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

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.