Group Resilience Training Lifts Coping and Mood in Karachi Nursing Home Elders

In a modest nursing home in Karachi, Pakistan, a group of older adults sat together week after week, learning skills that psychologists say may be among the most undervalued tools in geriatric care: resilience and adaptive coping. A new quasi-experimental study published in Ageing International suggests that a structured, group-based resilience program can measurably improve psychological well-being among institutionalized elders in a low- and middle-income country setting, a population that has long been overlooked in mental health intervention research. The findings arrive at a moment when the mental health of aging populations in the developing world is emerging as one of the most pressing, and least addressed, public health challenges of the coming decades.

The research, led by Shireen Bhamani of the University of South Florida’s College of Nursing and the Brain and Mind Institute at Aga Khan University, together with Mehwish Dawood of Oregon State University and Prisca Olabisi Adejumo of the University of Ibadan, set out to test whether resilience could actually be taught to frail, institutionalized older adults. The question matters because geriatric mental health is widely recognized as a significant public health concern, with mental illness both highly prevalent and profoundly disabling among the elderly. Those risks are amplified in nursing homes, where residents face a convergence of stressors: chronic illness, functional decline, bereavement, social isolation, and, in many cultural contexts, the stigma and grief associated with leaving family life behind.

The study enrolled 37 participants from a single nursing home in Karachi, using a quasi-experimental design in which each participant served as their own control. The median age was 65 years among female participants and 67 among males. Rather than mixing the sexes in a single group, the researchers delivered the intervention separately for men and women, a culturally attuned decision that reflects the social norms of Pakistan, where mixed-gender group therapy can be a barrier to participation. The program itself carried a fitting name: GRACE, short for Geriatric Resilience, Adaptive Coping, and Emotional well-being. It was delivered as a group-based intervention, drawing on the growing body of evidence that group formats are both cost-effective and socially reinforcing for older adults, who often benefit as much from the peer connection as from the curriculum itself.

Measurement was anchored in three validated instruments administered at baseline and again after the intervention. Depression was assessed with the Geriatric Depression Scale, a screening tool designed specifically for older populations that avoids somatic items likely to confound depression with physical illness. Coping was measured with the Brief COPE Scale, developed by psychologist Charles Carver as a compact alternative to longer coping inventories, capturing both adaptive strategies such as active coping, planning, and acceptance, and less constructive ones such as denial and behavioral disengagement. Resilience was assessed with the Resilience Scale, an instrument with a particular pedigree in Pakistan: an Urdu version of Wagnild and Young’s resilience scales was previously validated among women in Karachi’s urban squatter settlements by members of the same research group, giving the team a linguistically and culturally appropriate measure for this new population.

The statistical approach was deliberately simple and transparent. The researchers performed paired t-tests to compare scores from before to after the intervention, a method appropriate for a within-subject design in which each participant’s post-intervention score is compared against their own baseline. The results showed a significant increase in average resilience scores and a significant increase in coping scores, indicating that the intervention moved both psychological constructs in a positive direction. Notably, when the researchers examined outcomes by sex, they found no significant difference between males and females, suggesting that the benefits of the program were broadly distributed across the participant group rather than concentrated in one demographic.

Why does this matter so much for the science of aging? Resilience, in the psychological literature, is not a fixed trait but a dynamic capacity that can be strengthened through targeted practice. A substantial body of international research has linked higher resilience in older adults to lower depressive symptoms, better life satisfaction, improved physical functioning, and even survival. During the COVID-19 pandemic, resilience emerged as a key protective factor for older adults facing isolation and fear, with studies from senior housing communities in the United States to long-term care facilities in Spain documenting how psychological flexibility buffered the mental health toll of the crisis. Meta-analyses of psychological interventions have since confirmed that well-being can be improved through structured programs, and systematic reviews of mind-body and positive psychology approaches in geriatric populations have reported meaningful gains in resilience, physical activity, and emotional health.

What makes the Karachi study distinctive is its setting. Resilience-building interventions have been tested extensively in high-income countries, but they have been far less studied in nursing homes in low- and middle-income countries, where the demographic transition is unfolding fastest and where mental health services are scarcest. Pakistan’s own research record underscores the urgency. Cross-sectional studies in Karachi have documented substantial rates of depression among the elderly, and research on older adults living in shelter homes has revealed the profound dislocation experienced by those who move from family households into institutional care. Studies of senior care facilities across Pakistan have identified determinants of physical, psychological, and social well-being that are shaped by the institutional environment itself, while work during the pandemic documented significant stress, depression, and strained resilience among the country’s older population. Against this backdrop, a low-cost, group-delivered intervention that can be run by trained staff inside a nursing home represents a pragmatic form of prevention.

The authors argue that interventions of this kind can be integrated into the standard care practices of nursing homes, and the design of GRACE supports that claim. Group-based delivery means that a single facilitator can serve many residents at once, and the intervention does not require psychiatric infrastructure that most facilities in LMICs lack. The study has significant implications, the researchers write, for nursing homes and healthcare providers working with geriatric populations, because enhancing resilience and coping skills addresses a modifiable psychological target rather than simply managing symptoms after they appear. In a preventive framework, teaching adaptive coping before crisis strikes is analogous to vaccination: it builds capacity in advance of exposure to stressors that are inevitable in late life, from hospitalization to the death of peers.

The study also carries methodological lessons worth noting. The sample of 37 participants from a single nursing home is small, and the quasi-experimental design, without a randomized control group, means that factors such as the passage of time, the attention of participating in a group, or seasonal effects cannot be fully ruled out as contributors to the observed gains. Convenience sampling of this kind is common in pilot work and is appropriate for establishing feasibility and preliminary effect sizes, but the authors and readers alike must treat the results as a proof of concept rather than a definitive efficacy trial. The researchers themselves situate the work in a pilot tradition, and the funding came from the Aga Khan University School of Nursing and Midwifery’s mental health and geriatric streams, with the project originating in the Bankimoon Center’s Global Citizen Mentorship program. Ethical approval was obtained from the Aga Khan University Ethical Review Committee, and written informed consent was collected after participants were informed of the study’s purpose, procedures, risks, and benefits.

Still, the trajectory of this research team is instructive. The same group previously developed and validated the Safe Motherhood-Accessible Resilience Training, or SM-ART, intervention for pregnant women in Pakistan, and tested it in a randomized controlled trial that improved perinatal mental well-being. They have also tested an educational intervention to enhance resilience and self-efficacy among schoolteachers in Karachi. With GRACE, the resilience-training model has now been extended across the life course, from pregnancy to old age, in one of the world’s most populous LMICs. If larger, randomized, multi-site trials replicate the pattern seen in Karachi, the implications could extend well beyond Pakistan. The world’s aging population is growing fastest in exactly the countries least equipped with geriatric mental health specialists, and scalable, group-based psychological interventions may prove to be the most realistic path to protecting the minds of millions of older adults. For the residents of one Karachi nursing home, the lesson was already personal: the capacity to bend under pressure without breaking is not a gift of youth, but a skill that can be learned, even late in life, in the company of others learning alongside you.

Subject of Research: A resilience-building group intervention to improve coping and mental well-being among older adults in nursing homes in Karachi, Pakistan

Article Title: Promoting Resilience and Coping Among Older Adults Living in Nursing Homes in Karachi, Pakistan

Article References: Promoting Resilience and Coping Among Older Adults Living in Nursing Homes in Karachi, Pakistan. (n.d.). https://doi.org/10.1007/s12126-026-09680-w

Image Credits: AI Generated

DOI: 10.1007/s12126-026-09680-w

Keywords: resilience, older adults, nursing homes, geriatric mental health, coping, depression, Pakistan, Karachi, quasi-experimental study, GRACE intervention, low- and middle-income countries, psychological well-being