient-centered care perspectives: a call for design thinking. Frontiers in Public Health, 12, 1420919.
Manning, L. K., Carr, D. C., & Kail, B. L. (2016). Do higher levels of resilience buffer the deleterious impact of chronic illness on disability in later life? The Gerontologist, 56(3), 514-524.anning, Carr & Kail, 2016.
Maley, J. H., Brewster, I., Mayoral, I., Siruckova, R., Adams, S., McGraw, K. A., ... & Mikkelsen, M. E. (2016).
Resilience in survivors of critical illness in the context of the survivors’ experience and recovery. Annals of the American Thoracic Society, 13(8), 1351-1360.
Mittelmark, M. B., & Bauer, G. F. (2017). The meanings of salutogenesis. The handbook of salutogenesis, 7-13.
Dr. Gillie Gabay
Dr. Gillie Gabay is a visiting Professor in the Department of Health Economics at Cattolica University, Rome, and at the University of Life Sciences and Agriculture, Budapest, Hungary. She is a faculty member at Achva Academic College, Israel. She obtained her PhD in Business Administration at Portland State University, Oregon, USA. Dr. Gabay has extensive experience as a strategic consultant. As a systems science expert, she studies the management of health systems at the individual, team, organization, and policy levels. She also promotes and studies health innovations that remove existing barriers to overcome global challenges of health systems. Dr. Gabay published three books on the experiences of patients and clinicians in health and has published extensively in top-ranked academic journals.