Psychological resilience associated with better physical function, quality of life in patients with type 2 diabetes

A study found that older people with type 2 diabetes had better physical function and better quality of life (QOL) if they had greater psychological resilience.

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 (T2DM).

Psychological resilience has previously been linked to well-being, a healthy lifestyle, and reduced risk of mortality in older adults. With increased interest in identifying the reasons for healthy aging, researchers have turned their attention to assessing the psychological resilience of patients with T2DM due to the biopsychological challenges of the disease.

Elderly people from the observation phase of the Look AHEAD trial were included in this study. The study was designed to assess the effect of intensive lifestyle intervention (ILI) versus diabetes support and education (DSE) on the risk of cardiovascular morbidity or mortality in patients with T2DM. Data for this study were collected at a mean (SD) of 14.4 (0.9) years after randomization in the observational phase of the Look AHEAD trial. Participants aged 45 to 76 had a body mass index (BMI) greater than 25 kg/m2and had a confirmed diagnosis of T2D were included.

All participants reported demographic information, including age, gender, and race/ethnicity. Weight was measured using a digital scale and BMI was calculated with the collected data. Diabetic status was determined with hemoglobin A1 C measures. Hospitalizations were self-reported.

The Brief Resilience Scale (BRS), Medical Outcomes Survey, Patient Health Questionnaire-9 (PHQ-9), and Pepper Assessment Tool for Disability were used to assess resilience, quality of life, depressive symptoms, and disability , respectively. Gait speed and grip strength were used to assess physical function, while frailty was assessed with an altered Fried phenotype.

There were 3199 participants in the current study who provided complete data for the BRS. BRS was not associated with treatment (ESD, 3.8 [0.8]; OS, 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 hospitalized more frequently in the past year were associated with lower physical and mental quality of life, greater depressive symptoms, greater disability, lower walking speed, lower walking strength, weaker grip in kilograms and an increased risk of frailty. Associations of hospitalizations with disability and grip strength in kilograms (1.16; 95% CI, 0.809-1.506) were the only factors moderated by the BRS.

Psychological resilience was positively associated with physical resistance (odds ratio [OR], 3.44; 95% CI, 2.99-3.90) and mental (OR, 7.41; 7.02-7.80) and fewer depressive symptoms (total score PHQ-9, -2.02; 95% CI %, -2.16 to -1.87). It was also associated with a lower likelihood of meeting frailty criteria compared to non-frailty patients with 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 findings 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 analyzes performed. The single rating assumes that resilience is an enduring personality trait due to the nature of the BRS rating. Not all socio-cultural factors were 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 holistic perspective of aging-related health.” Finding ways to distinguish between psychological and physical resilience can be helpful in 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

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