Impact of psychological resilience on walking capacity in older adults following hip fracture

Perceived Health Status Predicts Resilience after Hip Fracture in Older People

Background and Objectives: Perceived health status (PHS) is associated with various health outcomes in older adults, but its relationship with resilience in the context of events with a major impact on functional status (FS), such as hip fracture, has not been explored. Our objective was to evaluate whether older adults who report good PHS before a hip fracture have a higher probability of returning to their baseline physical performance (PP) and personal independence. Materials and Methods: We analyzed data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) study, enrolling patients ≥ 65 years who experienced a hip fracture between these two waves. As study outcomes, we analyzed changes in PP and functional abilities (FAs). Results: We included 149 participants with a mean age of 75.7 years (SD: 6.5); women comprised 66%. The incidence of loss of PP was 51.7% among participants with good PHS and 59.6% among those with poor PHS. FA worsened in 40% of participants with good PHS and 58.4% in those with poor PHS. Relative risk (RR) for loss of FA in people with good PHS was 0.68 (95% CI: 0.48-0.98), which did not change after an adjustment for age, gender, baseline FA, depression, number of comorbidities, education, income, and social support, despite it not reaching statistical significance. After adjustment, the risk of worsening PP in participants with good PHS was reduced by 34% (95% CI: 0.41-1.06). Conclusions: A simple question on PHS may predict the resilience of older adults after an acute stressor. A systematic evaluation of PHS can help identify patients with a higher probability of regaining function after a hip fracture and thus provide useful information for resource allocation.

Aging precisely: Precision medicine through the lens of an older adult

Precision medicine presents an opportunity to use novel, data-driven strategies to improve patient care. The field of precision medicine has undergone many advancements over the past few years. It has moved beyond incorporation of individualized genetic risk into medical decision-making to include multiple other factors such as unique social, demographic, behavioral, and clinical characteristics. Geriatric medicine stands to benefit heavily from the integration of precision medicine into its standard practices. Older adults, compared with other populations, have high clinical and biological heterogeneity that can alter the risks and benefits of different approaches to patient care. These factors have not been routinely considered previously by geriatricians. Yet, geriatricians' ability to address older adults' baseline heterogeneity is increasingly recognized as a cornerstone of delivering quality care in a geriatric medical practice. Given the shared focus of individualized decision-making, precision medicine is a natural fit for geriatric medicine. This manuscript provides, via cases and discussion, examples that illustrate how precision medicine can improve the care of our older patients today. We will share specific and existing tools and evidence, and review the existing multilevel barriers to further incorporate and implement these tools into clinical practice. We propose methods to address these barriers and to help realize the full potential of precision medicine for the care of older adults. We conclude with a brief discussion of potential future directions of research of precision medicine in the care of older adults.

Resilience, Survival, and Functional Independence in Older Adults Facing Critical Illness

BACKGROUND

Older adults surviving critical illness often experience new or worsening functional impairments. Modifiable positive psychological constructs such as resilience may mitigate post-intensive care morbidity.

RESEARCH QUESTION

Is pre-ICU resilience associated with: (1) post-ICU survival; (2) the drop in functional independence during the ICU stay; or (3) the trend in predicted independence before vs after the ICU stay?

STUDY DESIGN AND METHODS

This retrospective cohort study was performed by using Medicare-linked Health and Retirement Study surveys from 2006 to 2018. Older adults aged ≥ 65 years admitted to an ICU were included. Resilience was calculated prior to ICU admission. The resilience measure was defined from the Simplified Resilience Score, which was previously adapted and validated for the Health and Retirement Study. Resilience was scored by using the Leave-Behind survey normalized to a scale from 0 (lowest resilience) to 12 (highest resilience). Outcomes were survival and probability of functional independence. Survival was modeled by using Gompertz models and independence using joint survival models adjusting for sociodemographic and clinical variables. Average marginal effects were estimated to determine independence probabilities.

RESULTS

Across 3,409 patients aged ≥ 65 years old admitted to ICUs, preexisting frailty (30.5%) and cognitive impairment (24.3%) were common. Most patients were previously independent (82.7%). Mechanical ventilation occurred in 14.8% and sepsis in 43.2%. Those in the highest resilience group (vs lowest resilience) had a lower risk of post-ICU mortality (adjusted hazard ratio, 0.81; 95% CI, 0.70-0.94). Higher resilience was associated with greater likelihood of post-ICU functional independence (estimated probability of functional independence 5 years after ICU discharge in highest-to-lowest resilience groups (adjusted hazard ratio [95% CI]): 0.53 (0.33-0.74), 0.47 (0.26-0.68), 0.49 (0.28-0.70), and 0.36 (0.17-0.55); P < .01. Resilience was not associated with a difference in the drop in independence during the ICU stay or a difference in the pre-ICU vs post-ICU trend in predicted independence .

INTERPRETATION

ICU survivors with higher resilience had increased rates of survival and functional independence, although the slope of functional decline before vs after the ICU stay did not differ according to resilience group.

Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture

This study aimed to test a model of factors associated with resilience and physical activity post-hip fracture and compare model fit between men and women. We used data from the seventh Baltimore Hip Study that included 339 participants. Model testing indicated that health status (men: β = .237, p = .002; women: β = .265, p = <.001), depression (men: β = -.245, p = .001; women: β = -.241, p = <.001), and optimism (men: β = .320, p = <.001; women: β = .282, p = <.001) were associated with resilience in men and women, but resilience was only associated with physical activity in men (β = .203, p = .038) and not in women. Social interaction was related to physical activity only among women (β = .206, p = .044). This study provides support for the relationship between resilience and physical activity at least among men.

Psychometric Properties of the Resilience Scale in Older Adults Post-Hip Fracture

Objectives: The purpose of this study was to evaluate the psychometric properties of the modified 25-item Resilience Scale (RS-25) in older adults post-hip fracture using Rasch analysis. Methods: This was a descriptive study using baseline data from the Seventh Baltimore Hip Studies (BHS-7). There were 339 hip fracture patients included in this analysis. Results: Findings suggest there was support for reliability of the measure based on person and item separation index. The INFIT and OUTFIT statistics for testing validity were all in the acceptable range indicating that each item on the modified RS-25 fits the appropriate concept. There was no evidence of Differential Item Functioning (DIF) between genders. Conclusions: This study demonstrated evidence that the modified RS-25 is a reliable and valid measure to evaluate resilience among older adults post-hip fracture and therefore can be used in this population in clinical practice and research.

Preoperative psychological resilience and recovery after hip fracture: Secondary analysis of the REGAIN randomized trial

BACKGROUND

How psychological resilience influences postoperative outcomes remains poorly characterized. We tested the hypothesis that psychological resilience is associated with lower odds of death or new inability to walk independently and other outcomes at 60 days after hip fracture surgery.

METHODS

This was a pre-planned secondary analysis of a multicenter randomized trial comparing spinal versus general anesthesia for hip fracture surgery. We analyzed data on 1360 adults aged 50 years or older who were hospitalized for hip fracture surgery at one of 46 US or Canadian hospitals and provided psychological resilience data preoperatively as measured via the Brief Resilience Scale. Major exclusions were the inability to walk without human assistance before fracture and contraindications to spinal anesthesia. Death or new inability to walk independently at 60 days after surgery was the primary outcome; death or new nursing home residence at 60 days and 60-day mortality were secondary outcomes.

RESULTS

Greater psychological resilience was associated with lower odds of death or new inability to walk at day 60 (adjusted odds ratio [aOR] 0.77; 95% Confidence Interval [CI], 0.61 to 0.98; p = 0.03). We observed a similar association between psychological resilience and outcomes among patients who did not experience complications after surgery (aOR 0.72; CI 0.55 to 0.94, p = 0.02), but not those who had complications (aOR 1.00; CI 0.59 to 1.69, p = 0.99). Psychological resilience was associated with lower odds of 60-day death or new nursing home residence (aOR 0.73; 95% CI 0.58 to 0.93; p < 0.001) but not with 60-day mortality (aOR 0.92; 95% CI 0.56 to 1.49; p = 0.73).

CONCLUSIONS

Psychological resilience is associated with better outcomes for older adults after hip fracture surgery, but largely among those who do not have postoperative complications. Future interventions may focus on improving psychological resilience preoperatively or providing support to patients with lower psychological resilience.

Design of well-matched end-structure of anatomical proximal femoral locking plate based on computer-assisted imaging combined with 3D printing technology: a quality improvement study

BACKGROUND

The extramedullary locking plate system was the common internal fixation method for hip fractures. However, common plates were poorly matched to femur, which was because they were designed based on anatomical parameters of the Western populations. Therefore, the aim was to design an end-structure of the anatomical proximal femoral locking plate that closely matched the anatomy of the Chinese population.

MATERIALS AND METHODS

From January 2010 to December 2021, consecutive patients aged 18 years and older who underwent a full-length computed tomography scan of the femur were included. The end-structure (male and female model) of the anatomical proximal femoral locking plate was designed based on anatomical parameters of femurs that were measured in three-dimensional space using computer-assisted virtual technology. The match degree between the end-structure and femur were evaluated. Inter-observer and intra-observer agreement for the evaluation of match degree was assessed. The matching evaluation based on a three-dimensional printing model was regarded as the gold standard to assess the reliability.

RESULTS

A total of 1672 patients were included, with 701 men and 971 women. Significant differences were seen between male and female for all parameters of the proximal femur (all P <0.001). All match degree of end-structure was over 90%. Inter-observer and intra-observer agreement was almost perfect (all kappa value, >0.81). The sensitivity, specificity, and percentage of correct interpretation of matching evaluation in the computer-assisted virtual model was all greater than 95%. From femur reconstruction to completion of internal fixation matching, the process takes about 3 min. Moreover, reconstruction, measurement, and matching were all completed in one system.

CONCLUSIONS

The results showed that based on the larger sample of femoral anatomical parameters, a highly matching end-structure of anatomical proximal femoral locking plate for Chinese population could be designed with use of computer-assisted imaging technology.