Associations of Resilience, Perceived Control of Health, and Depression With Geriatric Outcomes After Surgery.

Abstract

To identify whether depression, resilience, and perceived control of health are related to 2.5-year mortality and instrumental activities of daily living (IADL) decline among older adults after surgery. The relationships of psychosocial factors with postoperative mortality and IADL decline among older adults are understudied. We identified 3778 community-dwelling older adults in the health and retirement study with Medicare claims for surgery [mean (SD) age: 75.4 (7.8) years, 53.9% women, and 86.0% non-Hispanic White]. We assessed associations of depression, resilience, and perceived control of health with 2.5-year postoperative mortality and IADL decline using Cox and modified Poisson regression analyses, adjusting for sociodemographic and health variables. The incidence of 2.5-year postoperative mortality was 18.5%, and IADL decline was 9.4%. Depression was associated with a higher incidence and adjusted hazard (95% CI) of mortality [26% vs 16%, adjusted hazard ratio: 1.2 (0.9, 1.5)], but high resilience was associated with a lower incidence and adjusted hazard of mortality [9% vs 21%, adjusted hazard ratio: 0.6 (0.5, 0.8)]. Those with depression had higher incidence and adjusted relative risk (95% CI) of IADL decline [17% vs 7%, aRR: 1.6 (1.2, 2.2)], but the lower incidence and adjusted relative risk of IADL decline were identified for those with high resilience [4% vs 11%, aRR: 0.6 (0.4, 1.0)] and high perceived control of health [7% vs 10%, aRR: 0.6 (0.4, 1.0)]. While depression confers a greater risk of mortality and IADL decline, higher resilience and perceived control of health may be protective. Addressing psychosocial factors in the perioperative period may improve outcomes among older adults.