Psychological Resilience Associated With Better Physical Function, QOL in Patients With Type 2 Diabetes

A study published in the Journal of the American Geriatrics Society found that psychological resilience was associated with improved physical function and quality of life (QOL) in older adults with type 2 diabetes (T2D).

Psychological resilience has previously been linked to well-being, healthy lifestyle, and a reduced risk of mortality in older adults. With an increased interest in identifying reasons for healthy aging, the researchers were interested in assessing psychological resilience in patients with T2D due to the biopsychological challenges of the disease.

Older adults from the observational phase of the Look AHEAD Trial were included in this study. The study was designed to assess the effect of intensive lifestyle intervention (ILI) when compared with diabetes support and education (DSE) on risk of cardiovascular morbidity or mortality in patients with T2D. Data for this study were collected a mean (SD) of 14.4 (0.9) years after randomization in the observational phase of the Look AHEAD trial. Participants who were aged 45 to 76 years, had a body mass index (BMI) greater than 25 kg/m², and had a confirmed diagnosis of T2D were included.

All participants self-reported demographic information, including age, gender, and race/ethnicity. Weight was measured using a digital scale and BMI was calculated with the data collected. Diabetes status was determined with hemoglobin A_1c measures. Hospitalizations were self-reported.

The Brief Resilience Scale (BRS), the Medical Outcomes Survey, the Patient Health Questionnaire-9 (PHQ-9), and the Pepper Assessment Tool for Disability were used to assess resilience, QOL, depressive symptoms, and disability, respectively. Gait speed and grip strength were used to assess physical function, whereas frailty was assessed with a modified Fried’s phenotype.

There were 3199 participants in the current study who provided complete data for the BRS. The BRS was not associated with treatment (DSE, 3.8 [0.8]; ILI, 3.8 [0.7]) or age. However, BRS scores varied by gender (male, 3.9 [0.7]; female, 3.7 [0.8]) and race/ethnicity (White, 3.8 [0.8]; Black, 3.9 [0.7]; Hispanic, 3.7 [0.8]; other/mixed, 3.6 [0.7]).

Patients with more frequent hospitalizations in the past year were associated with having lower physical and mental QOL, greater depressive symptoms, greater disability, lower gait speed, lower grip strength in kilograms, and increased odds of frailty. The associations of hospitalizations with disability and grip strength in kilograms (1.16; 95% CI, 0.809-1.506) were the only factors to be moderated by BRS.

Psychological resilience was positively associated with physical (odds ratio [OR], 3.44; 95% CI, 2.99-3.90) and mental (OR, 7.41; 7.02-7.80) QOL and fewer depressive symptoms (PHQ-9 total score, –2.02; 95% CI, –2.16 to –1.87). It was also associated with lower likelihood of meeting criteria for frailty vs nonfrail patients with weight included (OR, 0.38; 95% CI, 0.33-0.45) and excluded (OR, 0.39; 95% CI, 0.33-0.46).

There were some limitations to this study. Causal conclusions could not be clarified due to the cross-sectional nature of the study. The possibility of a type 1 error is increased due to the multiple analyses done. The 1-time assessment assumes resilience is an enduring personality trait due to the nature of the BRS assessment. All sociocultural factors were not included in the study.

The researchers concluded that the association of psychological resilience with aging-related functions found in the study is “aligned with a more wholistic perspective on aging-related health.” Finding ways to distinguish between psychological and physical resilience can be useful for measuring these functions.

Reference

Olson KL, Howard M, McCaffery JM, et al. Psychological resilience in older adults with type 2 diabetes from the Look AHEAD Trial. J Am Geriatr Soc. Published online October 5, 2022. doi:10.1111/jgs.17986