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Community Resilience throughout the Lifespan The Potential

Contribution of Healthy Elders
OdeyaCohen, DiklahGeva, MooliLahad, ArkadyBolotin, DimaLeykin, AvishayGoldberg, LimorAharonsonDaniel
Published:February4,2016

DOI:10.1371/journal.pone.0148125

Abstract

Anincreaseintheexposureandpredispositionofcivilianpopulationstodisastershasbeenrecordedinthelastdecades.Inmajor
disasters,asdemonstratedrecentlyinNepal(2015)andpreviouslyinHaiti(2010),externalaidisvital,yetinthefirsthoursaftera
disaster,communitiesmustusuallycopealonewiththechallengeofprovidingemergentlifesavingcare.Communitiestherefore
needtobepreparedtohandleemergencysituations.Mappingtheneedsofthepopulationswithintheirpurviewisatryingtaskfor
decisionmakersandcommunityleaders.Inthiscontext,theelderlyaretraditionallytreatedasasusceptiblepopulationwithspecial
needs.Thecurrentstudyaimedtoexplorevariationsinthelevelofcommunityresiliencealongthelifespan.Thestudywas
conductedinninesmalltomidsizetownsinIsraelbetweenAugustandNovember2011(N=885).TheConjointCommunity
ResiliencyAssessmentMeasure(CCRAM),avalidatedinstrumentforcommunityresilienceassessment,wasusedtoexaminethe
associationbetweenageandcommunityresiliencescore.Statisticalanalysisincludedsplineandlogisticregressionmodelsthat
exploredcommunityresiliencyoverthelifespaninawaythatallowedflexiblemodelingofthecurvewithoutpriorconstraints.This
innovativestatisticalapproachfacilitatedidentificationoftheagesatwhichtrendchangesoccurred.Thestudyfoundasignificant
riseincommunityresiliencyscoresintheagegroupsof6175yearsascomparedwithyoungeragebands,suggestingthatolder
peopleingoodhealthmaycontributepositivelytobuildingcommunityresiliencyforcrisis.Ratherthanfocusingonthegrowing
medicalneedsandyearsofdependencyassociatedwithincreasedlifeexpectancyandtheresultingclimbintheproportionof
eldersinthepopulation,thispaperproposesthatactive"youngatheart"olderpeoplecanbeavaluableresourcefortheir
community.

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Citation:CohenO,GevaD,LahadM,BolotinA,LeykinD,GoldbergA,etal.(2016)CommunityResiliencethroughoutthe
LifespanThePotentialContributionofHealthyElders.PLoSONE11(2):e0148125.doi:10.1371/journal.pone.0148125
Editor:TakeruAbe,YokohamaCityUniversity,JAPAN
Received:May17,2015Accepted:January13,2016Published:February4,2016
Copyright:2016Cohenetal.ThisisanopenaccessarticledistributedunderthetermsoftheCreativeCommons
AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalauthor
andsourcearecredited.
DataAvailability:Dataisrestrictedfrompublicsharingduetoethicalrestrictionsonpatientdata.Fulldatasetcanbemade
availabletoallinterestedresearchersuponrequestthroughthePREPAREDCenterforEmergencyResponseResearchat
emed@bgu.ac.ilorthroughcontactingDr.OdeyaCohen,odeyac26@gmail.com.
Funding:Theauthorsreceivednospecificfundingforthiswork.
Competinginterests:Theauthorshavedeclaredthatnocompetinginterestsexist.
Introduction

Communityresiliencereflectsthecommunity'scapacitytoovercomechangesandcrises.Thedevelopmentandenhancementof
communityresilienceduringthepreemergencyperiodcanserveasacorecapabilityofcommunitiesinemergencysituations[1].
Communityresiliencehasalsobeenrelatedtosustainablelifestyle[2],[3],andaproviderofthesociety'sadaptivecapacitiesduring
crisissituations[4],[5].Thetermcommunityresiliencedescribesacomplexconstructthatencompassessocialaspectssuchas
leadership,collectiveefficacy,socialcohesionandplaceattachment,alongwithphysicaldimensionssuchasinfrastructure,
servicesandprotection[1],[6][8].Itisdiscussedintheliteratureinmanydisciplines,contentfieldsandlevels,resultingina
multiplicityofdefinitionsthatreflecttheabundanceofperspectives.However,wehavechosentocomplywiththefunctional
definitionphrasedabove.
Thereisacloserelationshipbetweenthemedicalcontext,orpublichealth,andcommunityresiliency[9],[10].Castledenetal.[11]
claimthatahealthypopulationisoneofthesignificantrewardsofpromotingcommunityresilience.Chandraetal.[12]foundthat
communityresilienceisconnectedtostateofphysicalandmentalhealthinthepreemergencyperiod,amongotherelements.

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Otheraspectsarerelatedtothecontinuityofhealthservicesduringthedifferentphasesoftheemergencysituationandtothe
abilitytoshareupdatedmedicalinformationduringthetimeofchange[10],[12].Poortinga[13]foundthatattributesofcommunity
resilienceweresignificantlyassociatedwithselfreportedhealth.
Anincreaseintheexposureofcivilianpopulationstodisastershasbeenrecordedinthelastdecades.Inmajordisasters,as
demonstratedrecentlyinNepal(2015)andpreviouslyinHaiti(2010),externalaidisvital,yetinthefirsthoursafteradisaster,
communitiesmustusuallycopealonewiththechallengeofprovidingemergentlifesavingcare.
Withintheoverlappingworldsofdisasterpreparedness,resiliencyandhealth,specialattentionshouldbepaidtotheissueofthe
agingpopulation.Thepercentageofolderadultsinthegeneralpopulationisincreasing,anditisimportanttoassessandattendto
theconsequences.AccordingtoWildetal.[14],moststudiesdealingwithresiliencelateinlifefailtoexaminetheroleofthe
community.Inthosestudiesthatdoconsiderthecommunity,researchersanalyzeitsroleonlyintermsoftheimpactthataginghas
onindividualresilience.Wilesetal.[15]notethat,especiallyinthelaterstageoflife,theframeofreferenceofresiliencyexpands,
encompassingboththeresourcesofthecommunityandindividualaspectsofresiliency.Fromsuchaperspectiveanolderperson
withamajorillnessorhardshipcouldbeperceivedasagingwellorevenasresilient.
Therearedifferentapproachesregardingtheageingpopulationduringsituationsofchange[16].Ontheonehand,theelder
populationisperceivedasvulnerable[12],[17][19].TheCDCreportsthatdisastersofallkindsaffectolderadults,especiallythose
withseverechronicdiseases[20],andotherstudiesassignresilientattributestoneighborhoodswithlowpercentagesofelder
residents[21].Ontheotherhand,thereisadifferenttrendfocusedonthepositiveinfluenceofeldersontheircommunity.Wiles
andJayasinha[22]foundthatolderpeoplecareabouttheirplaceofresidence,becominginvolvedinvolunteering,activism,
advocacy,andnurturingothersinthecommunity.SimilarfindingsemergedintheworkofAlessaetal.[23],[24],showingthatthe
presenceofelderlymembersstrengthensthecommunitysresiliencytocopewithchanges.AccordingtoKimhietal.[25],[26],
olderindividualswhohadbeenexposedtosecuritythreatsshowedahigherlevelofcommunityresilienceascomparedwith
youngerparticipants.
Ingeneral,theliteraturerevealsadearthofempiricevidencefromcommunityresiliencestudies[12],[27].Thecomplexityofthe
termcommunityresilienceandthediversityofcontentworldsthatusethetermmakeitdifficulttomeasurethisattributeorto
aggregateempiricalfindingsinagreedresearchframeworks[11].Thisstateofaffairsbecomesparticularlyacuteinthecaseof
researchonresiliencyamongageingpopulations[15],[16].
ThestateofcommunityresilienceresearchwasthedrivingforcebehindthedevelopmentoftheConjointCommunityResilience
AssessmentMeasurement(CCRAM),atoolforassessingcommunityresilience.Thistoolwasdevelopedandvalidatedbyagroup
ofmultidimensionalexpertsandreflectstheintegrationoftheirknowledgeandexperience[6],[28].Severallargestudieshavebeen
conductedusingCCRAMmappingofresiliencyinvariouscommunitieswithaviewtoexploringtheirweaknessesandstrengthsin
bothroutineandcrisissituations.Thesearedescribedelsewhere[6],[28],[29].

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Giventhelackofempiricalevidenceaboutcommunityresilienceinlaterlifeandtheplethoraofcontradictoryviewsregardingthe
capacitiesoftheageingpopulationinthefaceofchange,theaimofthecurrentpaperwastopresenttrendsinthelevelof
communityresiliencealongthelifespan,asportrayedbyapopulationbasedstudyofthisattribute.
MaterialsandMethods

CommunityresiliencewasassessedusingtheCCRAMtool[28].Theinstrumentincludes22backgroundquestionsfollowedby28
itemsona5pointLikertscale(1stronglydisagreeto5stronglyagree)regardingvariousaspectsofthecommunityandsocial
lifeoftheresponders.Theseitemswereshowninpreviousstudies[6]toformconstructsoffivefactors:leadership,collective
efficacy,preparedness,placeattachment,andsocialtrust.TheCCRAMscoreiscomposedoftheaveragescoreoftheconstructs
ofthesefactors,eachbeingassignedequalweight.
Thestudywasconductedinninesmalltomidsizetowns(upto50,000inhabitants)inIsraelfromAugusttoNovember2011.The
sizeofthecommunitywasfoundtobesignificantlyassociatedwithcommunityresiliencescores,thesmallcommunities(upto
10,000inhabitants)beingcharacterizedbyhigherlevelsofcommunalfeaturesthanmidsizecities[28].Thestudyusedbothdoor
todoorsurveysofrandomlyselectedaddresses,andelectronicquestionnairesdistributedtomailinglistsinsmallcommunitiesfor
whichafulllistofresidentswasavailable.Thestudywasapprovedbytheinstitutionalreviewboard(IRB)oftheFacultyofHealth
SciencesatBenGurionUniversityoftheNegev.Participantsgavetheirinformedconsenttotakepartinthestudy.Abrief
introductionatthebeginningofthequestionnairedescribedtheobjectivesofthestudyandspecifiedthatfillingthequestionnaire
wasvoluntaryandcouldbeterminatedatanytime,andalsothatthequestionnaireswereanonymous.Continuingtoanswerthe
questionsrepresentedinformedconsent,asapprovedbytheIRB.
Statisticalanalysis

ThestudyusedseveralstatisticalapproachestomeasurethevarianceoftheCCRAMscoresovertheagedistribution.Nonlinear
regressionwithsplinewasusedtoexploretherelationshipbetweenCCRAMscoreandage.Inthisanalysiswefittheknots
signifyingthepointswherethelinearslopechanged[30].Additionalpreliminaryanalysisexaminedtherelationshipbetweenthe
CCRAMscoreandotherstudycovariatesusingcorrelationcoefficientanalysisandchisquaretests.Inordertocomparethevalues
oftheoverallCCRAMscoresandthescoresforitsfactorsoverdifferentages,thestudyusedfiveagecategories:A<30years,n
=179B3145years,n=290C4660years,n=249D6175years,n=136E>75years,n=23.Theeffectofage
grouponthecommunityresiliencefactorsleadership,collectiveefficacy,preparedness,placeattachmentandsocialtrustwas
examinedusingmultivariateanalysisofvariance(MANOVA).Alogisticregressionmodelwasusedtoexplorethecharacteristicsof
highaverageCCRAMscores(intherangeof45,n=245)versuslowaverageCCRAMscores(scoresintherangeof12.99,n=
205).ANOVAwithScheffeposthoctestconfirmedsignificantdifferencesamongtheselevels:(F(2,882)=1928.91.91,p<0.001).
(CasesassociatedwithanintermediatelevelofaverageCCRAMscorescoresintherange33.99,n=433wereomittedfrom
thisanalysis.)Thefirstlogisticregressionanalysismodeledageforthefivecategoriesmentionedabove,withages3145takenas
thereference.Thesecondmodelforcedthepreviouslyidentifiedcovariatesthatwereselfreportedbytheresponders:gender,

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maritalstatus,childrenathome,physicalormentaldisabilitythatmayhampertheresponderduringemergencies,religion,travel
timetowork,educationlevel,incomelevel,belongingtoaCommunityEmergencyResponseTeam(CERT),andcommunitytype.
Foralllogisticregressionmodels,theoddsratios(OR)alongwith95%confidenceinterval(95%CI)werereported.Sensitivity
analysisforselectedcovariateswasusedinordertodemonstrategraphicallythetrendsoftheCCRAMscoreforsubgroupsacross
agecategoriesinamultipanelfigure.Finally,thecharacteristicsofthefiveagebracketswithdescriptivestatistics(meanSE)and
Bonferonicorrectedposthocpairwisecomparisonsweredetailed.Allotherpvaluesreportedatsignificancelevelofp=0.05with
nocorrectionformultipletesting.DatawereanalyzedusingStatisticalPackagefortheSocialSciences(SPSS)version18.0.
Results

Thisstudysampledadults(N=885)fromninesmalltomidsizetownsinIsrael:midsizetowns(n=465)andsmallcommunities(n
=417).Responseraterangedfrom8095%inthedifferenttypesofcommunities,withthesmallercommunitiesshowingthehigher
responserates.
Themeanageofresponderswas45.28years(median=44,range1885years,SD=15.40years).Asignificantdifferencewas
foundbetweencommunitytypesinrespondersages(t(765.61)=4.45,p<0.001):responderslivinginsmallcommunitieswere
olderonaverage(meanage=47.94,SD=16.22)thanthoselivinginmidsizecities(meanage=43.25,SD=14.33).Onaverage
responderslivedinthesamecommunityfor27.42years(range167years,SD=16.9years).Amongtheparticipants,55.7%were
women(n=490),and70.5%wereinapermanentrelationship(n=625).Fortytwopercenthadanacademicdegree(n=368)and
34.8%reportedtheirincomeassimilartotheaverageincomelevel(n=308).Withregardtodisability,14.6%oftheresponders
mentionedthattheyhadaphysicalormentaldisabilitywhichmighthampertheirfunctionalityinanemergencysituation(n=128).
Theclaimforadisabilitywassignificantlyhigherinthetwoolderagegroupsaboveage60(2(df=4,n=871)=128.75,p<0.01).
TheCCRAMaveragescorewas3.49(1.435range,SD=0.711),withnosignificantdifferencebetweengendersandreported
incomelevelsaccordingtotheanalysisofvariance(S1andS2Tables).
PearsoncorrelationanalysisdetectedasignificantweakassociationbetweenCCRAMscoresandage,r=0.187,atthe
significancelevelp<0.001.Further,agewasfoundtobeassociatedwithleadership,r=0.161,p<0.001,preparedness,r=0.131,
p<0.001,andplaceattachment,r=0.238,p<0.001collectiveefficacyandsocialtrustwerenotfoundtobesignificantly
correlatedwithage.
Fig1showsthemeanCCRAMscoreoverageoverlaidwithasplinefittedcurve.Thefittedsplinecurvewasstatisticallysignificant
withF(5,876)=9.162,p<0.001,with4knotsatages27,52,72and83years.Ateachknottheslope,b,takesasignificantturnat
age27b=0.049(p=0.011),atage52b=0.0169(p=0.045),atage72b=0.065(p=0.016),andatage83b=0.587(p=
0.031).ThismeansthatCCRAMincreaseswithageduringmostofadultlifeandpeaksattheageof72.Atthelateageof83years,
wenoticedasharpincreaseintheCCRAMscorewithage.However,thislatelifetrendisuncertain,asthegroupofparticipants
overtheageof75yearswassmall(n=23)andheterogeneousduetovarieddemographicsandhealthcharacteristics.

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Fig1.MeanCCRAMscoresbyage.

Notes:splineknotsoccuratage27,52,72and83.Agesover75werecharacterizedbyscarceandheterogeneousdata(n=
23).
doi:10.1371/journal.pone.0148125.g001
AtthesecondstagethemeanscoresoftheCCRAMfactorswereexaminedoverage.Fig2presentstheCCRAMfactormean
scoresaccordingtoagecategories.

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Fig2.CCRAMfactorsaccordingtoagecategories.

doi:10.1371/journal.pone.0148125.g002
MANOVAwasusedinordertoexaminetheeffectofagegrouponcommunityresiliencefactors.Thisanalysisyieldedasignificant
multivariateeffectforagegroup,F(20,3480)=4.84,p<.001,p2=.027.Univariateeffectsoftheresiliencefactorresultedin
significanteffectsforallfactors(seeTable1).

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Table1.Averagescoresforfivecommunityresiliencefactorsoveragegroups.

doi:10.1371/journal.pone.0148125.t001
AsdetailedinTable1,posthocmultiplecomparisonusingTukeyHSDyieldedthefollowingresults:Forthefactorofleadership,the
75+agegroupdifferedsignificantlyfromthe<30and3145agegroups,butnotsignificantlyfromthe4660and6175age
groups.Forthefactorofcollectiveefficacy,theonlysignificantdifferencewasfoundbetweenthe4660and6175agegroups(p<
.001).Forpreparedness,the6175agegroupscoredsignificantlyhigherforthisfactorcomparedtothe<30and3145age
groups.Forplaceattachment,the6175agegroupdifferedsignificantlyfromtheyoungeragegroupsbutnotfromthe75and
aboveagegroup.Asimilarpatternwasobservedforthesocialtrustfactor.
AlogisticregressionmodeledhighCCRAMscore(meanscorewiththerange45)vs.lowscore(meanwithintherange12.99).
Initiallythemodelonlyincludedageinthefivecategoriesmentionedabove.Ages3145weretakenasthereferencegroup.Over
all,agehadasignificantassociationwithCCRAM,andtheagecategoryof6175yearshadanoddsratioof3.12(95%CI1.66
5.86)withreferencetoage3145(p<0.001).Afteradjustmentforstudycovariates(gender,maritalstatus,childrenathome,
disability,religion,traveltimetowork,educationlevel,selfreportedincomelevel,belongingtoaCommunityEmergencyResponse
Team(CERT),andcommunitytype),thisrelationshiphadanevenhigherOR4.32(95%CI1.2514.99),p=0.021,forthesame
agecategory.ThepredictedprobabilitiesofthetwomodelsoveragearepresentedinFig3.Thetwomodelsshowasimilarupward
trenduntiltheagecategory6175yearsthereafterthecovariatesadjustmentmoderatesthedownwardtrendatlateageat>75
years.Table2presentstheregressioncoefficientsofthefinalmodeloflogisticregression,whichincludesagecategoriesandstudy
covariates.

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Fig3.Probabilityofhighresiliencescorebyagecategoriesaspredictedbylogisticregressionmodels.

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Table2.Variablesassociatedwithcommunityresiliencescoreinthefinalmodeloflogisticregression.

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Althoughtheagecategory6175yearsdemonstratesonaveragehigherCCRAMscores,itisunclearwhichcofactorexplainsthis.
Forafurtherexplorationofthecovariatesdistributionoverage,seeTable3,whichlistsconflictingevidenceofhighratesforbotha
riskfactor(disability,p=0.007,OR=0.20)andaprotectivefactor(communitytype,p<0.001,OR=17.2).Studycovariatesbythe
fiveagecategoriesarepresentedinTable3.

Table3.Characteristicsofsociodemographicvariablesbyagecategories.

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Sensitivityanalysis

TheagetrendoftheCCRAMscorewasexaminedinsubgroupswithdifferentcharacteristics.Fig4demonstratesthatthetrend
persistedinallsubgroups,withtheCCRAMmeanscoreincreasingat6175yearsforallsubsets:menandwomenpresenceof
healthdisabilitycommunitytype.

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Fig4.MeanCCRAMscorebyagecategoriesandbyselectedcharacteristics.

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Discussion

Thisstudyexaminedtheassociationbetweentheparticipants'ageandcommunityresiliencescoresasmeasuredbyCCRAM[6].
Usingsplineregressiontoexploreresiliencytrendsoverthelifespanhasimportantadvantages.First,itenablesflexiblemodeling
ofthecurvewithnoconstraintsonthepriorshapeasrequiredbythepolynomialfit,thusprovidingidentificationoftheagesat
whichtrendchangesoccur[31].
Thestudyidentifiedasignificantriseincommunityresiliencyscoresatthelateragesof6175yearsascomparedwithyounger
agebands.Throughoutthisproject,weusedthefulldatasetforanalysis.However,intheregressionmodelingwefoundthatthe
middlepopulationmaymaskassociations.Wethereforepresentthesignificantcontrastbetweenthelowerandupperscores,which
isindicativeofnonlinearitiesintheassociation.Afteradjustmentforstudycovariates(seeFig3),theresultsreinforcethefindings
fromthepreliminaryanalysisandovercomeexistingsamplinggaps.Examinationofthefactorsaffectingthecommunityresilience
score(presentedinTable2)revealsthatthemostinfluentialisresidenceinasmallcommunity(OR=17.2,p<0.001).However,
theresiliencescoreobtainedinthesensitivityanalysisdemonstratesthatrespondentslivinginmidsizetownsbehavedifferently
fromthoselivinginsmallcommunities.Whilebothshowatendencytowardincreasedcommunityresiliencescoresinthelater
decadesoflife,thisincreaseismuchmoreprominentinmidsizecommunities.
Inawaythisispuzzling,sincethegeneralperceptionofeldersplacesthemamongthosemostvulnerabletothedirectimpactof
disasters,especiallyascomparedwiththemiddleagedpopulation[17].Studieshavenotedthenegativeimpactofexposureof
olderadultstodisastersonsomaticsymptomsandmedicalandpsychologicalcomorbidities[32].Similarly,inresponseplansfor
emergencies,olderadultsareconsideredasubpopulationwithspecialneeds[33],[34].
However,adifferentapproachisdescribedbyRabinovici[35]inhisbook"Thesixagesofman."Rabinovicisuggeststhatoldageis
definednotbychronologybutratherbytheaccumulationofvariouscomponents,amongwhichtheinternalperceptionofthe
individualisthemostimportant.Lahad[36],supportingthisapproach,observesthatwhileacertainproportionoftheelderlyhave
specialneedsandshowadeclineinobjectivecharacteristicssuchasresponsetimeandswiftnessofmotion,somefeaturesofold
ageareanassetandaresource[36].Inparticularhementionslifeexperience,thefactthateldersarefreeofmostcommitments
andlookingforsomethingtodo,theirskills,andtheirneedtofeelmeaningfulandtobewithothers.
Researchonageingalsorevealsincreasingscoresinthelateryearsoflifeinrelatedfields.Jesteetal.[37]addressedthisissue
amongparticipantssufferingfromschizophreniaandarguedthat,contrarytothetendencytoconsiderageingasahomogeneous
process,thedeclineincognitivefunctioningandphysicalhealthamongsuchsubjectscontrastssharplywiththeimprovementin
psychosocialfunctioningandsubjectivequalityoflife.Stoneetal.[38]foundaUshapedistributionofwellbeinginrelationto

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participants'ages,withatendencytoincreasedwellbeinginlaterlife.Somestudieshavesoughttofindexplanationsforthis
seemingparadox.Somefocusedontheneurobiologicalprocessesthatoccurwithaging[39],[40],whileothersfoundthatsocial
factors,psychologicalaspectsandlifestylebutnotsomaticcomorbiditieswererelevantdeterminantsoflatelifesatisfaction[41].
ContrarytothefindingsofStoneetal.[38],Wunderetal.[31]haveshowninalongitudinalstudythatthereisanotherturningpoint
ofdeclineinthewellbeingdistribution,ashiftwhichwasoverlookedowingtotheforcedshapeofthefittedpolynomialinStone's
research.Wunder'sfindings[31]aresimilartothoseinthecurrentstudy.Frijters&Beatton[42]observedthatinEuropeanand
Australiandatabasesthereisahappinesspeakaroundtheageof70,withdecreaseinhappinessaspeoplegrowold.
Schaieetal.[43]studiedfactorsaffectingcognitivefunctioning.Accordingtothem[43],continuityofperformanceismaintaineduntil
adropoffpointaroundtheageof75withtheemergenceofchronicdiseaseanddisability.Inshort,avarietyoffactorshave
contributedtotheprolongationofbothoveralllifeexpectancyandwhathasbeentermedausefullifeexpectancyrelatively
undiminishedbyillnessordisability.Allthesefindingsprovidefurtherevidenceofthesimilarityfoundbetweenourcurveof
communityresiliencescoresandotherindicators[42],[43].
Itisbecomingincreasinglycommoninvariousdomainsofresearchontheelderlytoregardageingascomprisedoftwostages.
Ryffetal.[44]foundthatamongstudieswhichmeasuredselfreportedhealth,theearlierperiodofagingindicated,viasocial
comparisonprocesses,thatlaterlifephysicalhealthisassociatedwithpsychologicalwellbeing.
InapaperpresentedattheEuropeanparliamentbyLahadandFanaras[45]regardingtheimpactoftheeconomiccrisisinGreece,
theauthorsreportthatpersonsaged55andabovefeltthattheywerefaringbetterthaninthepast,incontrasttoyoungerpeople,
whofeltworse.Oneexplanationtheyofferisthattheoldergenerationwentthroughsomanycrisesinthecontemporaryhistoryof
Greecethattherecentoneisnotsofrighteningforthem[45].
Communityresilienceisnotacollectionofcommunitymemberscopingindividuallywithadversity.Pfefferbaumetal.[46]
emphasizethatcommunityresilienceis"theabilityofcommunitymemberstotakedeliberate,purposeful,andcollectiveactionto
alleviatethedetrimentaleffectsofadverseevents."Thisapproachmayshedlightontheabilityofelderstocontributetheir
communityleadershipexperience,overandabovetheirabilitytocopepersonallywithvariouschallenges.Thesefindingssupport
theconclusionsofCharles[47],namelythatolderadultsdevelopstrategiesthatmitigatenegativeemotionsmoreefficientlythan
youngeradults.Furthermore,ithasbeenshownthatretireestendtoexpandtheircivicactivitiessuchasvolunteering.They
becomemoresociallyinvolvedafterretirementand,assuch,theycanbeviewedasavaluableresourceforsociety[48].
Thesefindingscouldbeusefulintwoways:first,foridentifyingdimensionsthatassisttheageingpopulationandsecond,for
seekingresourcescapableofenrichingandempoweringthecommunityatlarge.Communityresilienceisimportantinroutinelife
aswellasduringtimesofcrisis[1],[2],[8].However,Maxwelletal.[49]arguethatthelocalcommunityassumesparticular
importanceinprotractedcrises.Atsuchjuncturesinthecommunity'slifecycle,itiscrucialtoidentifyresourcesthatimprovethe
community'scollectivecapacity,enablingthedevelopmentofcommunityabilitiestocopewithchangesorunexpectedevents.

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Nelson[4]arguesthattheperspectiveofresiliencycanstimulatethinkingaboutwaysofradicallyreorganizingsystemstomeet
needsandgoals.Nelsonsuggeststhattheconceptsofresiliencyandadaptationareintegrallyintertwinedwithhumanvaluesand
goalsthusiftheageingpopulationbecomesasourceofstrength,thisbecomesoneofthestepstoachievetheresiliencygoal.
Limitation

Thispaperpresentsresultsofacrosssectionalstudy.Longitudinalstudiesdealingwiththeassociationbetweenageingpopulation
andtheresiliencyoftheircommunitycouldshedmorelightonissuesidentifiedhere.
Conclusion

Thisstudyrevealedanincreaseincommunityresiliencescoresamongtheageingpopulation.Asearchfordataontrendsof
differentscoresoverthelifespanrevealssimilartrendsinotherindices.Thepresentstudysuggeststhattheincreaseinlife
expectancyandthegrowingproportionofeldersinthepopulationimpliessomethingmorethangrowingmedicalneedsandyears
ofdependency.Theresultspresentedaboveshowsthatolderpeoplehaveadifferentperceptionoftheircommunities'resiliency,
reflectedinhighercommunityresiliencescoresoverallCCRAMfactors.Thuseldersareapotentialresourcefortheircommunity.
Basedonourfindings,itissuggestedthatthelaterpartoflifebevisualizedascomprisingtwosubgroups:thefirstconsistsof
personsupto75yearsofage,where,asweshow,themajorityofthepopulationfeelresilientoratthe'happinesspeak[42],[43]
andthesecondconsistsofpersonsabove75yearsofage.Thisview,whichhasrecentlybeensuggestedbyauthorsfromother
disciplinesaswell[4244],couldresultinarevisionofdecisionmakersattitudestowardstheelderpopulation.Ithasbeenshown
thatthecontributionofthisagegrouptoacommunityincrisiscanbebasedontheirfunctionalityratherthantheirage.Itisour
suggestionthat,inconjunctionwiththepromotionofrelevantresponseplanssuitedtoolderadultsneeds,theuniqueinputofthis
subpopulationtothegeneralcommunityinemergenciesbeconsideredasapositiveasset.Thispopulationcanbeincludedin
communityenhancementprogramsthatutilizetheirresourcesandexperience.
SupportingInformation

S1Table.DistributionofscoresforindividualCCRAMquestions.

doi:10.1371/journal.pone.0148125.s001
(DOCX)
S2Table.DistributionofscoresforCCRAMfactors.

doi:10.1371/journal.pone.0148125.s002
(DOCX)

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Acknowledgments

ThismanuscriptisdedicatedwithappreciationandadmirationtoProfessorEmeritusY.Peres,aseniorconsultanttotheCCRAC
group,who,attheageof80,joinedusinchallengingthecommonassumptionthattheelderlyarefrail.Theauthorswouldliketo
thankMs.BettyBenZakenforhercontributiontodatacollection.TheCCRAMwasdevelopedthroughthededicatedworkofthe
ConjointCommunityResiliencyAssessmentCollaboration(CCRAC).
AuthorContributions

Conceivedanddesignedtheexperiments:OCLADAGMLDG.Performedtheexperiments:OCDGAB.Analyzedthedata:OCDG
ABDL.Contributedreagents/materials/analysistools:ABDG.Wrotethepaper:OCMLAGLADAB.
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