Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey

Assessing the properties of patient-specific treatment effect estimates from causal forest algorithms under essential heterogeneity

BACKGROUND

Treatment variation from observational data has been used to estimate patient-specific treatment effects. Causal Forest Algorithms (CFAs) developed for this task have unknown properties when treatment effect heterogeneity from unmeasured patient factors influences treatment choice - essential heterogeneity.

METHODS

We simulated eleven populations with identical treatment effect distributions based on patient factors. The populations varied in the extent that treatment effect heterogeneity influenced treatment choice. We used the generalized random forest application (CFA-GRF) to estimate patient-specific treatment effects for each population. Average differences between true and estimated effects for patient subsets were evaluated.

RESULTS

CFA-GRF performed well across the population when treatment effect heterogeneity did not influence treatment choice. Under essential heterogeneity, however, CFA-GRF yielded treatment effect estimates that reflected true treatment effects only for treated patients and were on average greater than true treatment effects for untreated patients.

CONCLUSIONS

Patient-specific estimates produced by CFAs are sensitive to why patients in real-world practice make different treatment choices. Researchers using CFAs should develop conceptual frameworks of treatment choice prior to estimation to guide estimate interpretation ex post.

Measuring bereavement prevalence in a complex sampling survey: the 2019 Georgia Behavioral Risk Factor Surveillance System (BRFSS)

BACKGROUND

The Behavioral Risk Factor Surveillance System (BRFSS) is an annual survey designed to identify trends in the public's health. In its 2019 field survey, the U.S. state of GA tested a new 3 - item module to measure the numbers of bereaved, resident adults aged 18 years and older. Participants were eligible if they answered 'Yes' to the item 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'. This analysis explores two research questions. Can estimates for bereavement prevalence be derived without large sampling errors, low precision, and small subsamples? Can multiple imputation techniques be applied to overcome non-response and missing data to support multivariate modeling?

METHODS

BRFSS is a non-institutionalized sample of adults aged 18 years and older living in the U.S. state of Georgia. Analyses in this study were conducted under two scenarios. Scenario 1 applies the complex sample weights created by the Centers for Disease Control and imputes values for missing responses. Scenario 2 treats the data as a panel - no weighting combined with removal of persons with missing data. Scenario 1 reflects the use of BRFSS data for public health and policy, while Scenario 2 reflects data as it is commonly used in social science research studies.

RESULTS

The bereavement screening item has a response rate (RR) of 69.1% (5206 of 7534 persons). Demographic subgroups and categories of health have RR of 55% or more. Under Scenario 1, the estimated prevalence of bereavement is 45.38%, meaning that 3,739,120 adults reported bereaved in 2018 or 2019. The estimated prevalence is 46.02% with Scenario 2 which removes persons with any missing data (4,289 persons). Scenario 2 overestimates the bereavement prevalence by 1.39%. An illustrative logistic model is presented to show the performance of exposure to bereavement under the two data scenarios.

CONCLUSIONS

Recent bereavement can be ascertained in a surveillance survey accounting for biases in response. Estimating bereavement prevalence is needed for measuring population health. This survey is limited to one US state in a single year and excludes persons aged 17 years and younger.

Estimating Prevalence of Bereavement, Its Contribution to Risk for Binge Drinking, and Other High-Risk Health States in a State Population Survey, 2019 Georgia Behavioral Risk Factor Surveillance Survey

BACKGROUND

Binge drinking is a pattern of alcohol abuse. Its prevalence and associated risk factors are not well documented. Heavy drinking, on the other hand, has a well-documented association with bereavement. This report uses a cross-sectional, population-based survey to estimate prevalence of bingeing and its association with new bereavement. Bingeing is defined as 4 or more drinks (women) or 5 or more drinks (men) in a 2-4-h setting. For the first time in 2019, the Georgia Behavioral Risk Factor Surveillance Survey (BRFSS) included a bereavement item: 'Have you experienced the death of a family member or close friend in the years 2018 or 2019?'

METHODS

Georgia BRFSS is a complex sampling survey administered annually. It is designed to represent the 8.1 million people aged 18 years and older in the U.S. state of Georgia. Alcohol consumption patterns are routinely measured in the common core. In 2019, the state added a new item probing for bereavement in the prior 24 months predating the COVID-19 pandemic. Imputation and weighting techniques were applied to yield the population prevalence rates of new bereavement, bingeing, and their co-occurrence with other high-risk health behaviors and outcomes. Multivariate models, adjusted for age, gender, and race, were used to estimate the risk for other unhealthy behaviors posed by the co-occurrence of bereavement and bingeing.

RESULTS

In Georgia, bereavement (45.8%), and alcohol consumption (48.8%) are common. Bereavement and alcohol use co-occurred among 1,796,817 people (45% of all drinkers) with a subset of 608,282 persons reporting bereavement combined with bingeing. The most common types of bereavement were death of a friend/neighbor (30.7%) or three plus deaths (31.8%).

CONCLUSIONS

While bingeing is a known risk to public health, its co-occurrence with recent bereavement is a new observation. Public health surveillance systems need to monitor this co-occurrence to protect both individual and societal health. In a time of global bereavement, documenting its influence on binge drinking can support the work towards Sustainable Development Goal #3-Good health and Well-Being.

Associating Outcomes After Hip Arthroscopy With Patient Resilience

Background

Higher patient resilience has been shown to be associated with improved patient-reported outcome measures (PROMs) at 6 months after hip arthroscopy.

Purpose

To examine the relationship between patient resilience and PROMs at minimum 2 years after hip arthroscopy.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Included were 89 patients (mean age, 36.9 years; mean follow-up, 4.6 years). Patient demographics, surgical details, and preoperative International Hip Outcome Tool-12 (iHOT-12) and visual analog scale (VAS) pain scores were collected retrospectively. Postoperative variables were collected via a survey and included the Brief Resilience Scale (BRS), Patient Activation Measure-13 (PAM-13), Pain Self-efficacy Questionnaire-2 (PSEQ-2), VAS satisfaction, and postoperative iHOT-12, and VAS pain scores. Based on the number of standard deviations from the mean BRS score, patients were stratified as having low resilience (LR; n = 18), normal resilience (NR; n = 48), and high resilience (HR; n = 23). Differences in PROMs were compared between the groups, and a multivariate regression analysis was performed to assess the relationship between pre- to postoperative change (Δ) in PROMs and patient resilience.

Results

There were significantly more smokers in the LR group compared with the NR and HR groups (P = .033). Compared with the NR and HR groups, patients in the LR group had significantly more labral repairs (P = .006), significantly worse postoperative iHOT-12, VAS pain, VAS satisfaction, PAM-13, and PSEQ-2 scores (P < .001 for all), and significantly lower ΔVAS pain and ΔiHOT-12 scores (P = .01 and .032, respectively). Regression analysis showed significant associations between ΔVAS pain and NR (β = -22.50 [95% CI, -38.81 to -6.19]; P = .008) as well as HR (β = -28.31 [95% CI, -46.96 to -9.67; P = .004) and between ΔiHOT-12 and NR (β = 18.94 [95% CI, 6.33 to 31.55]; P = .004) as well as HR (β = 20.63 [95% CI, 6.21 to 35.05]; P = .006). Male sex was a significant predictor of ΔiHOT-12 (β = -15.05 [95% CI, -25.42 to -4.69]; P = .006).

Conclusion

The study results indicate that lower postoperative resilience scores were associated with significantly worse PROM scores, including pain and satisfaction, at 2 years after hip arthroscopy.

Pathways to reduced overnight hospitalizations in older adults: Evaluating 62 physical, behavioral, and psychosocial factors

As our society ages and healthcare costs escalate, researchers and policymakers urgently seek potentially modifiable predictors of reduced healthcare utilization. We aimed to determine whether changes in 62 candidate predictors were associated with reduced frequency, and duration, of overnight hospitalizations. We used data from 11,374 participants in the Health and Retirement Study—a national sample of adults aged >50 in the United States. Using generalized linear regression models with a lagged exposure-wide approach, we evaluated if changes in 62 predictors over four years (between t0;2006/2008 and t1;2010/2012) were associated with subsequent hospitalizations during the two years prior to t2 (2012–2014 (Cohort A) or 2014–2016 (Cohort B)). After robust covariate-adjustment, we observed that changes in some health behaviors (e.g., those engaging in frequent physical activity had 0.80 the rate of overnight hospital stays (95% CI [0.74, 0.87])), physical health conditions (e.g., those with cancer had 1.57 the rate of overnight hospital stays (95% CI [1.35, 1.82])), and psychosocial factors (e.g., those who helped friends/neighbors/relatives 100–199 hours/year had 0.73 the rate of overnight hospital stays (95% CI [0.63, 0.85])) were associated with subsequent hospitalizations. Findings for both the frequency, and duration, of hospitalizations were mostly similar. Changes in a number of diverse factors were associated with decreased frequency, and duration, of overnight hospitalizations. Notably, some psychosocial factors (e.g., informal helping) had effect sizes equivalent to or larger than some physical health conditions (e.g., diabetes) and health behaviors (e.g., smoking). These psychosocial factors are mostly modifiable and with further research could be novel intervention targets for reducing hospitalizations.

Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging

Objective

There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters.

Methods

Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health.

Results

Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR.

Discussion

Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.

The brief resilience scale is associated with pre- and short-term postoperative outcomes following hip arthroscopy

BACKGROUND

Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs).

METHODS

40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed.

RESULTS

In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively (p < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population (p < 0.0001). Resilience was associated with return to activity (p = 0.017). A past history of anxiety/depression was associated with lower resilience (p = 0.039).

CONCLUSIONS

This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.

Assessing Response Readiness to Health Emergencies: A Spatial Evaluation of Health and Socio-Economic Justice in Pakistan

COVID19 pandemic has put the global health emergency response to the test. Providing health and socio-economic justice across communities/regions helps in resilient response. In this study, a Geographic Information Systems-based framework is proposed and demonstrated in the context of public health-related hazards and pandemic response, such as in the face of COVID19. Indicators relevant to health system (HS) and socio-economic conditions (SC) are utilized to compute a response readiness index (RRI). The frequency histograms and the Analysis of Variance approaches are applied to analyze the distribution of response readiness. We further integrate spatial distributional models to explore the geographically-varying patterns of response readiness pinpointing the priority intervention areas in the context of cross-regional health and socio-economic justice. The framework's application is demonstrated using Pakistan's most developed and populous province, namely Punjab (districts scale, n = 36), as a case study. The results show that ~ 45% indicators achieve below-average scores (value < 0.61) including four from HS and five from SC. The findings ascertain maximum districts lack health facilities, hospital beds, and health insurance from HS and more than 50% lack communication means and literacy-rates, which are essential in times of emergencies. Our cross-regional assessment shows a north-south spatial heterogeneity with southern Punjab being the most vulnerable to COVID-like situations. Dera Ghazi Khan and Muzaffargarh are identified as the statistically significant hotspots of response incompetency (95% confidence), which is critical. This study has policy implications in the context of decision-making, resource allocation, and strategy formulation on health emergency response (i.e., COVID19) to improve community health resilience.

Hope and Resilience Related to Fear of COVID-19 in Young People

In the face of the psychological crisis of fear caused by the COVID-19 pandemic, it is relevant to know the positive impact of hope and resilience during this context. The purpose of this study was to determine the correlation between hope and resilience with fear of COVID-19 in young people. The design was non-experimental, cross-sectional, and correlational. The sample consisted of 192 young people living in Metropolitan Lima, Peru. We used the Hope-Despair Questionnaire, the Resilience Scale, and the COVID-19 Fear Questionnaire. The results show that there is a significant correlation between hope, resilience, and fear of COVID-19 in young people. On the other hand, a significant difference was found in resilience according to gender. Likewise, it was found that the variables hope and resilience explain 81% (R2 adjusted) of the fear of COVID-19 (F test = 21.53; p < 0.01). Hope and resilience are protective factors that have a positive impact when facing the fear of COVID-19. Thus, policies, programs, and public health strategies related to positive mental health should be promoted, with emphasis on hope and resilience.

Quantifying Physical Resilience in Ageing Using Measurement Instruments: A Scoping Review

Purpose: The capacity to recover motor function with pathology or age-related decline is termed physical resilience. It is unknown what outcome domains are captured with existing measurement instruments. Thus, this scoping review aimed to identify measurement instruments for physical resilience, identify research gaps, and make recommendations for future research. Methods: Articles were included from the search when their subject matter included the term resilience in relation to the physical health of older adults. Data on physical resilience measurement instruments were extracted using the outcome domains: body function or structure, activity and participation, and societal impact. Results: The majority of the 33 included articles involved older adults with fractures, cardiac conditions, and cancer. Many measurement instruments quantified body function or structure, and some instruments captured activity and participation, and societal impact of physical resilience. Measurement instruments were pooled into 4 categories: psychological, physiological, motor function, and psychosocial scales. No studies combined all areas of measurement. Conclusions: A potential gap of a measurement instrument capturing social aspects of physical resilience was identified. Comprehensive measurement could identify which outcome domains could be targeted to foster resilience. This knowledge might be useful across many health disciplines and contribute to therapeutic decision-making and rehabilitation strategies.

Toxic Psychosocial Stress, Resiliency Resources and Time to Dementia Diagnosis in a Nationally Representative Sample of Older Americans in the Health and Retirement Study from 2006-2016

Background: Toxic stress (TS), resiliency-promoting factors (RPFs) and their interactions were investigated in relationship to incident dementia in a nationally representative sample (n = 6516) of American adults ≥50 years enrolled in the Health and Retirement Study between 2006 and 2016. Methods: TS included experiences of everyday discrimination and RPF included personal mastery. Race/ethnicity was self-reported as African American, Caucasian, or Other. Multivariable Cox proportional hazards regression models estimated TS-, RPF- and race-associated hazard ratios (HR) for dementia diagnosis and 95% confidence intervals (CIs) with adjustment for comorbidity, lifestyle, and socio-demographic confounders. Results: Discrimination-associated risk of dementia diagnosis on average increased with education level [discrimination x education, p = 0.032; HR = 1.75 (95% CI: 1.01–3.03) if < high school, HR = 5.67 (95% CI: 2.94–10.94) if high school completed and HR = 2.48 (95% CI: 1.53–4.00) if ≥some college education]. Likewise, African American vs. Caucasian race disparity in new-onset dementia was evident (HR = 2.12, 95% CI: 1.42–3.17) among adults with high-mastery while absent (HR = 1.35, 95% CI: 0.75–2.41) among adults with low mastery (Mastery x Race, p = 0.01). Conclusions: TS is a contextual driver of incident dementia that seemingly operates in a race and RPF-dependent fashion among American adults. Association pattern suggests that TS may overwhelm the cognitive reserve benefit of RPF particularly in status-inconsistent contexts including persons subjected to discrimination despite high education and persons of African American descent despite high mastery. Policies that reduce discrimination and promote equitable treatment by race/ethnicity may support cognitive resiliency and reduce the risk of dementia diagnosis in adult Americans.

Social Determinants and Health Behaviours among Older Adults Experiencing Multimorbidity Using the Canadian Longitudinal Study on Aging

This study examines associations between lifestyle behavioural factors and appraisals of “healthy aging” among older adults experiencing multimorbidity. A Social Determinants and Health Behaviour Model (SDHBM) is used to frame the analyses. Using baseline data from the Canadian Longitudinal Study on Aging (CLSA), we studied 12,272 Canadians 65 years of age or older who reported 2 or more of 27 chronic conditions. Additional analyses were conducted using three multimorbidity clusters: cardiovascular/metabolic, musculoskeletal, and mental health. Using hierarchical logistic regression, it was found that, for multmorbidity and the three illness clusters, healthy aging is consistently associated with not smoking (except for the mental health cluster), an absence of obesity (except for the cardiovascular and metabolic cluster), better sleep, and a better appetite. It is not associated with inactivity. Several socio-demographic, environmental, and illness covariates were also supported. The findings are examined using the SDHBM coupled with a resilience lens in order to elucidate how modifiable health behaviours can act as resources to mitigate multimorbidity adversities. This has implications for healthy aging for persons with multimorbidity, especially during the COVID-19 pandemic.

Resilience and occupational health of health care workers: a moderator analysis of organizational resilience and sociodemographic attributes

Objectives

Although previous studies have proposed a positive influence of resilience on the mental and physical health of health care workers, empirical evidence on its relationship with occupational health remains scarce. This study aimed to analyze the relationship between individual resilience and several occupational health indicators, as well as exploring the moderating role of organizational resilience and sociodemographic attributes on this relationship.

Methods

A cross-sectional design was used with a questionnaire applied to a sample of 325 workers from the Spanish health care sector.

Results

Individual resilience was significantly associated with the indicators of occupational health. A direct effect of individual resilience on job satisfaction was found. The influence of resilience on the perception of fatigue and suffering from an illness was reverse. Age moderated the impact of resilience on the perception of stress and medical leave. Besides, organizational resilience proved to be an important adjustment variable in job satisfaction and perception of stress.

Conclusions

The findings show the relevance to take both individual and organizational resilience into account when applying intervention programs to improve the occupational health of health care workers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01725-8.

Resilience in the Orthopaedic Patient

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Resilience is a dynamic psychological construct that refers to the ability to adapt and improve when facing adversity or other stressors.

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Recent investigations in various orthopaedic subspecialties have demonstrated that resilience may contribute to favorable mental health and physical function after a surgical procedure.

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More research, using well-designed prospective studies, is necessary to better define the role that resilience and other factors play in the health and outcomes of patients with orthopaedic conditions.

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Orthopaedic surgeons can consider incorporating resilience assessments into their practices to aid in identifying patients who will do well with a surgical procedure and those who may benefit from specialized therapy to optimize their health and function.

Resilience correlates with patient reported outcomes after reverse total shoulder arthroplasty

BACKGROUND

Personal and social factors may account for much of the variation in patient reported outcome scores, yet little evidence exists on how psychological properties affect patient outcomes following reverse total shoulder arthroplasty (rTSA). The objective of this study is to determine if resilience, characterised by the ability to return to a healthy level of function after experiencing stress, correlates with patient reported outcome scores after rTSA.

HYPOTHESIS

Resilience score will correlate positively with patient reported outcomes after rTSA.

METHODS

Seventy-three patients were identified that had undergone primary rTSA with minimum 2-year follow-up (4.7±1.8). These patients completed a phone survey that included the Brief Resilience Scale (BRS), a measure of general resilience in all aspects of life, along with American Shoulder and Elbow Surgeon (ASES), Penn, and Single Assessment Numerical Evaluation (SANE) scores. Mean outcome scores were calculated to identify any correlation between resilience and clinical outcomes.

RESULTS

The mean BRS score was 23.8±4.8 (range 12.0-30.0), with 41 patients classified as normal resilience (NR), 17 patients as low resilience (LR), and 15 as high resilience (HR). Postoperative BRS scores correlated with ASES (r=0.31, p=0.008), Penn (r=0.25, p=0.03), and SANE score (r=0.32, p=0.007). The mean ASES score was 14.0 points lower in the LR group (77.0 points), compared to the HR group (91.0 points; p=0.04). Similarly, the LR group had a mean SANE score that was 18.6 points lower than the HR group (73.4 and 91.9 points, respectively; p=0.021).

DISCUSSION

The observation that greater general life resilience correlates with lower pain intensity, lesser magnitude of limitations, and perception of greater normality of the shoulder after reverse total shoulder arthroplasty emphasises the importance of addressing personal and social health opportunities along with the physical in musculoskeletal care. Resilience may be a useful predictor of outcomes following rTSA.

LEVEL OF EVIDENCE

III.

Comorbid Conditions, Mental Health and Cognitive Functions in Adults with Fibromyalgia

This study examined age group differences across adulthood in comorbid conditions, mental health, and cognitive function in people with fibromyalgia. Participants completed an online survey about how fibromyalgia affects their everyday life. Chi square analyses were conducted to examine associations between age groups and (a) comorbid conditions and (b) severity of anxiety and depression. ANOVA analyses examined age group differences on aspects of self-report cognitive function. The greatest prevalence of comorbid conditions was found in middle adulthood. Early adulthood was associated with more cases of severe anxiety with the lowest number of cases being in the oldest age group. Middle adulthood was associated with worse self-report pain compared to the youngest age group. Older adults showed better self-report cognitive function compared to younger adults. Distinct age profiles based on comorbid conditions, mental health, and symptom severity across adulthood in fibromyalgia have been demonstrated.

Editorial Commentary: Resilience and Knee Arthroscopy: Are We Missing the Most Important Patient-Reported Outcome?

Resilience is a psychological factor that has been shown to affect outcomes after stressful events. Recent work has detected a correlation between patient resilience and surgical outcome. Issues of postoperative pain response, patient-reported outcomes, and ultimate outcomes may all be affected by resilience, and thus research into these relationships and how to optimize psychologic fitness as part of a perioperative plan are of interest.

Change in quality of life over eight years in a nationally representative sample of US adults with heart disease and type 2 diabetes:minority race and toxic stress as keysocial determinants

BACKGROUND

Toxic stress (TS), minority race and their interaction are evaluated as determinants of change in quality of life (QOL) over 8 years follow-up in a nationally representative sample of United States (US) adults (≥50 years old) with heart disease (HD) and/or type-2 diabetes (T2DM) diagnosed by 2006 as part of the Health and Retirement Study (HRS).

METHODS

Recent and life-course stress plus experiences of lifetime discrimination were measured every 2 years using the stressful life experiences questionnaire. QOL was assessed by participant self-rated health (SRH) and operationally defined as improved, unchanged or declined in current year versus two years prior. Repeated measures multinomial logistic regressionusing generalized estimating equations (GEEs) was implemented to estimate race-, TS and their interaction- related odds of worse SRH from2006-2014. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated with adjustment for time, age, sex and socio-economic status.

RESULTS

Three thousand nine hundred four adults with HD/T2DM, mean age 71.1 ± 9.3 years old, 80.9, 14.7 and 4.4% that respectively self-identified as Caucasian, African-American and Other race, were included. Over the eight-year follow-up, the odds of worse SRH for African-American and Other race were respectively 1.46 (95% CI: 1.25-1.70) and 1.43 (95% CI, 1.10-1.86) times higher relative to Caucasians. Relative to older Americans that reported ≥2 lifetime discrimination events, the odds of poor SRH was respectively 33% (OR = 0.67, 95%CI: 0.50-0.89) and 17% (OR = 0.83, 95%CI: 0.59-1.17) lower for those that reported none vs one lifetime discrimination experience. Furthermore, the relationship of life-course stress to SRH decline over 8 years varied by race (time*stress*race, p = 0.1173). Specifically, increasing life-course stress predicted worse QOL among Caucasians (p = 0.0063) and among African-American (p = 0.0820) but not among Other race (p = 0.9943).

CONCLUSION

Toxic stress and minority race are social determinants of deterioration in QOL among older Americans with chronic diseases (HD/T2DM). The types and prevalence of toxic stressors varied by race/ethnicity. Policy interventions to address root causes of TS while targeted at proximate drivers of TS by race/ethnicity represent a viable strategy for mitigating racial disparities in overall wellbeing and improving QOL in all aging Americans regardless of race.

The Resilient Athlete: Lessons Learned in the Military

Resilience, the capacity to recover from a setback or adversity, is a concept that has received considerable recent attention. An individual's resilience predicts their life trajectory following stressful events and this has increasingly been shown in a wide variety of applications. Our understanding of the degree to which we can modify our resilience, and the optimal means to do so, remains in its infancy. The US military has embraced extensive efforts to quantify and build resilience in service members in an effort to preserve the fighting force. We specifically look at the understanding of resilience as it relates to the athletes in terms of competition and return from injury. This article explores the concept of resilience, the efforts to build resilience, lessons learned from the military and applications of the resilience concept to surgical and trauma patients.

From the crisis in acute care to postdischarge resilience - The communication experience of Geriatric patients: A qualitative study

BACKGROUND

Hospital readmissions due to illness among geriatric patients result in human suffering and psychological trauma. Resilience in chronic illness protects geriatric patients from outcomes of trauma leads to psychological and physical well-being and enables bouncing back to life. While communication has been linked to improved health outcomes, little is known about communication pathways in the context of postdischarge resilience.

AIM AND OBJECTIVE

To explore the role of communication pathways that acute-care clinicians used with geriatric patients in postdischarge resilience.

METHODOLOGICAL DESIGN AND JUSTIFICATION

Participants were ten geriatric patients who were readmitted several times in the past year. Twenty narrative interviews were conducted, one upon discharge and the other a month thereafter. Data for each phase of interviews were analysed using methods of selection mechanisms and Bricolage.

ETHICAL ISSUES

The ethics committee approved the study. Participants signed an informed-consent form for participation and publication.

FINDINGS

Communication in acute care that enhanced health literacy, perceived control and reflection, contributed to higher comprehensibility and manageability during the hospitalisation and postdischarge meaningfulness postdischarge, contributing resilience. Participants who experienced other forms of communication demonstrated anxiety and helplessness with lingering psychological trauma postdischarge.

CONCLUSIONS

Acute care may provide clinicians with opportunities to alleviate the suffering of geriatric patients and contribute to their postdischarge resilience. The suggested T.E.R model delineates communication pathways to fuel the trajectory from psychological trauma to postdischarge resilience in practice.

Health behaviors and multimorbidity resilience among older adults using the Canadian Longitudinal Study on Aging

OBJECTIVE

Recently, there has been a growing interest in examining forms of illness-related resilience. This study examines associations between lifestyle behavioral factors and multimorbidity resilience (MR) among older adults.

METHODS

Using baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 6,771 Canadian adults aged 65 or older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: cardiovascular/metabolic, osteo-related, and mental health. Associations were explored using hierarchical linear regression modeling, controlling for sociodemographic, social/environmental, and illness context covariates.

RESULTS

Among older adults with two or more illnesses, as well as the cardiovascular/metabolic and osteo-related illness clusters, having a non-obese body mass, being a non-smoker, satisfaction with quality of sleep, having a good appetite, and not skipping meals are associated with MR. However, the mental-health cluster resulted in different behavioral lifestyle associations, where MR was not associated with obesity, smoking, or appetite, but inactivity demonstrated moderate positive associations with MR.

DISCUSSION

While there are similar patterns of lifestyle behaviors across multimorbidity and multimorbidity clusters involving physiological chronic illnesses, those associated with mental health are distinct. The results have implications for healthy aging among persons coping with multimorbidity.

High Resiliency Linked to Short-Term Patient Reported Outcomes and Return to Duty Following Arthroscopic Knee Surgery

Introduction

Resilience is a psychometric construct of a patient’s ability to recover from adversity and has been used to predict outcomes but its use in orthopedics has been limited. The purpose of this study was to examine the association between resilience and outcomes.

Materials and Methods

We performed a retrospective analysis of prospectively collected data of patient who underwent sports knee surgery at a single institution performed by 6 orthopedic surgeons from January 2017 to December 2017. We included active-duty patients with complete preoperative outcomes and a minimum of 6 month follow-up. All patients completed the Brief Resilience Scale (BRS), Veteran’s Rand-12 (VR-12), Patient-Reported Outcomes Measurement Information System 43 (PROMIS-43), International Knee Documentation Committee function score (IKDC), and Knee Injury and Osteoarthritis Outcome Score (KOOS). Patients were divided into low resilience (LR) and high resilience (HR) groups based on a score of less than 24 for low and greater than or equal to 24 according to BRS. Outcomes were then compared.

Results

We identified 50 active-duty patients who had complete preoperative and postoperative outcomes at a minimum of 6 months. Mean preoperative and postoperative BRS were significantly different (25.8 HR v 18.6 LR, p < 0.001). We found a difference in postop KOOS in pain, sports, and short form (pain 70.9 HR v 55.7 LR, p = 0.03; sports 50.3 HR v 32.2 LR, p = 0.03; short form (72.1 HR v 62.5 LR, p = 0.04). Similarly, there was a significant difference in postoperative IKDC score (58.0 HR v 44.0 LR, p = 0.03). Similarly we found significant differences in postoperative PROMIS-43 (anxiety 44.4 HR v 60.3 LR, p = 0.004; depression 41.6 HR v 58.1 LR, p = 0.004; fatigue 45.1 HR v 58.6 LR, p = 0.001; sleep 52.6 HR v 62.5 LR, p = 0.02; social participation 36.2 HR v 47.6 LR, p < 0.001). Postoperative VR-12 mental was also statistically different between the two groups (53.5 HR v 41.6 LR; p = 0.01). In addition, 2.3% of the HR group changed MOS as a result of their sports knee surgery compared to 22.2% of the LR group.

Conclusions

Active-military patients with high preoperative resilience appear to have significantly better early postoperative outcomes following sports knee surgery in terms of PROMIS-43, KOOS, and IKDC. There was also a lower rate of changing MOS secondary to sports knee surgery in patients with high resilience.

Neighborhood Social Cohesion, Resilience, and Psychological Well-Being Among Chinese Older Adults in Hawai’i

Background and Objectives

A growing body of literature indicates that neighborhood social cohesion is generally associated with lower levels of psychological distress and higher levels of life satisfaction (LS). However, very few studies have examined these relationships among Chinese older adults, the fastest growing aging population across all racial/ethnic groups in the U.S. Focusing on this population, the current study aims to examine the associations of neighborhood cohesion with psychological distress and LS as well as the mediating role of resilience and the moderating role of birth place in the associations.

Research Design and Methods

Ordinary least squares regressions were applied to analyze data collected among 430 Chinese older adults aged 55 and older residing in Honolulu, Hawai’i.

Results

Results show that neighborhood social cohesion was positively associated with lower levels of psychological distress and higher levels of LS for the whole sample. The association between social cohesion and psychological distress was moderated by birth place such that the protecting effects of neighborhood cohesion on distress were only salient for the U.S.-born but not for the foreign-born. Moreover, the mediating role of resilience was identified: It contributed to more than 60% of the association between social cohesion and psychological distress, and more than 22% of the association between social cohesion and LS.

Discussion and Implications

Our findings indicate the importance of a cohesive social environment and resilience in shaping psychological well-being and quality of life for older Chinese adults, the U.S.-born in particular, living in Honolulu, Hawai’i.

Association between diabetes-related self-care activities and positive health: a cross-sectional study

OBJECTIVES

The study aimed to examine the diabetes-related self-care activities (DRSCA) in association with positive health consisting of resilience, subjective well-being (SWB) and disease-related quality of life (DRQoL), and the associations of background information with resilience, SWB and DRQoL.

DESIGN

A cross-sectional study.

METHODS

A convenience sample of people with type 2 diabetes (T2DM) was recruited from two tertiary hospitals in eastern China. Self-reported survey data included DRSCA, resilience, SWB, DRQoL, and background information comprising demographics and social support. Data were analysed using hierarchical multiple regression analyses.

RESULTS

Two hundred and forty-six valid questionnaires were analysed. Among the components of positive health, hierarchical multiple regression analysis showed that DRSCA were significantly associated with improved SWB (β=0.140, p=0.020), but not with resilience and DRQoL after adjusting for background information. Participants with higher level of education had higher resilience and men had higher SWB than women. Social support (β=0.186, p=0.003) in Model 1 and resilience (β=0.298, p<0.001) in Model 2 were positively associated with SWB.

CONCLUSIONS

This study indicated an association between DRSCA and one component of positive health, namely SWB. This finding could help motivate patients to perform DRSCA and to improve SWB in people with T2DM. In addition, the fact that demographics, for example, gender, were associated with SWB and education was associated with resilience also needs to be accommodated when aiming to improve SWB and build resilience.

TRIAL REGISTRATION NUMBER

NCT02594748.

Differences in Autonomy and Health-Related Quality of Life between Resilient and Non-Resilient Individuals with Mild Cognitive Impairment

The dramatic increase in the number of older people with Mild Cognitive Impairment (MCI) entails a serious public health problem. MCI involves different degrees of dependence that has been previously related to a decrease in Health-Related Quality of Life (HRQoL), due to impairment in the performance of activities of daily living. Resilient coping, as an adaptive coping style, could reduce the associated limitations derived by the characteristic deficits of MCI, and hence improve HRQoL. The principal objective of this work was to compare the level of autonomy (measured in terms of independence in the performance of basic (ADL) and instrumental (IADL) activities of daily living), and HRQoL between resilient and non-resilient individuals with MCI. The results showed a positive relationship between resilience, autonomy, and HRQoL. Hence, resilient participants exhibited higher independence in daily living activities and better HRQoL than non-resilient individuals. Mediation analyses confirmed an indirect influence of resilience on HRQoL through the mediation effect of better performance in IADLs. These findings underline the relevance of resilience as a coping style to compensate deficits in daily living in people with MCI. The inclusion of intervention programs, oriented to the promotion of resilience coping for older adults, might increase the autonomy levels in this population, improving their HRQoL.

Relational aspects of mastery for frail, older adults: The role of informal caregivers in the care process

Frail, older care recipients are often thought of as individuals with a decreased mastery of everyday life skills. Various authors have proposed to acknowledge a relational dimension of mastery, defined as the ability to maintain control over one's life with the help of others. This study explores how frail, older adults experience relational aspects of mastery and the role of their informal caregivers in maintaining these aspects of mastery over the care process. Qualitative interviews (N = 121) were conducted in 2016 with potentially frail, community-dwelling older adults participating in the Detection, Support and Care for Older people: Prevention and Empowerment (D-SCOPE) project. A secondary analysis of 65 interviews reveals that, according to frail, older adults, informal caregivers contribute in various ways to the preservation of their mastery. This differs across the four elements of care: caring about (attentiveness), taking care of (responsibility), care-giving (competence), and care-receiving (responsiveness). However, in some cases, older adults experienced a loss of mastery; for example, when informal caregivers did not understand their care needs and did not involve them in the decision, organisation, and provision of care. A relational dimension of mastery needs to be acknowledged in frail, older care recipients since stimulating mastery is a crucial element for realising community care objectives and person-centred and integrated care.

The Role of Maternal Relationship in the Persisting Effect of Combat Exposure

Background and Objectives

The veteran population is aging. Combat exposure is associated with negative health and psychological outcomes in some, but not all veterans; others even appear to experience gains. One mechanism driving these varied responses might be early life relationships. This study investigated the extent to which the quality of early maternal relationships influences the association between combat exposures and life satisfaction (LS) among older male veterans.

Research Design and Methods

Data were drawn from a pooled sample of male veterans in the Health and Retirement Study who completed the 2013 Veteran Mail Survey (N = 1,160). We used ordinary least squares regression to examine the association between combat exposures (with and without exposure to death) and LS, and the moderating effect of maternal relationship quality on this association.

Results

We found a significant positive association between maternal relationship quality and LS, and a significant association of combat that was dependent on maternal relationship quality. Specifically, combat-exposed veterans with poor maternal relationship quality reported lower LS, whereas combat-exposed veterans with high relationship quality reported higher LS—relative to their noncombat-exposed counterparts. The effects of exposure to death of hazardous toxins did not mediate or moderate this relationship.

Discussion and Implications

Findings indicate that maternal relationships had a lasting influence on whether combat contributed to a positive, negative, or neutral long-term effect on wellbeing. Findings support previous studies that suggest early life factors may play an important role in the fostering of resilient health outcomes over the life course. Implications for preventative strategies in soldiers are discussed.

The effect of psychosocial measures of resilience and self-efficacy in patients with neck and lower back pain

BACKGROUND CONTEXT

Psychosocial risk factors may predispose to progression of back and neck pain to chronic pain or disability. Resilience (the ability to recover from stress) and pain self-efficacy (confidence that one can perform daily activities despite pain) are important psychometric properties shown to affect health and illness.

PURPOSE

To examine the relationships among resilience, pain self-efficacy, and disability in spine patients.

DESIGN/SETTING

Prospective, single-center orthopedic spine clinic.

PATIENT SAMPLE

One hundred and ninety five patients in a tertiary spine practice recruited between December 2016 and March 2017.

OUTCOME MEASURES

Self-reported measures: Brief Resilience Scale (BRS), Pain Self-Efficacy Questionnaire 2 (PSEQ-2) Short Form, Neck Disability Index (NDI), and Oswestry Disability Index (ODI).

METHODS

A prospective study was conducted of new patients visiting an orthopedic spine clinic complaining of neck pain or low back pain, with or without radiculopathy. Enrolled patients completed a survey of demographic information, the six-question BRS, the two-question PSEQ-2 Short Form, and NDI or ODI for neck or back pain, respectively. The relationship between BRS and NDI or ODI was examined, and the relationship between PSEQ-2 and NDI or ODI was also examined.

RESULTS

A total of 195 patients were evaluated. After excluding those with incomplete NDI or ODI, 180 patients were included in the analysis (46.1% men [83/180]; mean age 53 [standard deviation: 17] years). 139 (77.2%) subjects complained of low back pain and 41 (22.8%) subjects complained of neck pain. BRS was strongly negatively correlated with NDI (r=-0.61, p<.0001) and moderately negatively correlated with ODI (r=-0.34, p<.0001). PSEQ-2 was strongly negatively correlated with NDI (r=-0.69, p<.0001) and strongly negatively correlated with ODI (r=-0.62, p<.0001). BRS was moderately positively correlated with PSEQ-2 (r=0.36, p<.0001). For the low back pain cohort, the correlation between PSEQ-2 and ODI was significantly greater than the correlation between BRS and ODI (p=.0003); this difference was not noted in the neck pain cohort (p=.34).

CONCLUSIONS

Low resilience and low pain self-efficacy are both independently associated with greater functional disability in neck and low back pain patients. Spine surgeons may find it useful to incorporate the BRS and PSEQ-2 into preoperative assessment. Future studies should examine the utility of these simple validated questionnaires in predicting response to treatments, including surgical intervention.

Measurement instruments for quantifying physical resilience in aging: a scoping review protocol

BACKGROUND

Physical resilience is the ability to optimize or recover motor function in the face of disease, injury, or aging-related decline. Greater knowledge of how some individuals regain or maintain function despite pathology may help identify protective factors and approaches that promote healthy aging. To date, a scoping review on physical resilience has not been conducted. The aims are to (1) identify measurement instruments for physical resilience, (2) synthesize and map the key concepts of physical resilience, and (3) identify gaps and make recommendations for future research.

METHODS

A scoping review of Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Medline Ovid, PsycINFO, and AgeLine databases will take place using the search strategy "resilience" AND (aging OR elderly OR older adult). The initial electronic search will be supplemented by hand searching the reference lists and review articles to identify any missing studies. Two parallel independent assessments of study eligibility will be conducted for the title, abstract, and full-text screens. To meet study inclusion criteria, the term "resilience" must be applied in relation to the physical health of older adults. Any disagreement will be resolved by consensus and a third reviewer consulted to make a decision if consensus is not achieved initially. Physical resilience information to be extracted are measurement instruments that describe the core domains of (1) body function or structure (signs or symptoms, etc.), (2) activity and participation (quality of life, etc.), and (3) societal impact. Tables and/or charts will map the data with distribution of studies by core domains. Finally, the amalgamation of results will be an iterative process whereby reviewers will refine the plan for presenting results after data extraction is completed so that all of the contents of the extraction may be included in the results.

DISCUSSION

The information gleaned in this scoping review will be essential to understand how physical resilience is currently measured and identify gaps for further research.

Investigating the links between resilience, perceived HRM practices, and retirement intentions

Purpose

Human resource management (HRM) scholars’ interest in older employees’ resilience has only recently started to emerge. Little is known about how resilience and perceived HRM are linked to different retirement intentions. Drawing on the conservation of resources and social exchange theories, the purpose of this paper is to investigate the links between perceived HRM practices, resilience and retirement intentions. Additionally, the paper examines the possible mediating role of resilience in the relationship between perceived HRM practices and retirement intentions.

Design/methodology/approach

In 2016, a cross-sectional study was conducted among older (50+) nursing professionals working in a Finnish university hospital. Statistical methods, including mean comparisons and linear and logistic regression analyses, were used to analyze the data.

Findings

The results indicated that resilience partly mediated the relationship between perceived HRM practices and early retirement intentions, and fully mediated the association between perceived HRM practices and intentions to continue working after retirement age.

Originality/value

This study produces new knowledge regarding the links between resilience, perceived High involvement work practices and retirement intentions.

What matters in "multimorbidity"? Arguably resilience and personal health experience are central to quality of life and optimizing survival

RATIONALE

Much is written about "multimorbidity" as it is a difficult problem for health systems, as it reflects a complex phenomenon unique to each individual health journey and health service context. This paper proposes the adoption of 2 constructs or knowledge streams into mainstream "multimorbidity" care which are arguably most important to person-centered care-personal health perceptions and resilience.

ANALYSIS

"Multimorbidity" is the manifestation of multiple nonlinear physical, psychosocial, and environmental phenomena in an individual health journey. Multimorbidity encompasses very stable states for the most part together with highly unstable phases that are difficult to manage. Averting or controlling the underlying loss of resilience in instability can be challenging without early warning signals pointing towards tipping points. Monitoring resilience and early warning signals for tipping points is new to health care. Yet what should we monitor in the complexity of multimorbidity? There are multiple and competing health service features and biometrics that can be measured. However, an expanding of literature endorses importance of simply asking a person about their self-rated health in order to provide predictions of their resilience and survival. Interoception, exemplified as self-rated health, arises from internal neurocognitive self-monitoring functions of different internal and external phenomena. Interoception is being to be recognized as predictors and barometers of resilience and survival.

CONCLUSIONS

Two phenomena of human systems-interoception and resilience-can guide care in the complex nature of multimorbidity in unstable health journeys and should be incorporated into clinical practice.

Impact of resilience on health in older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS)

OBJECTIVES

Self-rated health (SRH) is a predictor of objective health measures, including mortality and morbidity. The link between resilience and SRH among the elderly is unclear. We aim to examine whether resilience aligns with SRH and, secondarily, whether resilience can override the negative health consequences of adverse childhood experiences (ACE).

DESIGN AND SETTING

We use 2012, 2014 and 2016 data from the International Mobility in Aging Study, a longitudinal cohort study that collects survey and biophysical data from Albania, Brazil, Colombia and Canada. The main independent variables were resilience and ACE (social and economic).

PARTICIPANTS

Community-dwelling 65-74 year olds (in 2012) were recruited through primary care registers. The sample size of the study was 1506.

PRIMARY OUTCOME

The outcome measure was SRH.

RESULTS

We found that sex, site, economic ACE, current income sufficiency, current depressive symptoms, current physical function and current resilience were associated with current SRH. In regression analyses, we showed that the association between ACE and SRH disappeared once factors such as sex, site, income, depression, physical health and resilience were considered.

CONCLUSIONS

The association between resilience and health poses a compelling argument for building resilience throughout life.

Development and validation of a multi-domain multimorbidity resilience index for an older population: results from the baseline Canadian Longitudinal Study on Aging

Background

Multimorbidity is recognized as a major public health issue that increases with age and affects approximately two-thirds of older people in Canada, the US, Australia and many European countries. This study develops and tests a three domain (functional, social and psychological) multimorbidity resilience composite index based on a previously developed lifecourse model of multimorbidity resilience, incorporating measures of adversity and positive adaptation. The criterion validity of the measure is demonstrated by means of an analysis of key outcome variables drawn from the literature.

Methods

We used the baseline data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging. Associations of functional, social, psychological as well as total resilience with two health utilization and three illness context outcome variables were examined using logistic regression analyses, adjusted for age, gender, marital status, income, education, region, and number of chronic conditions.

Results

The sample included all 6771 Canadian adults aged 65 or older (mean age 73.0, 57% women) who reported two or more of 27 possible chronic conditions. Total resilience was associated with: perceived health (OR = 1.68, CI 1.59–1.77); sleep quality (OR = 1.34, CI 1.30–1.38); perceived pain (OR = 0.80, CI 0.77–0.83); hospital overnight stays (OR = 0.87, CI 0.83–0.91); and emergency department visits (OR = 0.90, CI 0.87–0.94)., after adjusting for socio-demographic factors, and number of chronic conditions. These associations were similar for the unadjusted models, as well as for the functional, social and psychological resilience sub-indices.

Conclusions

Combining components of adversity and positive adaptation within functional, social and psychological domains produces a measure of multimorbidity resilience that is associated with more positive health outcomes. Several implications of a composite multimorbidity resilience measure for clinical practice are identified. This measure can be replicated using measures found in other secondary health data sets. Future validation using longitudinal data is warranted.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0851-y) contains supplementary material, which is available to authorized users.

Social relationships and GP use of middle-aged and older adults in Europe: a moderator analysis

OBJECTIVES

This paper investigates (1) how social relationships (SRs) relate to the frequency of general practitioner (GP) visits among middle-aged and older adults in Europe, (2) if SRs moderate the association between self-rated health and GP visits, and (3) how the associations vary regarding employment status.

METHODS

Data stem from the Survey of Health, Ageing and Retirement in Europe project (wave 4, 56 989 respondents, 50 years or older). GP use was assessed by frequency of contacts with GPs in the last 12 months. Predictors were self-rated health and structural (Social Integration Index (SII), social contact frequency) and functional (emotional closeness) aspects of SR. Regressions were used to measure the associations between GP use and those predictors. Sociodemographic and socioeconomic factors were used as covariates. Additional models were computed with interactions.

RESULTS

Analyses did not reveal significant associations of functional and structural aspects of SR with frequency of GP visits (SII: incidence rate ratio (IRR)=0.99, 95% CI 0.97 to 1.01, social contact frequency: IRR=1.04, 95% CI 1.00 to 1.07, emotional closeness: IRR=1.02, 95% CI 1.00 to 1.04). Moderator analyses showed that 'high social contact frequency people' with better health had more statistically significant GP visits than 'low social contact frequency people' with better health. Furthermore, people with poor health and an emotionally close network showed a significantly higher number of GP visits compared with people with same health, but less close networks. Three-way interaction analyses indicated employment status specific behavioural patterns with regard to SR and GP use, but coefficients were mostly not significant. All in all, the not employed groups showed a higher number of GP visits.

CONCLUSIONS

Different indicators of SR showed statistically insignificantly associations with GP visits. Consequently, the relevance of SR may be rated rather low in quantitative terms for investigating GP use behaviour of middle-aged and older adults in Europe. Nevertheless, investigating the two-way and three-way interactions indicated potential inequalities in GP use due to different characteristics of SR accounting for health and employment status.

Social relationships and physician utilization among older adults-A systematic review

Background

In older age health needs and demand for health services utilization increase. Individual’s social relationships can play a decisive role regarding the utilization of outpatient health care services. This systematic review examines the associations of structural and functional dimensions of social relationships with outpatient health services use of older adults.

Methods

The databases PubMed, CINAHL, SocINDEX, PsycINFO, International Bibliography of the Social Sciences (IBSS), Sociological Abstracts, and Applied Social Sciences Index and Abstracts (ASSIA) were searched in February 2016. The methodological and reporting quality of the articles was assessed and the results were synthesized descriptively and systematically.

Results

Out of 1.392 hits, 36 articles (35 studies) were included in the systematic review. The methodological and reporting quality of the included articles was reasonable. Various structural and functional characteristics of social relationships were associated with the use (yes/no) and the frequency of using outpatient care among older adults. The majority of the associations between structural dimensions of social relationships and the use of physicians were positive and moderate in strength. The associations between functional dimensions of social relationships and the probability of using physician services were inconsistent and varied in strength. For the most part, social relationship variables assigned to the structural dimension were positively and weakly to moderately associated with the frequency of physician visits. Functional aspects of social relationships also tended to have positive associations with the frequency of physician utilization. The associations were weak to moderate in strength.

Conclusions

Measuring social relationships and their influence on health services use is a challenging methodological endeavor indicated by the inconclusive results. The results suggest that the outpatient care utilization behavior of older individuals being structurally and functionally integrated in social relationships is different to older adults being socially isolated or having no social support. All in all, the current status of quantitative data was insufficient. Future health services research should accentuate social ties in more detail, especially according to quality aspects of social relationships.

Resilience correlates with outcomes after total shoulder arthroplasty

BACKGROUND

Resilience, characterized by an ability to bounce back or recover from stress, is increasingly recognized as a psychometric property affecting many outcomes' domains including quality of life, suicide risk in active-duty military personnel, and recovery in cancer patients. This study examines the correlation between resilience, as measured by the Brief Resilience Scale (BRS), and traditional outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn scores in patients undergoing total shoulder arthroplasty (TSA).

METHODS

Seventy patients undergoing primary anatomic TSA were followed up for a minimum of 2 years (mean, 30 ± 3 months). Patients were stratified into groups a priori, based on deviation from the mean of the BRS score, into low-resilience (LR), normal-resilience (NR), and high-resilience (HR) patients, and outcome scores were calculated for each group.

RESULTS

Postoperative BRS scores significantly correlated with ASES, Penn, and SANE scores (r = 0.41-0.44, P < .004 for all scores). When we evaluated patients based on resilience group, the LR group had a Penn score that was 34 points lower than that in the HR group. Likewise, the LR group had a SANE score that averaged 40 points lower than that in the HR group (SANE score of 53 points in LR group and 92 points in HR group, P = .05). When we evaluated ASES subscores, it appeared that the pain subscale was responsible for most of the difference between the LR and HR groups (29 points and 48 points [out of 50 points], respectively; P = .03).

CONCLUSIONS

Resilience is a major predictor of postoperative outcomes after TSA. Patients who are classified as having LR have outcome scores that are 30 to 40 points lower on traditional outcome scales than patients with HR.