Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial

Abstract

Background: There is growing interest in identifying factors associated with healthy aging. This cross-sectional study evaluated associations of psychological resilience with factors associated with aging in older adults with type 2 diabetes mellitus (T2DM).

Methods: Participants were 3199 adults (72.2 ± 6.2 years of age, 61% female, 61% White, body mass index [BMI] = 34.2 ± 8.2 kg/m² ) with T2DM enrolled in Look AHEAD (a multi-site randomized clinical trial comparing an intensive lifestyle intervention for weight loss to diabetes education and support). Participants were followed observationally after the 10-year intervention was discontinued. The following items were assessed approximately 14.4 years post-randomization in a cross-sectional analysis: Brief Resilience Scale; overnight hospitalizations in past year; physical functioning measured objectively (gait speed, grip strength) and via self-report (Pepper Assessment Tool for Disability; physical quality of life [QOL; SF-36]); a measure of phenotypic frailty based on having ≥3 of unintentional weight loss, low energy, slow gait, reduced grip strength, and physical inactivity. Depressive symptoms (PHQ-9) and mental QOL (SF-36) were also measured. Logistic/linear/multinomial regression was used to evaluate the association of variables with resilience adjusted for age, race/ethnicity, and gender.

Results: Greater psychological resilience was associated with lower BMI, fewer hospitalizations, better physical functioning (i.e., lower self-reported disability, better physical QOL, faster gait speed, greater grip strength, lower likelihood of frailty), fewer depressive symptoms, and greater mental QOL (all p < 0.05). Psychological resilience moderated the relationship of number of hospitalizations in the past year with self-reported disability and grip strength.

Conclusions: Psychological resilience is associated with better physical function and QOL among older adults. Results should be interpreted cautiously given cross-sectional nature of analyses. Exploring the clinical benefits of resilience is consistent with efforts to shift the narrative on aging beyond "loss and decline" to highlight opportunities to facilitate healthy aging.

Keywords: aging; disability; frailty; healthy aging; quality of life.

FIGURE 1

(A) Adjusted estimates for disability assessed with the Pepper Assessment Tool for Disability (PAT-D) by Brief Resilience Scale (BRS) score and number of hospitalizations in the past year. To provide a visual representation of the interaction of hospitalizations with resilience (BRS) in the association with disability (PAT-D), this figure depicts the model results for the following demographic values; average age, White, and male. Patterns remain similar when alternative demographic values are selected. As depicted above, hospitalization was associated with greater disability regardless of level of resilience. However, in comparing those with one hospitalization versus none in the past year, greater resilience was associated with a more modest increase in disability relative to those lower in resilience. Among those with two or more hospitalizations, the association of resilience with disability appears to be attenuated. (B) Adjusted estimates for grip strength scores by Brief Resilience Scale (BRS) scores and number of hospitalizations in the past year. To provide a visual representation of the interaction effect, this figure depicts the model results for the following demographic values: average age, White, and male. Patterns remain similar when alternative demographic values are selected. As depicted above, the estimated grip strength was similar between those with one and no hospitalizations in the last year for those with higher resilience. However, for those with lower resilience, having one hospitalization was associated with lower grip strength as compared to those with no hospitalizations. For those with two or more hospitalizations, the association of resilience with grip strength is attenuated, as evidenced by the lower grip strength associated with higher resilience as compared to those with no hospitalizations