Psychological Resilience Linked to Better Physical Function in Older Adults with T2D

KayLoni L. Olson, PhD

New data associate psychological resilience with better physical function and quality of life (QOL) in a cohort of older adults with a history of type 2 diabetes (T2D).

Greater resilience was linked to lower body mass index (BMI), lower self-reported disability, fewer hospitalizations, lower likelihood of frailty, and greater mental QOL (all P <.05).

Meanwhile, the association of resilience with metrics including grip strength and self-reported disability varied based on recent hospitalization history, with exploratory post hoc analyses suggesting that the associations could differ based on race and ethnicity.

“Among individuals with zero or one hospitalization, greater resilience was associated with less disability and greater grip strength,” wrote study author KayLoni L. Olson, PhD, Weight Control and Diabetes Research Center, Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital. “This association was attenuated following 2+ hospitalizations suggesting a threshold effect with resilience having a protective effect only in the context of fewer hospitalizations.”

As the population in the United States continues to age, there is increased urgency to identify contributors to healthy aging. Determining psychological resilience may have relevance for healthy aging, particularly in older adults with T2D.

The current cross-sectional study evaluated resilience, assessed its relationship to demographic factors and T2D management, evaluated the association of resilience with variables implicated in aging-related health, and evaluated resilience as a moderator of the association between hospitalization and aging-related health.

The study participants were men and women with T2D and overweight or obesity, who were 45 –76 years old, with a body mass index (BMI) of ≥25 kg/m². They were randomly assigned to intensive lifestyle intervention (ILI), compared to diabetes support and education (DSE).

The measures included demographic information, weight/height, diabetes status, number of hospitalizations, resilience, quality of life, depressive symptoms, disability, objective physical function, and frailty. Resilience was measured using the Brief Resilience Scale (BRS), a 6-item self-report scale of perceived ability to adapt and to avoid negative outcomes associated with stress.

From the 5145 participants who were randomized in the Look AHEAD trial, 3199 participants participated in the follow-up assessment and were eligible for inclusion in the analysis.

Investigators observed the BRS was not associated with treatment (DSE: 3.8 ± 0.8; ILI: 3.8 ± 0.7; P = .85) or age (r = .01, P = .69), but it did vary based on gender (Male: 3.9 ± 0.7; Female: 3.7 ± 0.8; P <.01) and race/ethnicity (White: 3.8 ± 0.8; Black: 3.9 ± 0.7; Hispanic: 3.7 ± 0.8).

The findings suggest more frequent hospitalization in the previous year was associated with lower physical (P <.001) and mental QOL (P = .001), greater depressive symptoms (P = .001), greater disability (P <.001), lower gait speed (P <.001), lower grip strength (P = .005), and increased odds of frailty status (P <.01). Investigators added that only the associations of hospitalizations in the past year with disability (P = .02) and grip strength (P = .05) were moderated by BRS.

Increasingly, resilience is believed to be dynamic and to vary over time,” Olson wrote. “The current study does not include all sociocultural factors (e.g., socioeconomic status) that may be relevant for resilience and some important  aspects  of  aging  were  not  assessed (e.g., cognitive function).”

The study, “Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial,” was published in the Journal of the American Geriatrics Society.