Better mental health and fewer depressive symptoms are associated with greater psychological resilience after hip fracture

Background: High psychological resilience is associated with improved functional outcomes for older adults recovering from hip fracture. The objective of this study was to identify factors associated with increased psychological resilience in older women after hip fracture.

Methods: 129 women aged ≥65 years with recent surgically-repaired hip fracture were enrolled in a trial of exercise and testosterone therapy. The Brief Resilience Scale (BRS) measured baseline resilience, and was categorized as low (BRS<4) or high (BRS≥4). Sociodemographic (e.g., education), medical, and neuropsychological factors (e.g., cognition by Short Blessed Test, mental health by a Global Mental Health Score (PROMIS-GMH), and depressive symptoms by Geriatric Depression Score (GDS)) were considered as independent variables. Individual factors were evaluated for their association with resilience using bivariate regression, and those having a significance level of p≤0.10 were entered into age-adjusted multivariate logistic regression models.

Results: 57 women (44%) reported high resilience. Neither education nor cognition was significantly associated with resilience. Lower GDS and better PROMIS-GMH scores were associated with high resilience in adjusted models. For every one-point worsening in GDS, the adjusted odds ratio (AOR) for high vs. low resilience was 0.76 (95% CI 0.61,0.93). In a model with GDS, PROMIS-GMH, and age, positive mental health remained significantly associated with higher resilience (AOR 1.34, 95% CI 1.14,1.58).

Conclusions: In older women after hip fracture, fewer depressive symptoms and better mental health were associated with higher psychological resilience. Addressing overall mental health when recovering from hip fracture could contribute to increasing psychological resilience thereby maximizing recovery potential.