TOPLINE

Greater ability to utilize psychological strengths and social support to adapt during challenging times, measured approximately 2 years before death, was associated with lower end-of-life symptom burden among adults aged 50 years or older.

METHODOLOGY

• Researchers retrospectively analyzed data from the Health and Retirement Study (2006-2022), including 4466 community-dwelling decedents (mean age, 76.1 years; 49.7% women), to assess the association of resilience with end-of-life symptom burden.
• Data on psychological resilience were obtained from a mail-in questionnaire, administered an average of 2 years before death. Next of kin confirmed the burden of symptoms during exit interviews following the participants' deaths.
• Psychological resilience was measured using a validated 12-item Simplified Resilience Score and categorized into quartiles ranging from lowest to highest resilience.
• The presence of 12 end-of-life symptoms was assessed, with symptoms grouped into physical (pain, difficulty breathing, appetite loss, vomiting, and cough), neuropsychiatric (depression, confusion, difficulty awakening, and uncontrolled temper), and functional impairment (fatigue, loss of control of the bowel or bladder, and difficulty controlling the arms/legs) domains.
• High symptom burden was defined as seven or more symptoms.

TAKEAWAY

• Higher resilience was associated with a lower prevalence of high symptom burden in adjusted analysis (P for trend < .001). High symptom burden was present in 31.1% of those with the lowest resilience vs 19.6% of those with the highest resilience.
• Neuropsychiatric symptoms showed the strongest link with resilience, with depression present in 57.9% of those with the lowest resilience vs 36.5% of those with the highest resilience (P for trend < .001).
• Among those with the highest vs lowest resilience, severe fatigue (56.7% vs 66.1%; P for trend = .001) and incontinence (35.0% vs 45.0%; P for trend < .001) were also noted less frequently.
• Pain was present in 56.1% of individuals with the lowest resilience vs 47.4% of those with the highest resilience (P for trend < .001).

IN PRACTICE

"[The study] findings establish resilience as a measurable and potentially modifiable determinant of the quality of dying," the researchers wrote.

SOURCE

The study was led by Niousha Bastian Elio Omid, of the Division of Geriatrics, at University of California, San Francisco. It was published online on August 25, 2026, in the Journal of the American Geriatrics Society.

LIMITATIONS

Reliance on symptoms reported by next-of-kin may introduce recall bias and underreporting of less observable symptoms. Participants who did not have a next-of-kin respondent were excluded.

DISCLOSURES

Four authors reported being supported by grants from the National Institute on Aging. One of these authors reported personal consulting fees from Papa Inc. Another author was supported by Beeson.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.