High psychological resilience tied to better function, independence in hip fracture patients

High psychological resilience among postoperative hip fracture patients leads to higher gains in functional scores and recovers functional independence, suggests a Singapore study.

“We found that high psychological resilience is present in approximately half of postoperative hip fracture patients, and although the results did not achieve statistical significance, our pilot findings suggest that high psychological resilience does seem to correlate with higher gains in Modified Barthel Index (MBI) scores and improves the ability to be functionally independent,” the researchers said.

This pilot prospective cohort study was conducted in Bright Vision Community Hospital in Singapore and invited postoperative elderly hip fracture patients aged ≥65 years and admitted from 4 June 2018 to 31 August 2019 to participate.

The researchers measured psychological resilience scores on day 1 of admission using CD-RISC 25 and categorized participants into high psychological resilience if CD-RISC 25 score was ≥62 or low psychological resilience if the score was <62. Then, they tracked functional outcomes weekly for 21 days using MBI while participants underwent rehabilitation.

More than half (n=22; 52.40 percent) of the postoperative hip fracture participants in this study had high psychological resilience. These individuals were more likely to be older (age 77.4±5.80 years) and have received at least secondary school education (n=11). Those with low psychological resilience, on the other hand, were more likely to stay alone (n=6). No statistically significant differences were observed in baseline demographics between groups. [Proc Singapore Healthc 2021;30:28-35]

Significantly more participants with high psychological resilience achieved functional independence compared to their low psychological resilience counterparts (55 percent vs 47.47 percent). However, this result did not achieve statistical significance.

“Using CD-RISC 25, we found that approximately one in two geriatric patients who had undergone surgery following a hip fracture in this study had high psychological resilience,” the researchers said. “This is higher compared with elderly populations from Western countries, where the prevalence ranged from 14–34 percent.” [Geriatr Nurs 2016;37:266-272]

Culture might have played a role as regards the difference in prevalence rates. In Asian countries like Singapore, the elderly are valued and respected, and this could potentially explain the higher prevalence rates of high psychological resilience as compared with the Western population, where ageism is common. [Int J Psychol 2017;52:136-144]

Additionally, an earlier study showed that social support was positively associated with improved functional outcomes in the elderly. [Top Geriatr Rehabil 2014;30:155]

“Ageing adults may not have the capacity to improve psychological resilience on their own, hence a number of interventions have been proposed: mindfulness meditation to assist in positive coping, cognitive reframing to change negative perceptions and mastery development to enhance one’s sense of achievement,” the researchers said. [https://www.aginglifecarejournal.org/resilience-in-the-elderly; BMJ Open 2018;8:e017858]

“However, there is no one-size-fits-all, and strategies to boost one’s psychological resilience should be individualised. In our local context, such interventions may be incorporated into programmes offered by day care centres or senior activity centres,” they added. [J Psychosoc Nurs Ment Health Serv 2009;47:28-33]

Furthermore, improved psychological resilience was found to be associated with better health and well-being and that resilience levels did not decline with age. [http://www.cpa.org.uk/information/reviews/CPA-Rapid-Review-Resilience-and-recovery.pdf]