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Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.

ABSTRACT: BACKGROUND:Geriatricians are often confronted with unexpected health outcomes in older adults with complex multimorbidity. Aging researchers have recently called for a focus on physical resilience as a new approach to explaining such outcomes. Physical resilience, defined as the ability to resist functional decline or recover health following a stressor, is an emerging construct. METHODS:Based on an outline of the state-of-the-art in research on the measurement of physical resilience, this article describes what tests to predict resilience can already be used in clinical practice and which innovations are to be expected soon. RESULTS:An older adult's recovery potential is currently predicted by static tests of physiological reserves. Although geriatric medicine typically adopts a multidisciplinary view of the patient and implicitly performs resilience management to a certain extent, clinical management of older adults can benefit from explicitly applying the dynamical concept of resilience. Two crucial leads for advancing our capacity to measure and manage the resilience of individual patients are advocated: first, performing multiple repeated measurements around a stressor can provide insight about the patient's dynamic responses to stressors; and, second, linking psychological and physiological subsystems, as proposed by network studies on resilience, can provide insight into dynamic interactions involved in a resilient response. CONCLUSION:A big challenge still lies ahead in translating the dynamical concept of resilience into clinical tools and guidelines. As a first step in bridging this gap, this article outlines what opportunities clinicians and researchers can already exploit to improve prediction, understanding, and management of resilience of older adults. J Am Geriatr Soc 67:2650-2657, 2019.

SUBMITTER: Gijzel SMW

PROVIDER: S-EPMC6916426 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.

Gijzel Sanne M W SMW Whitson Heather E HE van de Leemput Ingrid A IA Scheffer Marten M van Asselt Dieneke D Rector Jerrald L JL Olde Rikkert Marcel G M MGM Melis René J F RJF

Journal of the American Geriatrics Society 20190909 12

<h4>Background</h4>Geriatricians are often confronted with unexpected health outcomes in older adults with complex multimorbidity. Aging researchers have recently called for a focus on physical resilience as a new approach to explaining such outcomes. Physical resilience, defined as the ability to resist functional decline or recover health following a stressor, is an emerging construct.<h4>Methods</h4>Based on an outline of the state-of-the-art in research on the measurement of physical resilie ...[more]

PMID: 31498881

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Project description:Background:Hand grip strength (HGS) is gaining the attention of researchers and clinicians, including geriatricians as a readily available, inexpensive, and useful measure of muscle strength. Objective:To identify the indicators of abnormal HGS as measured by a Jamar handheld dynamometer in community-dwelling Egyptian senior citizens. Study Design:The study was approved by the relevant ethical committee. This cross-sectional study included 200 randomly selected older adults of both sexes who attended geriatric and internal medicine outpatient clinics. Informed consent was obtained, and comprehensive geriatric assessment was performed, including assessment of the health-related quality of life by the 12-Item Short-Form Health Survey (SF-12). Measurement:HGS was measured, and values of 20 kg or less in females and 30 kg or less in males were considered abnormal. Statistical Methods:IBM SPSS statistics v25.0 was used for data analysis. Data were expressed as the mean ± SD for quantitative parametric measures and as the number and percentage for categorical data. Student's t-test, the chi-squared test, the diagnostic validity test, and multiple logistic regression analysis were performed. The ROC (receiver operating characteristic) curve was constructed, and the AUC (area under the curve) was also calculated. Results:The subjects' ages ranged from 60 to 95 years with a mean age of 69 ± SD 7.1 years. The sample consisted of 117 females (58.5%) and 83 males (41.5%). The chi-squared test showed that abnormal findings for grip strength were significantly more common among females than males (67.7% vs 32.3%). Student's t-test showed that both height and weight were significantly lower among subjects with abnormal than normal HGS, while body mass index (BMI) showed a non-significant difference. Stepwise multiple logistic regression analysis showed that there was no actual relationship between sex and abnormality of HGS. Conclusion:The best indicators of abnormal HGS were found to be a general health score below 25 points on the SF-12 and a height of less than 178 cm. As the values of general health and height decrease below those cut-off points, HGS decreases as well, and vice versa.

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Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.

Publications

Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.

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