“Tough Times Have Become Good Times”: Resilience in Older Adults With a Low Socioeconomic Position

“Tough Times Have Become Good Times”: Resilience in Older Adults With a Low Socioeconomic... Abstract Background and Objectives This qualitative study applied a resilience perspective to socioeconomic inequalities in the functioning of older adults. We aimed to gain insight into how some older adults managed to age successfully despite having a low socioeconomic position (SEP) throughout their lives. Research Design and Methods Semistructured interviews were conducted with 11 resilient adults over the age of 79 years participating in the Longitudinal Aging Study Amsterdam, the Netherlands. Participants were defined as resilient on the basis of having a low lifetime SEP and favorable trajectories of physical, mental, and social functioning. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant adversities in their lives. The analysis focused on experiences linked to socioeconomic conditions. Results Six themes reflecting psychological, behavioral, and social factors were derived from the data: drawing support from social contacts; investing in younger generations; taking actions to manage or improve socioeconomic conditions; putting the impact of a low SEP into perspective; persevering; and resigning oneself to adversity. Discussion and Implications Findings suggest that successful aging despite a low SEP throughout one’s lifetime requires considerable psychological and social resources. In addition, resignation and specific manifestations of generativity are identified as new elements of resilience. These findings may help to reduce the stereotyping of older adults with a low SEP, and nuance the heroic image of resilience as something that is primarily attributable to extraordinary individual abilities or efforts. Successful aging, Life course/life span, Psychosocial, Poverty, Qualitative research methods A large body of research has reported substantial and persistent differences in physical, social, and mental functioning of older adults between groups with a higher and lower socioeconomic position (SEP; Adler & Newman, 2002; Grundy & Sloggett, 2003; House et al., 1994; Kim & Durden, 2007). Accordingly, several studies have found socioeconomic inequalities in successful aging, a holistic construct that on the individual level reflects the extent to which an older adult functions well physically and mentally and stays actively engaged with social life (Brandt, Deindl, & Hank, 2012; Jang, Choi, & Kim, 2009; Kok, Aartsen, Deeg, & Huisman, 2016; Rowe & Kahn, 1997). Much research has been concerned with identifying psychosocial and behavioral risk factors that explain the negative association between having a low SEP and health outcomes (e.g., Groffen et al., 2012; Uphoff, Pickett, Cabieses, Small, & Wright, 2013). The results of these studies constitute an important resource for designing public health policies aimed at reducing socioeconomic inequalities in health. As a result of such studies, however, groups with a low SEP also tend to be labeled as inherently vulnerable (Mechanic & Tanner, 2007). This labeling of everyone with a low SEP as vulnerable based on average risks leads to a disregard for the substantial variety in functioning among people with a low SEP (Fraser, Richman, & Galinsky, 1999). Applying the concept of resilience to socioeconomic inequalities in successful aging can help explain this variety by identifying factors that protect some individuals against the risks associated with a low SEP. This may provide novel insights into disparities in overall health and functioning of older adults. Although some studies have explored resilience in the face of low SEP in adult populations (e.g., Ryff et al., 2012), this article focuses on the experiences of older adults whom we have retrospectively defined as resilient on the basis of combining a low lifetime SEP with a high score on a previously developed index of successful aging. Defining Resilience Though the concept of resilience originated in developmental psychology, it is increasingly being applied to aging research (Smith & Hayslip, 2012; Windle, 2011). This application seems appropriate because older adults are tremendously heterogeneous with regard to functioning, in part due to differences in accumulation of and responses to stressors across the life course (Dannefer et al., 1987). The lifelong experiences of low SEP in the group of older adults interviewed in this study are of particular interest with regard to resilience. This is because early life socioeconomic conditions may affect successful aging independently of socioeconomic conditions later in life (Brandt et al., 2012). Additionally, early exposure to stressors may affect how people respond to adversity later in life (Rutter, 2012b). Resilience is often inferred from two conditions: (a) there is demonstrable risk of threats to development and (b) there are outcomes that are evaluated as good (Masten, 2001). A low SEP entails increased risks of developmental problems because it is linked to adverse material conditions, stronger accumulation of chronic and acute stressors, and less resources to effectively cope with these stressors (Aneshensel, 1992). Successful aging is presumed to be an unexpectedly good outcome within this context. In addition to satisfying these conditions, resilience is a phenomenon that emerges in interaction with the social environment and should not primarily be seen as an individual achievement (Wiles, Wild, Kerse, & Allen, 2012). Therefore, we adopt the following definition of resilience: “the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity” (Windle, 2011, p. 152). Previous Research on Resilience Most previous studies on resilience in older adults have focused on adversities associated with aging, most notably deteriorating health and changing social networks (Browne-Yung, Walker, & Luszcz, 2017; Wiles et al., 2012). These studies have demonstrated that individual characteristics (e.g., positive coping abilities) and contextual factors (e.g., social support) contribute to resilience. In contrast to focusing on aging-related adversity, the present study examines resilience in the face of lifelong experiences with socioeconomic adversity (e.g., having little education, living in poverty). Quantitative studies in adults have identified a high sense of control and social support as key factors for resilience in the face of socioeconomic adversity (Ryff et al., 2012). One qualitative study amongst individuals living in materially deprived households and their social welfare workers showed that resilience is a process involving transitions such as developing new skills and growing in self-confidence through helping others (Canvin, Marttila, Burstrom, & Whitehead, 2009). A mixed methods study found that social capital and attachment to place are principal factors that explain resilience of people living in deprived areas (Cairns-Nagi & Bambra, 2013). Additionally, two conceptual models of resilience in individuals with a low SEP have been developed. These models are useful for guiding research on resilience in older adults, but require further development on the basis of empirical studies. First, Chen and Miller (2012) propose that a combination of “shifting” and “persisting” characterizes individuals who remain physically healthy despite socioeconomic adversity. Shifting involves a capacity to re-evaluate stressful situations in a way that reduces their emotional impact, and persisting entails “enduring adversity with strength by finding meaning and maintaining optimism” (Chen & Miller, 2012, p. 137). Although the model mentions social factors, this conceptualization focuses on mental resources and is restricted to physical health outcomes. Second, Schafer, Shippee, and Ferraro (2009) propose a different model of resilience, suggesting that to be resilient, one must first consciously evaluate one’s SEP as unfavorable and then activate individual or social resources to improve one’s life circumstances. This model thus posits conscious awareness of disadvantage and the will and efforts to improve this situation as prerequisites for resilience. This model is not restricted to physical health outcomes, as is Chen and Miller’s (2012), yet the premises of the model require empirical verification. Our study extends research on resilience in individuals with a low SEP to older adults living in the Netherlands and addresses the following research question: Which elements across the life course contribute to resilience in the face of socioeconomic adversity? To answer this question, we conducted qualitative interviews with older adults who were expected to have relevant experiences because they had aged successfully despite a low lifetime SEP. We employ a qualitative methodology to (a) identify potentially new aspects of resilience specific to older adults, (b) better understand how factors identified in previous studies work from the perspective of resilient older adults, and (c) facilitate the tailoring of interventions and policy initiatives to the needs of older adults with low SEP. Design and Methods Selection and Study Setting Participants were obtained from a larger cohort of older adults participating in the Longitudinal Aging Study Amsterdam (LASA). LASA is a prospective cohort study based on a random sample in three geographically distinct regions in the Netherlands, which aims to investigate the changes in physical, mental, and social functioning associated with aging (Hoogendijk et al., 2016; Huisman et al., 2011). At baseline in 1992, LASA participants were aged 55–84 years. LASA has been approved by the Medical Ethics Board of the VU Medical Center in the Netherlands. Participants in the current study took part in LASA from 1992 onwards. They were selected on the basis of quantitative criteria in line with our definition of resilience, that is, the combination of a low SEP with successful aging. The following were the criteria for low SEP: (a) participant’s father had at most an elementary education; (b) participant had at most a low occupational skill level (e.g., cleaning staff, concrete worker); and (c) participant had at most a low vocational education (e.g., housekeeping school, low agricultural education). As many of the women who participated in the LASA study never had a paid job and had fewer opportunities for additional education, we set the criteria for low SEP somewhat lower for women than for men. Our definition of successful aging was having an above average score (>5.2 for women and >5.8 for men) on a previously developed successful aging index (Kok, Aartsen, Deeg, & Huisman, 2017). This index ranges from zero to nine and essentially expresses on how many out of nine indicators of physical, mental, and social functioning a participant had a favorable trajectory from 1992 to 2008. The index includes subjective and relatively objective measures that reflect older adults’ own perspectives on successful aging (Bowling, 2006). In total, 35 participants fulfilled these criteria and were still participating in LASA in 2016. In total, 22 of them were asked in a letter and subsequently by telephone whether they were interested in participating in a study about aging and the life course. Eleven of them were willing to do so (Table 1). Their successful aging index scores placed them among the top 35% of all LASA participants with a low SEP. Nonparticipation was mainly due to health limitations developed between 2008 and 2016 (n = 5) and to not wanting to talk about their lives (n = 3). Table 1. Characteristics of the Participants Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Note:aSA score: Successful Aging index-score, expressing the number of indicators (0–9) in which the participant had a favorable trajectory of functioning over 16 years (1992–2008; Kok et al., 2017). bSelf-employed. View Large Table 1. Characteristics of the Participants Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Note:aSA score: Successful Aging index-score, expressing the number of indicators (0–9) in which the participant had a favorable trajectory of functioning over 16 years (1992–2008; Kok et al., 2017). bSelf-employed. View Large Data Collection All interviews were conducted at the participants’ homes by the first author between March and May 2016. A research assistant was sometimes present to take notes and ask additional questions. We adopted a social constructivist perspective and regarded the data as the result of a joint effort of interviewer and participant to reconstruct participants’ experiences with resilience throughout the life course (Charmaz, 2006, p. 131). Therefore, we conducted semistructured interviews using an interview guide containing several topics (see Supplementary Appendix Table 1). To improve the initial interview guide, two pilot interviews were performed with older adults who did not participate in LASA. During three interviews, participants’ partners were present. Occasionally, they provided active contributions to the conversations, which were used in the analyses as additional context to the participants’ experiences. However, any responses made by the partner before the participant could express his/her own view were omitted from the analyses. The conversations were audio-recorded after receiving participants’ written informed consent and transcribed verbatim. Memos on conversations that took place before and after the recordings and on nonverbal communication were included in the analyses. These memos provided additional context and thick description to the data. To avoid imposing our assumption that a low SEP would be experienced as an adversity on the participants, we did not guide the interview toward a discussion of income and education and were careful not to frame a low SEP as a negative condition. The adversities that were discussed therefore could include, but were not restricted to, particular socioeconomic conditions. At approximately three quarters of the way through the interview, we showed participants a picture of a “societal ladder” with 10 rungs (Supplementary Appendix Figure 1; Adler, Epel, Castellazzo, & Ickovics, 2000). This was done to elicit participants’ views on social status. Participants were told that those best off in society were at the top of the ladder, whereas those worst off were at the bottom. No reference to socioeconomic factors was made in this introduction. Participants were then asked to position themselves on this ladder nowadays, when they were 30 years old, and when they were a child, and then asked why they chose these positions. Further details on the interview guide can be found in Supplementary Appendix Table 2. Data Analysis In principle, we assumed that anything could contribute to resilience (e.g., resources, strategies, and attitudes), as long as participants experienced it as something that enabled them to deal with significant adversities in their lives. In accordance with this explorative approach, we applied coding techniques derived from the Grounded Theory framework as interpreted and elaborated on by Charmaz (2006). The analysis focused on experiences explicitly or implicitly related to socioeconomic conditions. Recent functioning and events were not the primary focus of the present analysis. Data analysis and data collection were conducted iteratively. The analysis consisted of three phases. The result of each phase was evaluated by all authors. In the first phase, a preliminary coding scheme was derived from the initial coding of the first two interviews. A.K. and the research assistant independently highlighted segments of texts which in their view contained essential information about resilience. In total, they highlighted and provided codes for 131 segments, of which 85% were partially or fully highlighted by both. Agreement on the wording of all codes was attained through discussion. Following Charmaz (2006), we applied codes that expressed actions rather than concepts and stayed close to the data (e.g., “praying twice a day” instead of “prayer”). The resulting preliminary coding scheme contained the 131 text segments, described by 46 codes. In the second phase, A.K. coded nine interviews with the preliminary coding scheme in mind, while staying open to additional codes. Interviews were analyzed in pairs, comparing participants’ statements on similar codes within each pair (constant comparison). Emerging hypotheses about overarching themes were described in memos. Results were combined in a modified coding scheme (51 codes in total). M.H. and A.K. categorized these codes into six preliminary themes, which were added as an additional layer in the coding scheme. At this point in the analysis process, all authors agreed that the data contained sufficient richness and clarity about key themes and subthemes. Moreover, although analysis of the last two pairs of interviews substantially enriched the content of the already derived codes, it did not lead to extensions of the coding scheme. Therefore, no recruitment was attempted regarding the remaining 13 eligible participants. In the third phase, A.K. made code names more abstract on the basis of re-evaluating the essential content of all the quotations that had received the same code (focused coding). Additionally, the wording of the themes was sharpened on the basis of evaluating conceptual links between codes belonging to the same preliminary themes (axial coding). The final set of six themes and 11 subthemes was agreed on by all the authors. As recommended in the literature (van Nes, Abma, Jonsson, & Deeg, 2010), for the final manuscript, A.K. worked side by side with a native English editor skilled in Dutch to translate a selection of participants’ quotations into English. Additionally, a two-page summary of the interview was sent out to the participants to check whether they recognized and approved of the overall content of the interview. This led to minor corrections that did not influence the findings. Results Participant characteristics are provided in Table 1. Themes and subthemes are summarized in Table 2. Table 2. Summary of Themes and Subthemes Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity View Large Table 2. Summary of Themes and Subthemes Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity View Large Drawing Support From Social Contacts Receiving Instrumental Support Support from social contacts significantly contributed to participants’ ability to deal with adversity. Participants mentioned forms of instrumental support rather than emotional support. Instrumental support made it easier to live with few financial and material resources. For instance, one participant said that the general practitioner sometimes turned a blind eye to a bill because “he knew well that we did not have much to spend,” and another participant mentioned that housewives helped each other with all kinds of tasks because “none of us had a lot of money.” Several participants were regularly supported with money or a loan from more affluent family members. Instrumental support also benefited participants in situations where employment was at stake. For example, one participant’s neighbors helped him in his shoemaker’s shop after he became injured at work. Another participant’s friends provided him with a piece of land on which he could further develop his passion for plants and flowers and retain a sense of usefulness during a period of unemployment. The family members who lived nearby enabled another participant and his wife to work more in their painting business by regularly taking care of the couple’s children. Spouses were often a source of instrumental and emotional support, although the latter often remained implicit. For instance, participants who owned a business described a smooth and stimulating cooperation with their spouses, which was crucial to the success of their company: And then [my husband] said: “You go and work with the hay cannon, but (…) take it easy. If you don’t finish, I’ll help you.” And then I thought “This has to get done, this has to succeed.” (…) And then [my husband said]: “You worked so hard, go and buy that jacket; you worked hard for it the whole summer.” (Mrs. de W) Gaining a Sense of Belonging in a Stable and Easily Accessible Social Network Many participants were embedded in a stable and closely knit social environment. Participants often lived close to family, friends, and colleagues for a long time, sometimes their entire lives. Their experiences revealed openness to social interaction and demonstrated active contributions to building and managing social networks: I have plenty of contacts. [For example] with my former colleagues. (…) And this place is actually a kind of hangout, so to speak [stretches his arm to indicate the whole living room]. I bought this back then. And since then, we all meet here. (…) My door is always open; they can all come in just like that. (Mr. van G) Additionally, most forms of support were recurring and appeared to be a part of everyday life. One participant indicated that poverty was not a topic that was overtly talked about, but instead was silently acknowledged and acted upon within the community: When you needed something new or so, you had to wait for it much longer (…) If [the kids] needed new clothes again, well, then [the shop keeper] wrote it in his book until I got child allowance again. (…) And it wasn’t only me; there were many people who needed that. (Mrs. M) Investing in Younger Generations Encouraging and Emphasizing Children’s Career Success This subtheme was mentioned solely by women. Most female participants emphasized a lack of educational opportunities during their youth. Their responses to this circumstance were diverse. Some said they never experienced any negative consequences, while others were still overtly frustrated about “never having had the chance” to study. Nevertheless, there was a striking resemblance among them in mentioning that their children had earned diplomas, obtained good jobs, were doing their best, or were “enterprising.” Some participants had strongly encouraged their children to perform well in school, and they now seemed to experience their children’s successes as their own. Such investment seemed to compensate for their own dissatisfaction: [I am glad that my children studied]. Oh man, I’m as happy as a clam. (…) I’ve always said [to them]: “learn, learn, learn”. They all have good jobs. They’re all married to a good job. (…) If you learn, you can get anywhere later on. (Mrs. de R) Transmitting Knowledge and Experience to the Next Generation Another form of investment in younger generations was by transmitting knowledge and experience. This was mentioned solely by men. For instance, one participant developed himself from “the bottom” of society to obtaining a teaching position at an agricultural school, despite lacking formal diplomas for the job. He mentioned that being able to eventually teach others about flowers and plants was what he was most proud of in life. Another participant suggested that passing on his successful business to his sons offered relief and increased the subjective value of his own investments: That [my sons joined the company] eases my burden. Then you can… everything that you had to deal with. Let me put it like that. You can share that with the boys. They take over that. And I stand back. (Mr. B) Taking Actions to Manage or Improve Socioeconomic Conditions This theme reflects actions that either resulted in adaptation to poverty or in an increase in social status. Managing Expenses Three women indicated that they had lived in poverty, but found ways to retain an acceptable standard of living despite their limited financial resources. Examples included growing and conserving their own vegetables, making their own clothes, and saving up little amounts of money for years to be able to eventually buy a house. This frugality also involved managing expectations; some women made their young children well aware that they could not get expensive presents and requested that their children pay for their board once they got older. Furthermore, for some participants, frugality became a habit from which they still reap benefits. Developing One’s Working Career Although they had few opportunities to study, several participants took initiatives to develop their careers. For example, they took on various jobs to find the most fulfilling one, started a business, or took courses in order to find a better job, all of which increased their social status: I had those courses. Deboning and stuff. Cutting meat. (…) That also wasn’t paid for. But at least you had a trade. You did know something. You did know something. (…) That I didn’t have to work at the assembly line [as my brothers did], so to speak. I don’t want that. No. (Mr. van G) Only in special circumstances were some female participants able to continue working after marriage. Two of them worked in their husband’s business, and one started her own business after finding out she could not become pregnant. The work generated more income, resulted in a larger social network, and reinforced their self-esteem. For example, two participants mentioned that their occupational achievements are what they are most proud of in life. Putting the Impact of Socioeconomic Position into Perspective Valuing One’s Own Skills Although several participants mentioned that they worked long and hard hours and had little time for leisure activities, they experienced their work as enjoyable and considered themselves good at it. This applied to paid work as well as to volunteer and domestic work. Many participants emphasized how skillful they were, for instance at typing, spinning, cleaning, and performing executive roles within a volunteer organization. Some recalled compliments they received, sometimes decades ago. This indicated that other people’s acknowledgement of their skills contributed to their self-esteem: [I was once the chairwoman of an association for women living in the countryside] and I had to deliver a speech. And there was a gentleman who was [always] very critical [who said:] “Well, Mrs. de W, you did an excellent job.” Well, I thought that was really nice of him; that was something really special. So I hold on to that, that I’m good at something, at least. (Mrs. de W) Experiencing a good fit between one’s skills and one’s work provided additional pleasure and satisfaction from work, as was the case for the shoemaker: Apparently I had mastered it. I was better with my fingers than my head. Yes, and I believe that’s why I got tremendous pleasure from carrying out my work. (Mr. E) Valuing Other Aspects of Life More Highly than SEP Most participants showed a certain disregard for social status. One participant chose the middle position on the societal ladder on principle because “no-one is above me and no-one is below me,” and another participant argued that someone low in the occupational hierarchy is as important as the general manager. Some participants implied that other positive aspects of their life compensated for their otherwise meager lives: I didn’t have a rich life. But I did have a rich life health wise. (Mrs. D) We’ve always lived well. Lived simply. No luxury at all. And always…never had quarrels, so to speak. With each other. Never. No bad words or things like that. It was always fine. It was always fine. (Mr. van G) Emphasizing Gradual Improvements in Living Conditions For some participants, emphasizing the temporary nature of living in adverse socioeconomic conditions seemed to reflect light-heartedness about the impact of adverse socioeconomic conditions on their lives. Participants said that small and gradual positive improvements in living conditions made life easier throughout later adulthood: Very tough times have become very good times, really. Because we’ve been through that, from having nothing so to speak, to where we are now. (…) It’s all kinds of little things, in everything, in the surroundings, or in the furniture, or in all stuff…You’ve actually moved with the times, but things have always improved. (Mrs. D) Rather than viewing these improvements as a result of personal effort, participants pointed to a general rise in the standard of living and working conditions in the second half of the 20th century. Additionally, some participants suggested that child benefits and unemployment benefits helped them to make ends meet. Persevering Mentally Combating Adversity One way of persevering through difficult times was by mentally combating adversity. This kind of strategy was mentioned in relation to a wide range of situations, such as having an alcoholic husband, facing neglect by one’s parents in childhood, recovering from a stroke, and becoming widowed. The term perseverance was adopted from a participant’s definition of resilience: [Resilience is] perseverance. (…) The urge to do. When things went against me. Then we have that urge, we don’t let it get us down. The urge to solve something eventually or whatever. That we don’t say: “Just leave it.” (Mr. B) Mr. B’s definition also indicated that perseverance is something that can be acquired together, as he switched from “me” to “we” while elaborating. Similar features of resilience were apparent from the responses of other participants, who used phrases such as “mentally fighting,” the necessity to “handle yourself” in difficult times, and convincing yourself that you “mustn’t whine.” The purpose of this attitude was to keep on going and focus on the future. Holding on to Faith Religious faith acted as a psychological resource that helped participants to persevere. First, praying offered mental support. It provided tranquility or allowed participants to leave their worries behind and “become strengthened by Jesus or God.” Second, religious rules and practices provided structure to daily life (e.g., reading from the Bible every day or living according to the 10 commandments). Third, one participant and his wife believed that prayer could effectuate favorable changes in life: Then we got a message: [a large painting job] was cancelled, for the first time. (…) So in the evening we prayed. (…) And at eleven o’clock the phone rang. And there was a painter from S asking whether we could start work for them immediately. (…) Well, we were saved. You got plenty of work. (…) I mean, we often had our prayers answered. (Mr. B’s wife) Resigning Oneself to Adversity Several participants indicated that they had little control over their opportunities in life, particularly as adolescents and young adults. This predominantly applied to the women. They referred to social norms that prohibited them from furthering their education or having a career, and to living in harsh material conditions. One participant gave a lively description of her experiences as a mother of nine, struggling to manage heavy housework while having poor housing conditions and a low income. Most participants were discontent with their circumstances at the time, but they often felt there was no other choice than to resign themselves to them for as long as they lasted. They repeatedly said “you didn’t know any better,” or “that was life back in those days,” which reflected a kind of reluctant acceptance. In order for this resignation to become a source of resilience, however, it seemed crucial that it was combined with a positive way of coming to terms with the adversity afterwards. This positive stance was for instance apparent from participants showing pride in having been able to endure harsh circumstances, questioning whether realizing their ambitions would really have improved their life, or showing relief: I’m now astounded that I managed [with little money and nine kids at home]. But that was how it was and it can’t be changed. It will not return, as we say. Fortunately. (Mrs. M) Discussion and Implications Based on the qualitative interviews with older adults who aged successfully despite having a low SEP, this study identified six themes that point toward factors enabling resilience in the face of socioeconomic adversity. Whereas drawing support from social contacts and taking actions to manage or improve socioeconomic conditions were tangible ways of dealing with present socioeconomic adversity, putting the impact of a low SEP into perspective, persevering, and resignation reflected mindsets or attitudes that contributed to resilience. Investing in younger generations may have compensated for a lack of educational or occupational opportunities or helped to prepare for the future. These resources and actions may have contributed to the high level of successful aging observed in the participants of this study, despite their low SEP. Our findings provided three key contributions to the literature on resilience. First, we identified elements of resilience that have received little attention in previous studies on socioeconomic adversity. The theme “investing in younger generations” resonates with the concept of generativity (Erikson, 1963). Generativity has been defined as “the desire to invest one’s substance in forms of life and work that will outlive the self” (Kotre, 1984, p. 10). Generative action may give a sense of purpose and worth to one’s life narrative (Kotre, 1984). Whereas women compensated for a lack of opportunities by stimulating their children, men transferred their knowledge and experience to the next generation. In line with other studies on resilience in different contexts (e.g., Emlet, Harris, Furlotte, Brennan, & Pierpaoli, 2017), participants described generative action as a significant source of life satisfaction, which in turn is important for successful aging. Furthermore, we found that the combination of resigning oneself to difficult circumstances while they last and having a positive way of coming to terms with these circumstances afterwards may provide an effective way of dealing with socioeconomic adversity. The finding that this apparently passive way of coping can be effective may nuance the heroic image that is often associated with resilience. It shows that resilience is not necessarily something that requires extraordinary efforts from extraordinary people, but often derives from basic human adaptive processes (Masten, 2001), which may include resignation. Second, our findings provide a better understanding of how personality traits that are often included in resilience measurement scales, such as competence, self-esteem, and optimism (Windle, 2011), manifest themselves in the experience of resilient older adults with a low SEP. Several participants described attitudes toward adversity that they applied across different situations, including “mentally fighting” and feeling an “urge to do.” Such examples support the importance of coping abilities and control beliefs for resilience (Hildon, Smith, Netuveli, & Blane, 2008). Moreover, participants valued their own (manual) skills and remembered compliments about these skills from others. Such findings illustrate sources of self-worth that may contribute to successful aging particularly in older adults with a low SEP. In addition to personal characteristics, social support is often found to be a protective factor in studies on resilience (Rutter, 2012a). Our results suggest that concrete forms of support such as money or aid and attachment to place are important. Moreover, some participants indicated a culture of tacit acknowledgement of poverty in their neighborhood, reflected by ongoing mutual aid, which helped to make ends meet. In line with previous studies (Cairns-Nagi & Bambra, 2013), this implies that in addition to social support, stability in social and physical surroundings may be important as well. Our findings further show that resilience may be fostered through societal factors. Social security arrangements, such as child and unemployment benefits, and the general rise in the standard of living in the second half of the twentieth century may have contributed to resilience in the general population with a low SEP. Taken together, our findings on social support suggest that resilience of the individual is linked to community and societal resilience. Third, our findings may help to evaluate emerging theories on resilience in the face of socioeconomic adversity. We found some support for the shift-and-persist model that is argued to characterize resilience in individuals with a low SEP (Chen & Miller, 2012). In our study, themes like valuing one’s skills and valuing other aspects of life more highly than SEP reflect ways to reduce the emotional impact of adversity posited by this model (“shifting”), whereas persevering is similar to endurance (“persisting”). However, our findings did not support the idea that individuals with a low SEP are predominantly restricted to coping strategies directed at the self rather than at the external environment (Chen & Miller, 2012). Some participants successfully undertook actions that favorably changed their living conditions. This discrepancy with Chen and Miller’s (2012) model may be because their model was originally developed to reflect resilience in children, who may have less resources to change the external environment than (older) adults do. At first glance, the participants’ actions seem to support Schafer and colleagues’ (2009) proposition that resilience entails being conscious of disadvantage and then activating resources to improve the situation. However, our findings also nuance Schafer and colleagues’ (2009) model. Not all participants in our study consciously experienced a low SEP as a disadvantaged position. Rather, some of them disregarded social status and were proud of their simple lives. This attitude seemed to contribute to their resilience. Moreover, enduring adversity without much reflection and coming to terms with adversity later in life could also contribute to resilience. Implications Our findings echo earlier findings on the importance of social support and personality factors for resilience. The relatively new factors identified in this study point to the importance of valuing skills, generativity, and resignation for individuals with a low SEP. Whereas some factors clearly relate to earlier life stages, other factors (e.g., social support, using one’s skills) may still be amenable to intervention in older adults. Moreover, macro-level interventions (e.g., social security arrangements) may increase general opportunities for low SEP individuals to age successfully. Possible interventions should be discussed and designed in collaboration with older adults themselves. At the very least, taking note of our findings may reduce potential stereotyping of older adults with a low SEP. Strengths and Limitations We consider the use of extensive quantitative criteria for selecting resilient participants as a strength of this study. Moreover, we believe that the explorative approach to resilience in this study supported the search for factors that are protective across different adversities and outcomes (Kaplan, 2005). One limitation inherent to qualitative research is that findings cannot be generalized. This also applies to the small sample of 11 older adults in this study. Additionally, we did not interview nonresilient older adults, mainly because these participants already dropped out of the study due to death or other reasons. A second limitation may be that our findings are possibly not generalizable to other countries with social security and health care systems different from those in the Netherlands. Nevertheless, most of our findings resemble those of previous studies on resilience in other populations and are thus valuable for understanding resilience across national contexts. Conclusion We identified key elements that may contribute to resilience in older adults with a low SEP. The participants in this study possessed multiple individuals and social resources that enabled them to deal with various adversities throughout their lives. This suggests that it requires a lot—mentally and socially—to age successfully with a low SEP. Nevertheless, this study provided new insights into factors that may prevent the risks associated with a low SEP from translating into impaired health and functioning in old age. Supplementary Material Supplementary data is available at The Gerontologist online. Funding This work was supported by the “Longitudinal Aging Study Amsterdam” (LASA; www.lasa-vu.nl), largely funded by the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care and by a VIDI fellowship from the Netherlands Organization for Scientific Research (grant number 452-11-017 to M.H.). Conflict of Interest None reported. References Adler , N. E. , Epel , E. S. , Castellazzo , G. , & Ickovics , J. R . ( 2000 ). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women . Health Psychology , 19 , 586 – 592 . doi: 10.1037/0278-6133.19.6.586 Google Scholar CrossRef Search ADS PubMed Adler , N. 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“Tough Times Have Become Good Times”: Resilience in Older Adults With a Low Socioeconomic Position

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Abstract

Abstract Background and Objectives This qualitative study applied a resilience perspective to socioeconomic inequalities in the functioning of older adults. We aimed to gain insight into how some older adults managed to age successfully despite having a low socioeconomic position (SEP) throughout their lives. Research Design and Methods Semistructured interviews were conducted with 11 resilient adults over the age of 79 years participating in the Longitudinal Aging Study Amsterdam, the Netherlands. Participants were defined as resilient on the basis of having a low lifetime SEP and favorable trajectories of physical, mental, and social functioning. Grounded Theory coding techniques were applied to identify themes reflecting distinct ways in which participants dealt with what they indicated were the most significant adversities in their lives. The analysis focused on experiences linked to socioeconomic conditions. Results Six themes reflecting psychological, behavioral, and social factors were derived from the data: drawing support from social contacts; investing in younger generations; taking actions to manage or improve socioeconomic conditions; putting the impact of a low SEP into perspective; persevering; and resigning oneself to adversity. Discussion and Implications Findings suggest that successful aging despite a low SEP throughout one’s lifetime requires considerable psychological and social resources. In addition, resignation and specific manifestations of generativity are identified as new elements of resilience. These findings may help to reduce the stereotyping of older adults with a low SEP, and nuance the heroic image of resilience as something that is primarily attributable to extraordinary individual abilities or efforts. Successful aging, Life course/life span, Psychosocial, Poverty, Qualitative research methods A large body of research has reported substantial and persistent differences in physical, social, and mental functioning of older adults between groups with a higher and lower socioeconomic position (SEP; Adler & Newman, 2002; Grundy & Sloggett, 2003; House et al., 1994; Kim & Durden, 2007). Accordingly, several studies have found socioeconomic inequalities in successful aging, a holistic construct that on the individual level reflects the extent to which an older adult functions well physically and mentally and stays actively engaged with social life (Brandt, Deindl, & Hank, 2012; Jang, Choi, & Kim, 2009; Kok, Aartsen, Deeg, & Huisman, 2016; Rowe & Kahn, 1997). Much research has been concerned with identifying psychosocial and behavioral risk factors that explain the negative association between having a low SEP and health outcomes (e.g., Groffen et al., 2012; Uphoff, Pickett, Cabieses, Small, & Wright, 2013). The results of these studies constitute an important resource for designing public health policies aimed at reducing socioeconomic inequalities in health. As a result of such studies, however, groups with a low SEP also tend to be labeled as inherently vulnerable (Mechanic & Tanner, 2007). This labeling of everyone with a low SEP as vulnerable based on average risks leads to a disregard for the substantial variety in functioning among people with a low SEP (Fraser, Richman, & Galinsky, 1999). Applying the concept of resilience to socioeconomic inequalities in successful aging can help explain this variety by identifying factors that protect some individuals against the risks associated with a low SEP. This may provide novel insights into disparities in overall health and functioning of older adults. Although some studies have explored resilience in the face of low SEP in adult populations (e.g., Ryff et al., 2012), this article focuses on the experiences of older adults whom we have retrospectively defined as resilient on the basis of combining a low lifetime SEP with a high score on a previously developed index of successful aging. Defining Resilience Though the concept of resilience originated in developmental psychology, it is increasingly being applied to aging research (Smith & Hayslip, 2012; Windle, 2011). This application seems appropriate because older adults are tremendously heterogeneous with regard to functioning, in part due to differences in accumulation of and responses to stressors across the life course (Dannefer et al., 1987). The lifelong experiences of low SEP in the group of older adults interviewed in this study are of particular interest with regard to resilience. This is because early life socioeconomic conditions may affect successful aging independently of socioeconomic conditions later in life (Brandt et al., 2012). Additionally, early exposure to stressors may affect how people respond to adversity later in life (Rutter, 2012b). Resilience is often inferred from two conditions: (a) there is demonstrable risk of threats to development and (b) there are outcomes that are evaluated as good (Masten, 2001). A low SEP entails increased risks of developmental problems because it is linked to adverse material conditions, stronger accumulation of chronic and acute stressors, and less resources to effectively cope with these stressors (Aneshensel, 1992). Successful aging is presumed to be an unexpectedly good outcome within this context. In addition to satisfying these conditions, resilience is a phenomenon that emerges in interaction with the social environment and should not primarily be seen as an individual achievement (Wiles, Wild, Kerse, & Allen, 2012). Therefore, we adopt the following definition of resilience: “the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and ‘bouncing back’ in the face of adversity” (Windle, 2011, p. 152). Previous Research on Resilience Most previous studies on resilience in older adults have focused on adversities associated with aging, most notably deteriorating health and changing social networks (Browne-Yung, Walker, & Luszcz, 2017; Wiles et al., 2012). These studies have demonstrated that individual characteristics (e.g., positive coping abilities) and contextual factors (e.g., social support) contribute to resilience. In contrast to focusing on aging-related adversity, the present study examines resilience in the face of lifelong experiences with socioeconomic adversity (e.g., having little education, living in poverty). Quantitative studies in adults have identified a high sense of control and social support as key factors for resilience in the face of socioeconomic adversity (Ryff et al., 2012). One qualitative study amongst individuals living in materially deprived households and their social welfare workers showed that resilience is a process involving transitions such as developing new skills and growing in self-confidence through helping others (Canvin, Marttila, Burstrom, & Whitehead, 2009). A mixed methods study found that social capital and attachment to place are principal factors that explain resilience of people living in deprived areas (Cairns-Nagi & Bambra, 2013). Additionally, two conceptual models of resilience in individuals with a low SEP have been developed. These models are useful for guiding research on resilience in older adults, but require further development on the basis of empirical studies. First, Chen and Miller (2012) propose that a combination of “shifting” and “persisting” characterizes individuals who remain physically healthy despite socioeconomic adversity. Shifting involves a capacity to re-evaluate stressful situations in a way that reduces their emotional impact, and persisting entails “enduring adversity with strength by finding meaning and maintaining optimism” (Chen & Miller, 2012, p. 137). Although the model mentions social factors, this conceptualization focuses on mental resources and is restricted to physical health outcomes. Second, Schafer, Shippee, and Ferraro (2009) propose a different model of resilience, suggesting that to be resilient, one must first consciously evaluate one’s SEP as unfavorable and then activate individual or social resources to improve one’s life circumstances. This model thus posits conscious awareness of disadvantage and the will and efforts to improve this situation as prerequisites for resilience. This model is not restricted to physical health outcomes, as is Chen and Miller’s (2012), yet the premises of the model require empirical verification. Our study extends research on resilience in individuals with a low SEP to older adults living in the Netherlands and addresses the following research question: Which elements across the life course contribute to resilience in the face of socioeconomic adversity? To answer this question, we conducted qualitative interviews with older adults who were expected to have relevant experiences because they had aged successfully despite a low lifetime SEP. We employ a qualitative methodology to (a) identify potentially new aspects of resilience specific to older adults, (b) better understand how factors identified in previous studies work from the perspective of resilient older adults, and (c) facilitate the tailoring of interventions and policy initiatives to the needs of older adults with low SEP. Design and Methods Selection and Study Setting Participants were obtained from a larger cohort of older adults participating in the Longitudinal Aging Study Amsterdam (LASA). LASA is a prospective cohort study based on a random sample in three geographically distinct regions in the Netherlands, which aims to investigate the changes in physical, mental, and social functioning associated with aging (Hoogendijk et al., 2016; Huisman et al., 2011). At baseline in 1992, LASA participants were aged 55–84 years. LASA has been approved by the Medical Ethics Board of the VU Medical Center in the Netherlands. Participants in the current study took part in LASA from 1992 onwards. They were selected on the basis of quantitative criteria in line with our definition of resilience, that is, the combination of a low SEP with successful aging. The following were the criteria for low SEP: (a) participant’s father had at most an elementary education; (b) participant had at most a low occupational skill level (e.g., cleaning staff, concrete worker); and (c) participant had at most a low vocational education (e.g., housekeeping school, low agricultural education). As many of the women who participated in the LASA study never had a paid job and had fewer opportunities for additional education, we set the criteria for low SEP somewhat lower for women than for men. Our definition of successful aging was having an above average score (>5.2 for women and >5.8 for men) on a previously developed successful aging index (Kok, Aartsen, Deeg, & Huisman, 2017). This index ranges from zero to nine and essentially expresses on how many out of nine indicators of physical, mental, and social functioning a participant had a favorable trajectory from 1992 to 2008. The index includes subjective and relatively objective measures that reflect older adults’ own perspectives on successful aging (Bowling, 2006). In total, 35 participants fulfilled these criteria and were still participating in LASA in 2016. In total, 22 of them were asked in a letter and subsequently by telephone whether they were interested in participating in a study about aging and the life course. Eleven of them were willing to do so (Table 1). Their successful aging index scores placed them among the top 35% of all LASA participants with a low SEP. Nonparticipation was mainly due to health limitations developed between 2008 and 2016 (n = 5) and to not wanting to talk about their lives (n = 3). Table 1. Characteristics of the Participants Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Note:aSA score: Successful Aging index-score, expressing the number of indicators (0–9) in which the participant had a favorable trajectory of functioning over 16 years (1992–2008; Kok et al., 2017). bSelf-employed. View Large Table 1. Characteristics of the Participants Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Pseudonym Age (Former) occupation Urban/rural SA scorea Interview length Partner present? 1 Mrs. M 86 Homemaker Rural 5.8 1 hr 48 Widow 2 Mr. N 79 Flower breeder, teacher Urban 7.2 1 hr 53 No 3 Mrs. de R 87 Homemaker, typist, cleaner Rural 5.5 1 hr 32 Widow 4 Mrs. D 85 Homemaker Rural 8.0 1 hr 18 No 5 Mrs. T 83 Homemaker Rural 7.3 1 hr 25 Widow 6 Mr. E 93 Shoemakerb Urban 8.1 1 hr 28 Yes 7 Mr. van G 87 Butcher shop clerk Rural 6.0 1 hr 22 No partner 8 Mrs. K 90 Co-owner cigar shopb Urban 5.8 1 hr 07 Widow 9 Mrs. V 84 Homemaker, volunteer Urban 7.8 1 hr 38 Yes 10 Mr. B 84 Painter, wall-papererb Rural 7.9 1 hr 39 Yes 11 Mrs. de W 78 At husband’s dairy farmb Rural 8.7 1 hr 55 No Note:aSA score: Successful Aging index-score, expressing the number of indicators (0–9) in which the participant had a favorable trajectory of functioning over 16 years (1992–2008; Kok et al., 2017). bSelf-employed. View Large Data Collection All interviews were conducted at the participants’ homes by the first author between March and May 2016. A research assistant was sometimes present to take notes and ask additional questions. We adopted a social constructivist perspective and regarded the data as the result of a joint effort of interviewer and participant to reconstruct participants’ experiences with resilience throughout the life course (Charmaz, 2006, p. 131). Therefore, we conducted semistructured interviews using an interview guide containing several topics (see Supplementary Appendix Table 1). To improve the initial interview guide, two pilot interviews were performed with older adults who did not participate in LASA. During three interviews, participants’ partners were present. Occasionally, they provided active contributions to the conversations, which were used in the analyses as additional context to the participants’ experiences. However, any responses made by the partner before the participant could express his/her own view were omitted from the analyses. The conversations were audio-recorded after receiving participants’ written informed consent and transcribed verbatim. Memos on conversations that took place before and after the recordings and on nonverbal communication were included in the analyses. These memos provided additional context and thick description to the data. To avoid imposing our assumption that a low SEP would be experienced as an adversity on the participants, we did not guide the interview toward a discussion of income and education and were careful not to frame a low SEP as a negative condition. The adversities that were discussed therefore could include, but were not restricted to, particular socioeconomic conditions. At approximately three quarters of the way through the interview, we showed participants a picture of a “societal ladder” with 10 rungs (Supplementary Appendix Figure 1; Adler, Epel, Castellazzo, & Ickovics, 2000). This was done to elicit participants’ views on social status. Participants were told that those best off in society were at the top of the ladder, whereas those worst off were at the bottom. No reference to socioeconomic factors was made in this introduction. Participants were then asked to position themselves on this ladder nowadays, when they were 30 years old, and when they were a child, and then asked why they chose these positions. Further details on the interview guide can be found in Supplementary Appendix Table 2. Data Analysis In principle, we assumed that anything could contribute to resilience (e.g., resources, strategies, and attitudes), as long as participants experienced it as something that enabled them to deal with significant adversities in their lives. In accordance with this explorative approach, we applied coding techniques derived from the Grounded Theory framework as interpreted and elaborated on by Charmaz (2006). The analysis focused on experiences explicitly or implicitly related to socioeconomic conditions. Recent functioning and events were not the primary focus of the present analysis. Data analysis and data collection were conducted iteratively. The analysis consisted of three phases. The result of each phase was evaluated by all authors. In the first phase, a preliminary coding scheme was derived from the initial coding of the first two interviews. A.K. and the research assistant independently highlighted segments of texts which in their view contained essential information about resilience. In total, they highlighted and provided codes for 131 segments, of which 85% were partially or fully highlighted by both. Agreement on the wording of all codes was attained through discussion. Following Charmaz (2006), we applied codes that expressed actions rather than concepts and stayed close to the data (e.g., “praying twice a day” instead of “prayer”). The resulting preliminary coding scheme contained the 131 text segments, described by 46 codes. In the second phase, A.K. coded nine interviews with the preliminary coding scheme in mind, while staying open to additional codes. Interviews were analyzed in pairs, comparing participants’ statements on similar codes within each pair (constant comparison). Emerging hypotheses about overarching themes were described in memos. Results were combined in a modified coding scheme (51 codes in total). M.H. and A.K. categorized these codes into six preliminary themes, which were added as an additional layer in the coding scheme. At this point in the analysis process, all authors agreed that the data contained sufficient richness and clarity about key themes and subthemes. Moreover, although analysis of the last two pairs of interviews substantially enriched the content of the already derived codes, it did not lead to extensions of the coding scheme. Therefore, no recruitment was attempted regarding the remaining 13 eligible participants. In the third phase, A.K. made code names more abstract on the basis of re-evaluating the essential content of all the quotations that had received the same code (focused coding). Additionally, the wording of the themes was sharpened on the basis of evaluating conceptual links between codes belonging to the same preliminary themes (axial coding). The final set of six themes and 11 subthemes was agreed on by all the authors. As recommended in the literature (van Nes, Abma, Jonsson, & Deeg, 2010), for the final manuscript, A.K. worked side by side with a native English editor skilled in Dutch to translate a selection of participants’ quotations into English. Additionally, a two-page summary of the interview was sent out to the participants to check whether they recognized and approved of the overall content of the interview. This led to minor corrections that did not influence the findings. Results Participant characteristics are provided in Table 1. Themes and subthemes are summarized in Table 2. Table 2. Summary of Themes and Subthemes Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity View Large Table 2. Summary of Themes and Subthemes Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity Theme Subthemes Drawing support from social contacts Receiving instrumental support Gaining a sense of belonging in a stable and easily accessible social network Investing in younger generations Encouraging and emphasizing children’s career success Transmitting knowledge and experience to the next generation Taking actions to manage or improve socioeconomic conditions Managing expenses Developing one’s working career Putting the impact of a low socioeconomic position into perspective Valuing one’s own skills Valuing other aspects of life more highly than social status Emphasizing gradual improvements in living conditions Persevering Mentally combating adversity Holding on to faith Resigning oneself to adversity View Large Drawing Support From Social Contacts Receiving Instrumental Support Support from social contacts significantly contributed to participants’ ability to deal with adversity. Participants mentioned forms of instrumental support rather than emotional support. Instrumental support made it easier to live with few financial and material resources. For instance, one participant said that the general practitioner sometimes turned a blind eye to a bill because “he knew well that we did not have much to spend,” and another participant mentioned that housewives helped each other with all kinds of tasks because “none of us had a lot of money.” Several participants were regularly supported with money or a loan from more affluent family members. Instrumental support also benefited participants in situations where employment was at stake. For example, one participant’s neighbors helped him in his shoemaker’s shop after he became injured at work. Another participant’s friends provided him with a piece of land on which he could further develop his passion for plants and flowers and retain a sense of usefulness during a period of unemployment. The family members who lived nearby enabled another participant and his wife to work more in their painting business by regularly taking care of the couple’s children. Spouses were often a source of instrumental and emotional support, although the latter often remained implicit. For instance, participants who owned a business described a smooth and stimulating cooperation with their spouses, which was crucial to the success of their company: And then [my husband] said: “You go and work with the hay cannon, but (…) take it easy. If you don’t finish, I’ll help you.” And then I thought “This has to get done, this has to succeed.” (…) And then [my husband said]: “You worked so hard, go and buy that jacket; you worked hard for it the whole summer.” (Mrs. de W) Gaining a Sense of Belonging in a Stable and Easily Accessible Social Network Many participants were embedded in a stable and closely knit social environment. Participants often lived close to family, friends, and colleagues for a long time, sometimes their entire lives. Their experiences revealed openness to social interaction and demonstrated active contributions to building and managing social networks: I have plenty of contacts. [For example] with my former colleagues. (…) And this place is actually a kind of hangout, so to speak [stretches his arm to indicate the whole living room]. I bought this back then. And since then, we all meet here. (…) My door is always open; they can all come in just like that. (Mr. van G) Additionally, most forms of support were recurring and appeared to be a part of everyday life. One participant indicated that poverty was not a topic that was overtly talked about, but instead was silently acknowledged and acted upon within the community: When you needed something new or so, you had to wait for it much longer (…) If [the kids] needed new clothes again, well, then [the shop keeper] wrote it in his book until I got child allowance again. (…) And it wasn’t only me; there were many people who needed that. (Mrs. M) Investing in Younger Generations Encouraging and Emphasizing Children’s Career Success This subtheme was mentioned solely by women. Most female participants emphasized a lack of educational opportunities during their youth. Their responses to this circumstance were diverse. Some said they never experienced any negative consequences, while others were still overtly frustrated about “never having had the chance” to study. Nevertheless, there was a striking resemblance among them in mentioning that their children had earned diplomas, obtained good jobs, were doing their best, or were “enterprising.” Some participants had strongly encouraged their children to perform well in school, and they now seemed to experience their children’s successes as their own. Such investment seemed to compensate for their own dissatisfaction: [I am glad that my children studied]. Oh man, I’m as happy as a clam. (…) I’ve always said [to them]: “learn, learn, learn”. They all have good jobs. They’re all married to a good job. (…) If you learn, you can get anywhere later on. (Mrs. de R) Transmitting Knowledge and Experience to the Next Generation Another form of investment in younger generations was by transmitting knowledge and experience. This was mentioned solely by men. For instance, one participant developed himself from “the bottom” of society to obtaining a teaching position at an agricultural school, despite lacking formal diplomas for the job. He mentioned that being able to eventually teach others about flowers and plants was what he was most proud of in life. Another participant suggested that passing on his successful business to his sons offered relief and increased the subjective value of his own investments: That [my sons joined the company] eases my burden. Then you can… everything that you had to deal with. Let me put it like that. You can share that with the boys. They take over that. And I stand back. (Mr. B) Taking Actions to Manage or Improve Socioeconomic Conditions This theme reflects actions that either resulted in adaptation to poverty or in an increase in social status. Managing Expenses Three women indicated that they had lived in poverty, but found ways to retain an acceptable standard of living despite their limited financial resources. Examples included growing and conserving their own vegetables, making their own clothes, and saving up little amounts of money for years to be able to eventually buy a house. This frugality also involved managing expectations; some women made their young children well aware that they could not get expensive presents and requested that their children pay for their board once they got older. Furthermore, for some participants, frugality became a habit from which they still reap benefits. Developing One’s Working Career Although they had few opportunities to study, several participants took initiatives to develop their careers. For example, they took on various jobs to find the most fulfilling one, started a business, or took courses in order to find a better job, all of which increased their social status: I had those courses. Deboning and stuff. Cutting meat. (…) That also wasn’t paid for. But at least you had a trade. You did know something. You did know something. (…) That I didn’t have to work at the assembly line [as my brothers did], so to speak. I don’t want that. No. (Mr. van G) Only in special circumstances were some female participants able to continue working after marriage. Two of them worked in their husband’s business, and one started her own business after finding out she could not become pregnant. The work generated more income, resulted in a larger social network, and reinforced their self-esteem. For example, two participants mentioned that their occupational achievements are what they are most proud of in life. Putting the Impact of Socioeconomic Position into Perspective Valuing One’s Own Skills Although several participants mentioned that they worked long and hard hours and had little time for leisure activities, they experienced their work as enjoyable and considered themselves good at it. This applied to paid work as well as to volunteer and domestic work. Many participants emphasized how skillful they were, for instance at typing, spinning, cleaning, and performing executive roles within a volunteer organization. Some recalled compliments they received, sometimes decades ago. This indicated that other people’s acknowledgement of their skills contributed to their self-esteem: [I was once the chairwoman of an association for women living in the countryside] and I had to deliver a speech. And there was a gentleman who was [always] very critical [who said:] “Well, Mrs. de W, you did an excellent job.” Well, I thought that was really nice of him; that was something really special. So I hold on to that, that I’m good at something, at least. (Mrs. de W) Experiencing a good fit between one’s skills and one’s work provided additional pleasure and satisfaction from work, as was the case for the shoemaker: Apparently I had mastered it. I was better with my fingers than my head. Yes, and I believe that’s why I got tremendous pleasure from carrying out my work. (Mr. E) Valuing Other Aspects of Life More Highly than SEP Most participants showed a certain disregard for social status. One participant chose the middle position on the societal ladder on principle because “no-one is above me and no-one is below me,” and another participant argued that someone low in the occupational hierarchy is as important as the general manager. Some participants implied that other positive aspects of their life compensated for their otherwise meager lives: I didn’t have a rich life. But I did have a rich life health wise. (Mrs. D) We’ve always lived well. Lived simply. No luxury at all. And always…never had quarrels, so to speak. With each other. Never. No bad words or things like that. It was always fine. It was always fine. (Mr. van G) Emphasizing Gradual Improvements in Living Conditions For some participants, emphasizing the temporary nature of living in adverse socioeconomic conditions seemed to reflect light-heartedness about the impact of adverse socioeconomic conditions on their lives. Participants said that small and gradual positive improvements in living conditions made life easier throughout later adulthood: Very tough times have become very good times, really. Because we’ve been through that, from having nothing so to speak, to where we are now. (…) It’s all kinds of little things, in everything, in the surroundings, or in the furniture, or in all stuff…You’ve actually moved with the times, but things have always improved. (Mrs. D) Rather than viewing these improvements as a result of personal effort, participants pointed to a general rise in the standard of living and working conditions in the second half of the 20th century. Additionally, some participants suggested that child benefits and unemployment benefits helped them to make ends meet. Persevering Mentally Combating Adversity One way of persevering through difficult times was by mentally combating adversity. This kind of strategy was mentioned in relation to a wide range of situations, such as having an alcoholic husband, facing neglect by one’s parents in childhood, recovering from a stroke, and becoming widowed. The term perseverance was adopted from a participant’s definition of resilience: [Resilience is] perseverance. (…) The urge to do. When things went against me. Then we have that urge, we don’t let it get us down. The urge to solve something eventually or whatever. That we don’t say: “Just leave it.” (Mr. B) Mr. B’s definition also indicated that perseverance is something that can be acquired together, as he switched from “me” to “we” while elaborating. Similar features of resilience were apparent from the responses of other participants, who used phrases such as “mentally fighting,” the necessity to “handle yourself” in difficult times, and convincing yourself that you “mustn’t whine.” The purpose of this attitude was to keep on going and focus on the future. Holding on to Faith Religious faith acted as a psychological resource that helped participants to persevere. First, praying offered mental support. It provided tranquility or allowed participants to leave their worries behind and “become strengthened by Jesus or God.” Second, religious rules and practices provided structure to daily life (e.g., reading from the Bible every day or living according to the 10 commandments). Third, one participant and his wife believed that prayer could effectuate favorable changes in life: Then we got a message: [a large painting job] was cancelled, for the first time. (…) So in the evening we prayed. (…) And at eleven o’clock the phone rang. And there was a painter from S asking whether we could start work for them immediately. (…) Well, we were saved. You got plenty of work. (…) I mean, we often had our prayers answered. (Mr. B’s wife) Resigning Oneself to Adversity Several participants indicated that they had little control over their opportunities in life, particularly as adolescents and young adults. This predominantly applied to the women. They referred to social norms that prohibited them from furthering their education or having a career, and to living in harsh material conditions. One participant gave a lively description of her experiences as a mother of nine, struggling to manage heavy housework while having poor housing conditions and a low income. Most participants were discontent with their circumstances at the time, but they often felt there was no other choice than to resign themselves to them for as long as they lasted. They repeatedly said “you didn’t know any better,” or “that was life back in those days,” which reflected a kind of reluctant acceptance. In order for this resignation to become a source of resilience, however, it seemed crucial that it was combined with a positive way of coming to terms with the adversity afterwards. This positive stance was for instance apparent from participants showing pride in having been able to endure harsh circumstances, questioning whether realizing their ambitions would really have improved their life, or showing relief: I’m now astounded that I managed [with little money and nine kids at home]. But that was how it was and it can’t be changed. It will not return, as we say. Fortunately. (Mrs. M) Discussion and Implications Based on the qualitative interviews with older adults who aged successfully despite having a low SEP, this study identified six themes that point toward factors enabling resilience in the face of socioeconomic adversity. Whereas drawing support from social contacts and taking actions to manage or improve socioeconomic conditions were tangible ways of dealing with present socioeconomic adversity, putting the impact of a low SEP into perspective, persevering, and resignation reflected mindsets or attitudes that contributed to resilience. Investing in younger generations may have compensated for a lack of educational or occupational opportunities or helped to prepare for the future. These resources and actions may have contributed to the high level of successful aging observed in the participants of this study, despite their low SEP. Our findings provided three key contributions to the literature on resilience. First, we identified elements of resilience that have received little attention in previous studies on socioeconomic adversity. The theme “investing in younger generations” resonates with the concept of generativity (Erikson, 1963). Generativity has been defined as “the desire to invest one’s substance in forms of life and work that will outlive the self” (Kotre, 1984, p. 10). Generative action may give a sense of purpose and worth to one’s life narrative (Kotre, 1984). Whereas women compensated for a lack of opportunities by stimulating their children, men transferred their knowledge and experience to the next generation. In line with other studies on resilience in different contexts (e.g., Emlet, Harris, Furlotte, Brennan, & Pierpaoli, 2017), participants described generative action as a significant source of life satisfaction, which in turn is important for successful aging. Furthermore, we found that the combination of resigning oneself to difficult circumstances while they last and having a positive way of coming to terms with these circumstances afterwards may provide an effective way of dealing with socioeconomic adversity. The finding that this apparently passive way of coping can be effective may nuance the heroic image that is often associated with resilience. It shows that resilience is not necessarily something that requires extraordinary efforts from extraordinary people, but often derives from basic human adaptive processes (Masten, 2001), which may include resignation. Second, our findings provide a better understanding of how personality traits that are often included in resilience measurement scales, such as competence, self-esteem, and optimism (Windle, 2011), manifest themselves in the experience of resilient older adults with a low SEP. Several participants described attitudes toward adversity that they applied across different situations, including “mentally fighting” and feeling an “urge to do.” Such examples support the importance of coping abilities and control beliefs for resilience (Hildon, Smith, Netuveli, & Blane, 2008). Moreover, participants valued their own (manual) skills and remembered compliments about these skills from others. Such findings illustrate sources of self-worth that may contribute to successful aging particularly in older adults with a low SEP. In addition to personal characteristics, social support is often found to be a protective factor in studies on resilience (Rutter, 2012a). Our results suggest that concrete forms of support such as money or aid and attachment to place are important. Moreover, some participants indicated a culture of tacit acknowledgement of poverty in their neighborhood, reflected by ongoing mutual aid, which helped to make ends meet. In line with previous studies (Cairns-Nagi & Bambra, 2013), this implies that in addition to social support, stability in social and physical surroundings may be important as well. Our findings further show that resilience may be fostered through societal factors. Social security arrangements, such as child and unemployment benefits, and the general rise in the standard of living in the second half of the twentieth century may have contributed to resilience in the general population with a low SEP. Taken together, our findings on social support suggest that resilience of the individual is linked to community and societal resilience. Third, our findings may help to evaluate emerging theories on resilience in the face of socioeconomic adversity. We found some support for the shift-and-persist model that is argued to characterize resilience in individuals with a low SEP (Chen & Miller, 2012). In our study, themes like valuing one’s skills and valuing other aspects of life more highly than SEP reflect ways to reduce the emotional impact of adversity posited by this model (“shifting”), whereas persevering is similar to endurance (“persisting”). However, our findings did not support the idea that individuals with a low SEP are predominantly restricted to coping strategies directed at the self rather than at the external environment (Chen & Miller, 2012). Some participants successfully undertook actions that favorably changed their living conditions. This discrepancy with Chen and Miller’s (2012) model may be because their model was originally developed to reflect resilience in children, who may have less resources to change the external environment than (older) adults do. At first glance, the participants’ actions seem to support Schafer and colleagues’ (2009) proposition that resilience entails being conscious of disadvantage and then activating resources to improve the situation. However, our findings also nuance Schafer and colleagues’ (2009) model. Not all participants in our study consciously experienced a low SEP as a disadvantaged position. Rather, some of them disregarded social status and were proud of their simple lives. This attitude seemed to contribute to their resilience. Moreover, enduring adversity without much reflection and coming to terms with adversity later in life could also contribute to resilience. Implications Our findings echo earlier findings on the importance of social support and personality factors for resilience. The relatively new factors identified in this study point to the importance of valuing skills, generativity, and resignation for individuals with a low SEP. Whereas some factors clearly relate to earlier life stages, other factors (e.g., social support, using one’s skills) may still be amenable to intervention in older adults. Moreover, macro-level interventions (e.g., social security arrangements) may increase general opportunities for low SEP individuals to age successfully. Possible interventions should be discussed and designed in collaboration with older adults themselves. At the very least, taking note of our findings may reduce potential stereotyping of older adults with a low SEP. Strengths and Limitations We consider the use of extensive quantitative criteria for selecting resilient participants as a strength of this study. Moreover, we believe that the explorative approach to resilience in this study supported the search for factors that are protective across different adversities and outcomes (Kaplan, 2005). One limitation inherent to qualitative research is that findings cannot be generalized. This also applies to the small sample of 11 older adults in this study. Additionally, we did not interview nonresilient older adults, mainly because these participants already dropped out of the study due to death or other reasons. A second limitation may be that our findings are possibly not generalizable to other countries with social security and health care systems different from those in the Netherlands. Nevertheless, most of our findings resemble those of previous studies on resilience in other populations and are thus valuable for understanding resilience across national contexts. Conclusion We identified key elements that may contribute to resilience in older adults with a low SEP. The participants in this study possessed multiple individuals and social resources that enabled them to deal with various adversities throughout their lives. This suggests that it requires a lot—mentally and socially—to age successfully with a low SEP. Nevertheless, this study provided new insights into factors that may prevent the risks associated with a low SEP from translating into impaired health and functioning in old age. Supplementary Material Supplementary data is available at The Gerontologist online. Funding This work was supported by the “Longitudinal Aging Study Amsterdam” (LASA; www.lasa-vu.nl), largely funded by the Netherlands Ministry of Health, Welfare and Sports, Directorate of Long-Term Care and by a VIDI fellowship from the Netherlands Organization for Scientific Research (grant number 452-11-017 to M.H.). Conflict of Interest None reported. References Adler , N. E. , Epel , E. S. , Castellazzo , G. , & Ickovics , J. R . ( 2000 ). Relationship of subjective and objective social status with psychological and physiological functioning: Preliminary data in healthy white women . Health Psychology , 19 , 586 – 592 . doi: 10.1037/0278-6133.19.6.586 Google Scholar CrossRef Search ADS PubMed Adler , N. 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The GerontologistOxford University Press

Published: Feb 27, 2018

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