• Sanne M W Gijzel, Jerrald Rector, Fokke B van Meulen, Rolinka Schim van der Loeff, Ingrid A van de Leemput, Marten Scheffer, Olde RikkertMarcel G MMGMDepartment of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands., and MelisRené J FRJFDepartment of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands. Electronic address: Rene.Melis@radboudumc.nl..
• Department of Geriatrics, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Environmental Sciences, Wageningen University, Wageningen, the Netherlands.
• J Am Med Dir Assoc. 2020 Apr 1; 21 (4): 525-530.e4.

ObjectivesAcute illnesses and subsequent hospital admissions present large health stressors to older adults, after which their recovery is variable. The concept of physical resilience offers opportunities to develop dynamical tools to predict an individual's recovery potential. This study aimed to investigate if dynamical resilience indicators based on repeated physical and mental measurements in acutely hospitalized geriatric patients have added value over single baseline measurements in predicting favorable recovery.DesignIntensive longitudinal study.Setting And Participants121 patients (aged 84.3 ± 6.2 years, 60% female) admitted to the geriatric ward for acute illness.MeasurementsIn addition to preadmission characteristics (frailty, multimorbidity), in-hospital heart rate and physical activity were continuously monitored with a wearable sensor. Momentary well-being (life satisfaction, anxiety, discomfort) was measured by experience sampling 4 times per day. The added value of dynamical indicators of resilience was investigated for predicting recovery at hospital discharge and 3 months later.Results31% of participants satisfied the criteria of good recovery at hospital discharge and 50% after 3 months. A combination of a frailty index, multimorbidity, Clinical Frailty Scale, and or gait speed predicted good recovery reasonably well on the short term [area under the receiver operating characteristic curve (AUC) = 0.79], but only moderately after 3 months (AUC = 0.70). On addition of dynamical resilience indicators, the AUC for predicting good 3-month recovery increased to 0.79 (P = .03). Variability in life satisfaction and anxiety during the hospital stay were independent predictors of good 3-month recovery [odds ratio (OR) = 0.24, P = .01, and OR = 0.54, P = .04, respectively].Conclusions And ImplicationsThese results highlight that measurements capturing the dynamic functioning of multiple physiological systems have added value in assessing physical resilience in clinical practice, especially those monitoring mental responses. Improved monitoring and prediction of physical resilience could help target intensive treatment options and subsequent geriatric rehabilitation to patients who will most likely benefit from them.Copyright © 2019 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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