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J Am Geriatr Soc. 2019 Sep 9. doi: 10.1111/jgs.16149. [Epub ahead of print]

Resilience in Clinical Care: Getting a Grip on the Recovery Potential of Older Adults.

Author information

1
Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
2
Department of Environmental Sciences, Wageningen University, Wageningen, The Netherlands.
3
Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
4
Duke Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina.
5
Geriatrics Research Education and Clinical Center, Durham Veteran Affairs (VA) Medical Center, Durham, North Carolina.

Abstract

BACKGROUND:

Geriatricians are often confronted with unexpected health outcomes in older adults with complex multimorbidity. Aging researchers have recently called for a focus on physical resilience as a new approach to explaining such outcomes. Physical resilience, defined as the ability to resist functional decline or recover health following a stressor, is an emerging construct.

METHODS:

Based on an outline of the state-of-the-art in research on the measurement of physical resilience, this article describes what tests to predict resilience can already be used in clinical practice and which innovations are to be expected soon.

RESULTS:

An older adult's recovery potential is currently predicted by static tests of physiological reserves. Although geriatric medicine typically adopts a multidisciplinary view of the patient and implicitly performs resilience management to a certain extent, clinical management of older adults can benefit from explicitly applying the dynamical concept of resilience. Two crucial leads for advancing our capacity to measure and manage the resilience of individual patients are advocated: first, performing multiple repeated measurements around a stressor can provide insight about the patient's dynamic responses to stressors; and, second, linking psychological and physiological subsystems, as proposed by network studies on resilience, can provide insight into dynamic interactions involved in a resilient response.

CONCLUSION:

A big challenge still lies ahead in translating the dynamical concept of resilience into clinical tools and guidelines. As a first step in bridging this gap, this article outlines what opportunities clinicians and researchers can already exploit to improve prediction, understanding, and management of resilience of older adults.

KEYWORDS:

adaptive capacity; complex dynamical system; personalized medicine; resistance; time series analysis

PMID:
31498881
DOI:
10.1111/jgs.16149

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