Measurement of Dynamical Resilience Indicators Improves the Prediction of Recovery Following Hospitalization in Older Adults

Gijzel, Sanne M.W.; Rector, Jerrald L.; Meulen, Fokke B. van; Loeff, Rolinka Schim van der; Leemput, Ingrid A. van de; Scheffer, Marten; Rikkert, Marcel G M Olde; Melis, René J. F.

doi:10.1016/j.jamda.2019.10.011

Cited by 34 publications

(44 citation statements)

References 39 publications

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“…These pre-existing determinants could provide a threshold for any individuals or organism's resilience (even in the absence of a particular stressor). A recent study by Gijzel and colleagues has highlighted the importance of measurement of factors (referred to as dynamic indicators of resilience) such as physical activity, heart rate, mental well-being in predicting recovery following hospitalization of older patients (13). Furthermore, past studies have shown age, mental status, mobility, nutritional status, and comorbidity to be major determinants of regaining activities of daily livings (ADL) after hospital admissions (14,15).…”

Section: How Are Ic and Pr Related?mentioning

confidence: 99%

“…Furthermore, past studies have shown age, mental status, mobility, nutritional status, and comorbidity to be major determinants of regaining activities of daily livings (ADL) after hospital admissions (14,15). Handgrip strength which is also a strong measure of vitality has been shown to represent higher IC (16) and to predict functional recovery in multiple scenarios (13,17). The importance of psychosocial factors in determining recovery after an insult has been well established in psychological resilience studies and various scales have been validated (18).…”

Section: How Are Ic and Pr Related?mentioning

confidence: 99%

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Intrinsic Capacity as a Determinant of Physical Resilience in Older Adults

Chhetri

Qin

et al. 2021

The Journal of nutrition, health and aging

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The traditional disease-oriented model of healthcare is inadequate to address the needs of the older population. Greater attention should be given to strategies that promote healthy aging. Recently proposed constructs of intrinsic capacity (IC) and physical resilience (PR) hold great potential to reshape geriatric medicine and aging research. These constructs accentuate the positive health attributes of older people in contrast to the popular frailty construct that is centered on functional deficits. IC was introduced by the World Health Organization (WHO) as a composite of all the physical and mental capacities. WHO has emphasized enhancement of IC throughout the life course so as to maintain functional ability in old age. PR, recently highlighted by the National Institute on Aging, is the ability to successfully cope with stressors. High levels of resilience can result in desirable clinical and functional outcomes after stressors. Therefore, it is important to understand the underlying physiology of PR and the risk factors contributing to diminished PR. The main goal of this article is to explore the potential relationship between IC and PR. Based on a classical theory of aging, we postulate that IC is a determinant of PR and is also a high-level integrative measure of physiologic reserve which is the fundamental factor underlying one’s ability to withstand stressors. A major implication of our postulates is that even though IC is only one of the many determinants of PR, it could serve as an important intervenable target for enhancing resilience in older adults.

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Section: How Are Ic and Pr Related?mentioning

confidence: 99%

Section: How Are Ic and Pr Related?mentioning

confidence: 99%

Intrinsic Capacity as a Determinant of Physical Resilience in Older Adults

Chhetri

Qin

et al. 2021

The Journal of nutrition, health and aging

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“…Participants were included from the Wellbeing and Resilience Study at Radboud University Medical Center (11). Eligible patients aged 65 years or over admitted to the geriatric ward were consecutively enrolled between March and October 2017.…”

Section: Methodsmentioning

confidence: 99%

“…These indicators of CSD are reflected statistically in increased variance, temporal autocorrelation and cross-correlations between sub-systems, respectively (8). Empirical validation of the predictive validity of these CSDrelated indicators in human psychology and physiology is emerging (10)(11)(12)(13). By extracting these indicators from the patient's dynamic responses to naturally occurring small-scale perturbations, or micro-perturbations, such as ingesting a meal or standing from a chair, one can make predictions about the response of the older adult to a larger perturbation in the future (7)(8)(9)13).…”

Section: Introductionmentioning

confidence: 99%

Dynamical Indicators of Resilience from Physiological Time Series in Geriatric Inpatients: Lessons Learned

Rector¹,

Gijzel

Leemput

et al. 2020

Preprint

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BackgroundThe concept of physical resilience may help geriatric medicine objectively assess patients’ ability to ‘bounce back’ from future health challenges. Indicators hypothesized to forecast resilience after a stressor have been developed under two paradigms with different perspectives: Critical Slowing Down (CSD) and Loss of Complexity (LoC). This study explored if and how these indicators, based on fluctuations in physiologic signals, can validly reflect the physical resilience of geriatric inpatients.MethodsGeriatric patients (n = 121, 60% female) had their heart rate and physical activity continuously monitored using a chest-worn sensor. Measures of health functioning (multimorbidity, frailty and Activities of Daily Living [ADL]) were obtained by questionnaire at admission. Indicators from both paradigms (CSD: variance, autocorrelation, cross-correlation; LoC: [multivariate] multiscale entropy) were extracted from both physiological signals. The relationships among indicators and their associations with health functioning were assessed by correlation and linear regression analyses, respectively.ResultsGreater complexity and higher variance in physical activity were associated with lower frailty (β = –0.28, p=.004 and β = –0.37, p<.001, respectively) and better ADL function (β = 0.23, p=.022 and β = 0.38, p<.001). The associations of physical activity variance with health functioning was not in the expected direction based on the Critical Slowing Down paradigm.ConclusionsAssociations between dynamical resilience indicators tested here and measures of health functioning were not all in the expected direction. In retrospect, these observations stress the importance of matching the underlying assumptions of the resilience paradigm to the homeostatic role of the variable monitored.

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“…Additionally, the participants suggested combinations of the two approaches. A recent article portrays a first example of a combination of the approaches as suggested by the participants during the focus groups (22). This study applied both the a priori and the dynamical systems approach at the same time surrounding a high-impact stressor.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

The Application of the Concept of Resilience in Aging Research and Older Adult Care: A Focus Group Study

et al. 2020

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Introduction: Research incorporating resilience, a concept featuring a positive outcome despite some type of stressor, has the potential to identify possibilities for promotion of the well-being of older people. This study aims to gain insight into the value and potential applications of resilience in both research and care practice from the perspective of researchers and care professionals. Specifically, the value of two scientific approaches, the a priori (i.e., based on a priori definition of a stressor and outcome) and dynamical systems approaches (i.e., based on mathematically modeled patterns in the real-time response to perturbations), was explored. Methods: Focus groups were performed to explore the thoughts of academic researchers from different disciplines in the fields of aging and care and care professionals on the application of the concept of resilience, including the a priori and dynamical systems approaches. Analysis of these focus groups was based on the framework method. Results: Five focus groups were held with a total of nine researchers from different disciplines (e.g., epidemiology, sociology) and 15 older adult care professionals from different professions (e.g., elderly care physician, physiotherapist). The participants described resilience as a concept with value for both aging research and care through its positive connotation and comprehensiveness. Continued research was thought to play an important role in clearing up some of the existing ambiguity surrounding resilience. The importance of resilience in the context of both high-and low-intensity stressors was underscored. The a priori and dynamical systems approaches were considered to have their specific advantages and disadvantages on both conceptual and feasibility levels. Therefore, the use of both approaches, side by side and in combination, was suggested. Conclusion: This qualitative exploration among researchers and care professionals confirms that the concept of resilience, including the a priori and dynamical systems approaches, is valuable. However, more work is necessary before can be delivered Angevaare et al. Resilience and Older Adult Care on the potential of resilience in aging research and older adult care practice. Greater conceptual and operational clarity can be achieved through more qualitative studies on the concept that take the perspective of older people into account and through empirical studies that work with both approaches simultaneously and/or in combination.

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Measurement of Dynamical Resilience Indicators Improves the Prediction of Recovery Following Hospitalization in Older Adults

Cited by 34 publications

References 39 publications

Intrinsic Capacity as a Determinant of Physical Resilience in Older Adults

Intrinsic Capacity as a Determinant of Physical Resilience in Older Adults

Dynamical Indicators of Resilience from Physiological Time Series in Geriatric Inpatients: Lessons Learned

The Application of the Concept of Resilience in Aging Research and Older Adult Care: A Focus Group Study

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