Skip to main content

Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey



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.


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.


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.


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.

This is a preview of subscription content, access via your institution.


  1. 1.

    Brown, D. W., et al. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389–396.

    Article  PubMed  Google Scholar 

  2. 2.

    Chapman, D. P., et al. (2011). Adverse childhood experiences and sleep disturbances in adults. Sleep Medicine, 12(8), 773–779.

    Article  PubMed  Google Scholar 

  3. 3.

    Chartier, M. J., Walker, J. R., & Naimark, B. (2010). Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abuse and Neglect, 34(6), 454–464.

    Article  PubMed  Google Scholar 

  4. 4.

    Felitti, V. J., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Thurston, R. C., et al. (2014). Abuse and subclinical cardiovascular disease among midlife women: The study of women’s health across the nation. Stroke, 45(8), 2246–2251.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Widom, C. S., et al. (2012). A prospective investigation of physical health outcomes in abused and neglected children: New findings from a 30-year follow-up. American Journal of Public Health, 102(6), 1135–1144.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Maschi, T., et al. (2013). The aftermath of childhood trauma on late life mental and physical health: A review of the literature. Traumatology: An International Journal, 19(1), 49–64.

    Article  Google Scholar 

  8. 8.

    Slopen, N., et al. (2014). Childhood adversity, adult neighborhood context, and cumulative biological risk for chronic diseases in adulthood. Psychosomatic Medicine, 76(7), 481–489.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Waite, R., Davey, M., & Lynch, L. (2013). Self-rated health and association with ACES. Journal of Behavioral Health, 2(3), 197–205.

    Google Scholar 

  10. 10.

    Gawronski, K. A., Kim, E. S., & Miller, L. (2014). Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits. Journal of Psychosomatic Research, 77(2), 90–96.

    Article  PubMed  Google Scholar 

  11. 11.

    Seery, M. D., et al. (2010). Lifetime exposure to adversity predicts functional impairment and healthcare utilization among individuals with chronic back pain. Pain, 150(3), 507–515.

    Article  PubMed  Google Scholar 

  12. 12.

    Bellis, M. A., et al. (2014). Adverse childhood experiences: Retrospective study to determine their impact on adult health behaviours and health outcomes in a UK population. Journal of Public Health, 36(1), 81–91.

    Article  PubMed  Google Scholar 

  13. 13.

    Miles, T. P., et al. (2014). In a longevity society, loss and grief are emerging risk factors for health care use findings from the health and retirement survey cohort aged 50 to 70 Years. American Journal of Hospice and Palliative Medicine, 1–6.

  14. 14.

    Rostila, M., Saarela, J., & Kawachi, I. (2013). Mortality from myocardial infarction after the death of a sibling: a nationwide follow-up study from Sweden. Journal of the American Heart Association, 2(2), e000046.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Krause, N., Shaw, B. A., & Cairney, J. (2004). A descriptive epidemiology of lifetime trauma and the physical health status of older adults. Psychology and Aging, 19(4), 637.

    Article  PubMed  Google Scholar 

  16. 16.

    Nygren, B., et al. (2005). Resilience, sense of coherence, purpose in life and self-transcendence in relation to perceived physical and mental health among the oldest old. Aging & Mental Health, 9(4), 354–362.

    CAS  Article  Google Scholar 

  17. 17.

    Lamond, A. J., et al. (2008). Measurement and predictors of resilience among community-dwelling older women. Journal of Psychiatric Research, 43(2), 148–154.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Ward, M. M. (2012). Sense of control and sociodemographic differences in self-reported health in older adults. Quality of Life Research, 21(9), 1509–1518.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Windle, G., Markland, D. A., & Woods, R. T. (2008). Examination of a theoretical model of psychological resilience in older age. Aging and Mental Health, 12(3), 285–292.

    Article  PubMed  Google Scholar 

  20. 20.

    Netuveli, G., et al. (2008). Mental health and resilience at older ages: Bouncing back after adversity in the British Household Panel Survey. Journal of Epidemiology and Community Health, 62(11), 987–991.

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Lavretsky, H. (2012). Resilience, stress, and mood disorders in old age. Annual Review of Gerontology and Geriatrics, 32(1), 49–72.

    Article  Google Scholar 

  22. 22.

    Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior, 51(Suppl), 41–53.

    Article  Google Scholar 

  23. 23.

    Cicchetti, D. (2010). Resilience under conditions of extreme stress: A multilevel perspective. World Psychiatry, 9(3), 145–154.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Karatoreos, I. N., & McEwen, B. S. (2013). Annual research review: The neurobiology and physiology of resilience and adaptation across the life course. Journal of Child Psychology and Psychiatry, 54(4), 337–347.

    Article  PubMed  Google Scholar 

  25. 25.

    Aldwin, C., & Igarashi, H. (2012). An ecological model of resilience in late life. Annual Review of Gerontology and Geriatrics, 32(1), 115–130.

    Article  Google Scholar 

  26. 26.

    McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences, 896, 30–47.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Uchino, B. N. (2006). Social support and health: A review of physiological processes potentially underlying links to disease outcomes. Journal of Behavioral Medicine, 29(4), 377–387.

    Article  PubMed  Google Scholar 

  28. 28.

    Benka, J., et al. (2014). Social support as a moderator of functional disability’s effect on depressive feelings in early rheumatoid arthritis: A four-year prospective study. Rehabilitation Psychology, 59(1), 19–26.

    Article  PubMed  Google Scholar 

  29. 29.

    Dinicola, G., et al. (2013). The role of social support in anxiety for persons with COPD. Journal of Psychosomatic Research, 74(2), 110–115.

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7), e1000316.

    Article  Google Scholar 

  31. 31.

    Hughes, B. M., & Howard, S. (2009). Social support reduces resting cardiovascular function in women. Anxiety, Stress, and Coping, 22(5), 537–548.

    Article  PubMed  Google Scholar 

  32. 32.

    Bowen, K. S., et al. (2014). The stress-buffering effects of functional social support on ambulatory blood pressure. Health Psychology, 33(11), 1440–1443.

    Article  PubMed  PubMed Central  Google Scholar 

  33. 33.

    Kiecolt-Glaser, J. K., et al. (1991). Spousal caregivers of dementia victims: Longitudinal changes in immunity and health. Psychosomatic Medicine, 53(4), 345–362.

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Miyazaki, T., et al. (2005). Association between perceived social support and Th1 dominance. Biological Psychology, 70(1), 30–37.

    Article  PubMed  Google Scholar 

  35. 35.

    Pearlin, L. I., et al. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583–594.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Bergland, A., Nicolaisen, M., & Thorsen, K. (2014). Predictors of subjective age in people aged 40–79 years: A five-year follow-up study. The impact of mastery, mental and physical health. Aging & Mental Health, 18(5), 653–661.

    Article  Google Scholar 

  37. 37.

    Krokavcova, M., et al. (2008). Mastery, functional disability and perceived health status in patients with multiple sclerosis. European Journal of Neurology, 15(11), 1237–1244.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Byma, E. A., et al. (2009). The effects of mastery on pain and fatigue resolution. Oncology Nursing Forum, 36(5), 544–552.

    Article  PubMed  Google Scholar 

  39. 39.

    Kurtz, M. E., et al. (2008). Patient optimism and mastery-do they play a role in cancer patients’ management of pain and fatigue? Journal of Pain and Symptom Management, 36(1), 1–10.

    Article  PubMed  Google Scholar 

  40. 40.

    Mausbach, B. T., et al. (2008). The moderating effect of personal mastery and the relations between stress and Plasminogen Activator Inhibitor-1 (PAI-1) antigen. Health Psychology, 27(2 Suppl), S172–S179.

    Article  PubMed  Google Scholar 

  41. 41.

    Roepke, S. K., & Grant, I. (2011). Toward a more complete understanding of the effects of personal mastery on cardiometabolic health. Health Psychology, 30(5), 615–632.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Surtees, P. G., et al. (2010). Mastery is associated with cardiovascular disease mortality in men and women at apparently low risk. Health Psychology, 29(4), 412–420.

    Article  PubMed  Google Scholar 

  43. 43.

    Mausbach, B. T., et al. (2008). A 5-year longitudinal study of the relationships between stress, coping, and immune cell beta(2)-adrenergic receptor sensitivity. Psychiatry Research, 160(3), 247–255.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Löfvenmark, C., et al. (2009). Perceived loneliness and social support in patients with chronic heart failure. European Journal of Cardiovascular Nursing, 8(4), 251–258.

    Article  PubMed  Google Scholar 

  45. 45.

    Murray, C. J., et al. (2013). The state of US health, 1990–2010: Burden of diseases, injuries, and risk factors. JAMA, 310(6), 591–606.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Turner, R. J., Wheaton, B., & Lloyd, D. A. (1995). The epidemiology of social stress. American Sociological Review, 60(1), 104–125.

    Article  Google Scholar 

  47. 47.

    Ward, M. M. (2013). Sense of control and self-reported health in a population-based sample of older Americans: Assessment of potential confounding by affect, personality, and social support. International Journal of Behavioral Medicine, 20(1), 140–147.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Juster, R.-P., McEwen, B. S., & Lupien, S. J. (2010). Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience and Biobehavioral Reviews, 35(1), 2–16.

    Article  PubMed  Google Scholar 

  49. 49.

    Karlamangla, A. S., et al. (2002). Allostatic load as a predictor of functional decline: MacArthur studies of successful aging. Journal of Clinical Epidemiology, 55(7), 696–710.

    Article  PubMed  Google Scholar 

  50. 50.

    Golden, J., Conroy, R. M., & Lawlor, B. A. (2009). Social support network structure in older people: Underlying dimensions and association with psychological and physical health. Psychology, Health & Medicine, 14(3), 280–290.

    Article  Google Scholar 

  51. 51.

    McLaughlin, K. A., et al. (2010). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: A test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine, 40(10), 1647–1658.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  52. 52.

    Putnam, K. T., Harris, W. W., & Putnam, F. W. (2013). Synergistic childhood adversities and complex adult psychopathology. Journal of Traumatic Stress, 26(4), 435–442.

    Article  PubMed  Google Scholar 

  53. 53.

    Olofsson, N. (2014). A life course model of self-reported violence exposure and ill-health with a public health problem perspective. AIMS Public Health, 1(1), 9–24.

    Google Scholar 

  54. 54.

    Stein, D. J., et al. (2010). Early childhood adversity and later hypertension: Data from the World Mental Health Survey. Annals of Clinical Psychiatry: Official Journal of the American Academy of Clinical Psychiatrists, 22(1), 19.

    Google Scholar 

  55. 55.

    Taylor, S. E. (2010). Mechanisms linking early life stress to adult health outcomes. Proceedings of the National Academy of Sciences, 107(19), 8507–8512.

    CAS  Article  Google Scholar 

  56. 56.

    Montez, J. K., & Hayward, M. D. (2014). Cumulative childhood adversity, educational attainment, and active life expectancy among US adults. Demography, 51(2), 413–435.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Bonanno, G. A. (2012). Uses and abuses of the resilience construct: Loss, trauma, and health-related adversities. Social Science and Medicine, 74(5), 753–756.

    Article  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Toni P. Miles.

Additional information

A. Ezeamama and J. Elkins equally share first author status.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 33 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ezeamama, A.E., Elkins, J., Simpson, C. et al. Indicators of resilience and healthcare outcomes: findings from the 2010 health and retirement survey. Qual Life Res 25, 1007–1015 (2016).

Download citation


  • Midlife
  • Public health
  • Comorbid conditions
  • Resilience
  • Healthcare utilization
  • Health and retirement survey