One of the key factors for delivery of the nature therapy and dementia programme is about increasing resilience amongst the carers older people. But the question arises of how can we measure if taking part in our programme actually builds resilience to burn out. One of the challenges is that there are many different ways of understanding the concept of resilience but there is no consensus on what it actually is. In addition, we have no idea if resilience is a dynamic process or a fixed character trait. There is little point in measuring fixed character trait before and after a programme because it is - fixed.
Demakakos et al (2012) define resilience as the ability of people to resist adversity and flourish under it. They noted that resilient older people are more satisfied with their lives and had a better quality of life than non-resilient people. We are keen to ascertain if nature therapy enhances resilience in carers so they can cope with future adversity or if, as some believe, measuring resilience actually requires the existence of adversity to see if people effectively overcome it. This latter concept raises challenges as we would only know if there was any increase in resilience after they reached a crisis situation, which of course might be years away, or indeed never.
Then again, if resilience is resisting adversity, we have to be clear what we mean by adversity. Financial crisis, bereavement, and ill health are all considered to be situations that could be classified as adverse, or it could be anything that might significantly impact on an individual. Measuring changes in mood levels has been thought of as one way of measuring resilience.
The research evidence is not clear if socio demographic factors such as gender, age, marital status, education, and income impact on resilience and of course these are factors that projects such as ours have no control over. Feelings of loss of control have been implicated in individuals experiencing depressive symptoms.
One further issue we need to take into consideration when measuring resilience is that adversity can be compound. That is one event such as illness can trigger other adversities such as loss of income thereby compounding the effect of loss of choice and control.
So, having set out some of the challenges in measuring resilience, we set out to look at what was the best possible tool we could use to measure any change in our nature therapy and dementia care work. Consultation with older carers suggested the best possible tool for them as one that was easily completed, visual, did not involve a great deal of writing, did not make them feel depressed completing it, was quick, and was in a format they could easily understand without having to think too much. So we reviewed the available scales against this criteria.
Windle (2011) of Bangor University reviewed 19 resilience scales. She noted that some of the scales are relatively new and concluded none identify any specific scale as more reliable. However five measures (the RSA, the CD-RISC, the Brief Resilience Scale, the ER-89 and the Dispositional Resilience Scale provided test-retest information, and the Resilience Scale for Adults (RSA) scored the maximum for this criteria. This provides some indication of the measure's stability, and an early indication of the potential for it to be able to detect important change, as opposed to measurement error.
The RSA scale was validated in Norwegian samples raising concerns about cultural significance. In addition, there is a significant cost associated with the licence for this scale. This equate to 150 US dollars for every 50 people. As the intention is to use this scale with every single person who downloads an online planner pre and post completion, the use of the scale was outside of our financial resources.
Our review into measuring resilience is on going, meanwhile we are using a self assessed likert scale to determine any change for the person with dementia based on observable factors such as less agitation and aggression, better sleep and sign of enjoyment in life. We are asking carers to scale this factos both before and after the carers pop up dementia theatre experience to see if they change anything they do as a result of the Think Sense campaign that ultimately impacts on the person they are caring for.
In addition we use the much simpler Compassion Fatigue Scale for carers as that can be applied both before their involvement in our nature therapy and dementia care work and again after.
Early results are showing a significant improvement in Compassion Fatigue plus less agitation and aggression being expressed by older people with dementia.