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The Impact of Psychological Status, Social Well‐Being, and Physical Function on Healthcare Utilization

Two articles 1,2 in this issue explore the impact of psychological, social, and functional factors on unplanned hospitalizations and other types of healthcare utilization. The article by Straatmann et al is based on data from the Swedish National Study on Aging and Care in Kungsholmen and evaluates 2139 older adults over 4 years. The authors developed standardized indexes of psychological well-being (integrating life satisfaction and positive and negative affect) and social well-being (including social connections, social support, and participation) and hypothesized that older adults with high psychological and social well-being would have a lower risk of unplanned hospital use, and individuals with both high psychological and high social well-being would have the greatest protective effect against unplanned hospital use. The hypotheses were supported in this study. Specifically, when controlling for age, sex, education and occupation, health status, personality based on the NEO Five-Factor Inventory (which describes individuals as being in one of three categories: extraversion, neuroticism, and openness), and alcohol and nicotine use, higher levels of psychological well-being were associated with fewer unplanned admissions and fewer hospital days. Psychological well-being was defined by the research team to include valid assessments of life satisfaction and positive and negative affect. Evaluated alone, social well-being (based on an assessment that included social connections, social support, and social participation) was not associated with hospital utilization. There was, however, a combined effect such that those with high levels of both psychological and social well-being showed the lowest rates of unplanned hospital admissions and shorter lengths of stay. These findings make good logical sense, although it is useful to consider closely what is actually being measured with regard to psychological and social factors. The authors refer to their assessment as “psychological well-being,” although it seems what they really measured was resilience. The measures used to evaluate psychological well-being were the Life Satisfaction Index A and the Positive and Negative Affect Schedule (PANAS). The components of both of these measures are consistent with the definition of and personality components of resilience. Specifically, the Life Satisfaction Index A considers zest vs apathy; resolution and fortitude; congruence between desired and achieved goals; positive self-concept; and mood tone. The PANAS measure evaluates the following positive affect behaviors within individuals: active, inspired, determined, alert, and enthusiastic. Negative affect was also evaluated and included the extent to which a person was distressed, upset, scared, or nervous. By definition, resilience is “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress.” Being resilient indicates that the individual has the human ability to adapt in the face of tragedy, trauma, adversity, hardship, and ongoing significant life stressors. The same factors measured in this study are considered to be factors or qualities within individuals that are associated with resilience. These include such things as positive interpersonal relationships, building social connectedness with a willingness to work with others, strong internal resources, having an optimistic or positive perspective about life and challenges encountered throughout the lifespan, maintaining realistic expectations, setting achievable goals and working toward those goals consistently, high self-esteem or self-concept, high self-efficacy, and determination. Thus, the findings from this study support the need to continue to focus on developing interventions to strengthen resilience. In so doing, we may be able to facilitate the behaviors needed to remain at home following hospitalization and assure short lengths of stay when hospitalized. These behaviors include engaging in function and physical activities while hospitalized and in the posthospitalization period, adhering to appropriate treatment recommendations, and consuming appropriate nutrition and fluid intake. The lack of significance between social well-being (ie, social connections, social support, and social participation) and unplanned hospitalizations and lengths of stay was likewise not surprising. Social well-being, as measured in this study, focused on the individual’s social network, whether the individual was satisfied with that network and the material or psychological support provided, the sense of affinity with the individual’s social network, and the individual’s participation in social activities. The evaluation did not indicate what the “social support” or caregiver may have done with regard to care giving, what his or her skill set and comfort was with providing care in the home DOI: 10.1111/jgs.16331