Journal of Advanced Nursing

An Ecological and Processual Understanding of Family Resilience in Dementia: A Qualitative Meta‐Synthesis

ABSTRACT

Aim

To explore how family resilience emerges and unfolds in dementia.

Design

Qualitative meta-synthesis using thematic synthesis.

Data Sources

PubMed, CINAHL, Web of Science, PsycINFO were searched from inception through August 26, 2025.

Methods

Studies examining family-level resilience, adaptation or coping in home-based dementia care using qualitative methods were included. Two researchers independently screened and assessed quality. Thematic synthesis was applied to 18 studies selected through systematic prioritization until theoretical sufficiency.

Results

Of 2437 records, 18 studies were analysed yielding 68 codes and 28 descriptive themes. Thematic synthesis revealed family resilience manifests three characteristics: ecological multidimensionality, iterative and cyclical progression and integrative manifestation. An ecological-processual interpretive framework was developed showing family resilience unfolds along two intersecting axes (ecological: intrapersonal, interpersonal, societal; processual: five iterative stages). Six analytical themes emerged integratively: multilevel adaptive resources and motivation; individual active adaptation; redefining dyadic relationships through dementia-personhood separation; family collaboration and structural reconstruction; social support construction and transcendent meaning expansion.

Conclusion

Family resilience unfolds as a dynamic process continuously reconstructed across ecological levels rather than a static outcome. Iterative and cyclical understanding is essential.

Implications for the Profession and/or Patient Care

Practice requires longitudinal, process-oriented support for entire families including persons with dementia. Policy should establish family-unit assessment systems identifying changing patterns and respecting autonomy.

Impact

This study addressed how family resilience dynamically unfolds in dementia, which remained unclear despite research shifting from burden to resilience focus. An ecological-processual interpretive framework was developed integrating six themes across multiple ecological levels. Mental health nurses, dementia care practitioners, and policymakers will benefit from this framework when developing family-centered dementia care systems.

Reporting Method

This review adhered to ENTREQ guidelines.

Patient or Public Contribution

This study did not include patient or public involvement in its design, conduct or reporting.

Trial Registration

Protocol registration PROSPERO: CRD42023485589