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Rehabilitation After Urgent or Elective Orthopedic Surgery: The Role of Resilience in Elderly Patients

An investigation published in RNJ seeks to identify what role resilience plays in the rehabilitation outcomes of elderly people

In general, resilience is thought of as the capacity to bounce back from injury or trauma. With regard to older adults, resilience can be described as the ability to achieve, retain, or regain a level of physical or emotional health after illness.  

Because aging is characterized by many physical, social, and psychological challenges—it was a period that needed further investigation into the mechanics of resilience. Assessing resilience could also provide clinicians with more insight into better managing the rehabilitation of geriatric patients.

The rehabilitation department of the Istituto Ortopedico Gaetano Pini in Milan, Italy conducted an open study of 80 patients, 60 years and older, hospitalized between December 1, 2013, and May 31, 2014.

Their findings, published in the September 2018 issue of Rehabilitation Nursing Journal, look at the role of resilience in our elderly population during the course of post-acute rehabilitation for orthopedic surgery, and to identify differences in the role of resilience on rehabilitation outcomes between the group of hip fracture patients and people undergoing elective surgery (total knee arthroplasty or total hip arthroplasty). Their study focuses on elderly people who sustained an orthopedic surgery and were hospitalized in a rehabilitation ward. 

More than 50% of patients don't return to their pre-fracture functional level 

The researchers discuss the benefits of a routine resiliency assessment for geriatric patients. Introducing screening for low resilience enables patients with lower rehabilitation potential to be identified. Failing to identify these patients can be a missed opportunity to improve their functional recovery.

Resilient people perceive stressful events differently 

The RNJ article also notes that stressful events such as hip fractures are perceived differently by those who consider themselves to be resilient. Strengthening a person's resilience can facilitate successful aging, leading to quicker recovery following acute events such as hip fracture, stroke, or traumatic brain injury.

Healthcare providers are in a unique position to improve resilience in older adults, as they often spend the most time with these patients. Providing resilience tutoring and training can be an important part of their treatment program.

The Istituto Ortopedico Gaetano Pini's study outlines four key factors that were discovered:

  • Hip-fractured persons were significantly older, more clinically fragile, and less resilient than elective orthopedic surgery patients.
  • Low resilience was associated with poorer rehabilitation outcomes in elderly hip-fractured patients, unlike elective patients.
  • Measure of the resilience level should be introduced in the routine clinical assessment of future outcome studies in rehabilitation.
  • RS-10 offers a short and easily administered questionnaire to measure level of resilience among older people.

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