Social
Examining Resilience Factors, Discrimination, and Comorbidity Severity Among Older Adults in the United States Isabella Tullio* Isabella Tullio Tullio Tullio Tullio Tullio Department of Epidemiology, University of Delaware, Newark, DE, USA
Background: Discrimination contributes to a greater comorbidity burden among older adults. Resilience resources may buffer these effects and support adaptation to health challenges.
Objective: To examine associations between resilience factors and comorbidity burden, measured by the Charleston Comorbidity Index (CCI), among middle-aged and older adults, and to assess whether this relationship differed by experiences of age-, gender-, or race-based discrimination.
Methods: A total of 2,926 adults aged ≥50 years from seven mid-Atlantic states completed an online cross-sectional survey. Exposures included resilience (Brief Resilience Scale), self-efficacy, social support, trust in the medical profession, and social cohesion (high/moderate versus low). CCI was categorized as low (no/mild) or high (moderate/severe). Adjusted logistic regression models estimated the odds of high versus low CCI, and product terms assessed effect modification by discrimination type.
Results: Negative relationships between higher versus lower self-efficacy (adjusted OR = 0.91, 95% CI: 0.70–1.17), social support (0.89, 0.70–1.11), and resilience (0.79, 0.51–1.22), and higher CCI were most compatible with the data. Positive relationships were observed for trust in medical professions (1.13, 0.90-1.42) and social cohesion (1.15, 0.92-1.44). Our assessment for effect modification showed that race-based discrimination modified the association between self-efficacy and CCI (p = 0.003). Among those reporting race-based discrimination, high self-efficacy was associated with lower odds of high CCI (0.30, 0.14–0.65) while a null relationship among those with no race-based discrimination was most compatible (1.03, 0.78-1.35).
Conclusion: Our findings were mixed. However, self-efficacy may be beneficial among those experiencing race-based discrimination. Prospective studies on the role of resilience in mitigating negative impacts of discrimination in shaping health outcomes among older adults are needed.