Indicators of Resilience and Healthcare Outcomes: Findings from the 2010 Health and Retirement Survey

Purpose: There is increasing evidence that cumulative lifetime adversity has a dose-dependent association with psychosocial and physical health risk across the life course. This includes cigarette smoking, obesity, physical inactivity, heart disease, cardiovascular disease, stroke, diabetes, skeletal fractures, liver disease, sleep disturbances and poor self-rated health. Emerging evidence also suggests that adverse childhood experiences are associated with higher levels of health care utilization in later adulthood. Despite the growing attention to resilience and recognition that it evolves throughout the developmental life course trajectory, comparatively less attention has focused on resilience processes in older adulthood. In later life, resilience is conceptualized as both a process as well as an outcome and a resource. Accordingly, attention should be paid to the mechanisms contributing to vulnerability and resilience to health and healthcare utilization (HCU).  A recent systematic review found an association between childhood trauma and later mental and physical health outcomes in older adulthood. Protective factors included self-esteem, optimism, life satisfaction, agency, social support, meaning-making and spirituality. Factors associated with resilient outcomes in later adulthood include psychosocial resources such as meaning making, optimism, perceived control, social support, and family stability. Stress research has provided evidence that resources such as personal mastery and social support can buffer the negative impact of stress on health. The current study adds to this understudied aspect of resilience and health care utilization by examining indicators of risk (i.e., cumulative lifetime adversity) and resilience (i.e., social support, mastery) in a nationally representative sample of 4,568 U.S. adults aged 50 to 70 years from the 2010 Health and Retirement Survey.

Methods:  Multivariate logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for high vs. low resilience in relation to HCU and SRH improvements over two years. Cumulative lifetime adversity was defined as 0, 1-2, 3-4 or 5+ events. HCU included hospitalization (any vs. none) and physician visits (<20 vs.≥ 20) over two years.

Findings:  Hospitalization risk declined by 25% (OR=0.75, 95%CI: 0.64-0.86), risk of ≥ 20 physician visits declined by 47% (OR = 0.53, 95% CI: 0.45-0.63) and SRH improvement increased by 49% (OR=1.49, 95% CI: 1.17-1.88) for respondents with high vs. low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU.  Specifically, hospitalization risk was respectively 25%, 80% and 142% elevated for participants with 1-2, 3-4 and 5+ vs. 0 lifetime adversities.  High global, financial and health mastery respectively predicted improved SRH, lower physician’s visits and hospitalizations.

Implications: In this sample of adults, greater mastery was associated with lower HCU and improvement in SRH while greater cumulative lifetime adversity confered higher risk of hospitalization. These findings are consistent with a conceptualization of resilience as a dynamic, multidimensional, and developmental process.  Understanding resilience as malleable, rather than static, highlights the potential for targeted preventive interventions for higher risk individuals. Collaborative, transdisciplinary intervention strategies that identify risk factors (i.e., cumulative lifetime adversity) enhance protective factors (e.g. mastery and self-efficacy) in older adults may translate to better health outcomes by reducing excessive HCU and increasing subjective wellbeing.