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

Objective: 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. Background: The relationships of psychosocial factors with postoperative mortality and IADL decline among older adults are understudied. Methods: 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. Results: 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)]. Conclusions: 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.