Impact of change in psychological resilience on subsequent all-cause and cause-specific mortality in community-dwelling older adults: a nationwide cohort study

OBJECTIVE: Psychological resilience, commonly conceptualized as the capacity to rebound or surmount various forms of adversity, reflects the dynamic adaptability to the aging process. This study examines the impact of change in psychological resilience on all-cause and cause-specific mortality in older adults. STUDY DESIGN: Prospective cohort study. METHODS: 7311 older individuals (mean age 79.61 ± 10.66 years, 53.39 % female) were enrolled from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Psychological resilience was assessed using a 7-item scale in two consecutive waves (2002 and 2005), and survival information was collected in subsequent four follow-up waves (2008, 2011, 2014, and 2018). Participants were classified based on change patterns of psychological resilience: sustained high resilience (n = 3140), resilience decrease (n = 1690), resilience increase (n = 1149), and sustained low resilience (n = 1332). Cox proportional hazards models adjusted for demographic characteristics, health behaviors, and health conditions were employed to assess mortality risk. RESULTS: Over 34946.58 person-years of follow-up [median: 3.5 (1.51-6.59) years], 4238 deaths were documented including 987 from cardiovascular diseases (CVD). Compared to sustained low resilience group, fully adjusted hazard ratios (HRs) for all-cause mortality were 0.76 (95 % CI: 0.70-0.83) for sustained high resilience group, 0.98 (95 % CI: 0.90-1.08) for resilience decrease group, and 0.80 (95 % CI: 0.72-0.88) for resilience increase group. Similar trends were observed for CVD and non-CVD mortality risks in all participants. Sensitivity and subgroup analyses consistently supported these findings. CONCLUSION: Maintaining and enhancing resilience is linked to reduced mortality risks among older adults. These findings underscore the potential benefits of integrating resilience-focused interventions into public health initiatives to promote healthy aging.