title: Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey.
abstract: OBJECTIVE
  To test the hypothesis that higher levels of resilience indicators are associated with lower overall healthcare utilization (HCU) as well as improvements in self-rated health (SRH), we analyzed a representative sample of 4562 adults 50-70 years old enrolled in the US 2010 health and retirement survey.
  
  
  METHODS
  Multivariable logistic regression models estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for high versus low resilience in relation to HCU and SRH improvements over 2 years. Resilience indicators included: cumulative lifetime adversity, social support, global mastery and domain-specific mastery. 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 2 years.
  
  
  RESULTS
  Hospitalization odds declined by 25 % (OR 0.75, 95 %CI 0.64-0.86), odds of ≥ 20 physician visits declined by 47 % (OR 0.53, 95 % CI 0.45-0.63) and the odds of SRH improvement increased by 49 % (OR 1.49, 95 % CI 1.17-1.88) for respondents with high versus low health mastery. Cumulative lifetime adversity manifested a dose-dependent positive relationship with HCU. Specifically, hospitalization odds was, respectively, 25, 80 and 142 % elevated for participants that reported 1-2, 3-4 and 5+ versus 0 lifetime adversities. High versus low global, financial and health mastery, respectively, predicted improved SRH, lower physician's visits and hospitalizations.
  
  
  CONCLUSIONS
  In this sample of adults near or in retirement, resilience predicted lower HCU and improved SRH. Resilience is a dynamic state that can be enhanced in adults with positive impacts on subjective well-being and HCU.
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA.
authors.forename: Amara E
authors.initials: AE
authors.lastname: Ezeamama
authors.affiliation: School of Social Work, University of Georgia, Athens, GA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Elkins
authors.affiliation: School of Nursing, University of Texas, Austin, TX, USA.
authors.forename: Cherie
authors.initials: C
authors.lastname: Simpson
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA.
authors.forename: Shaniqua L
authors.initials: SL
authors.lastname: Smith
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Allegra
authors.affiliation: Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 101 Buck Hall, Miller Hall, Room 110, Athens, GA, 30602, USA. tonimile@uga.edu.
authors.forename: Toni P
authors.initials: TP
authors.lastname: Miles
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000191:economics; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D055500:Resilience, Psychological; D012179:Retirement / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Comorbid conditions; Health and retirement survey; Healthcare utilization; Midlife; Public health; Resilience