{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T13:46:11Z","timestamp":1789393571271,"version":"build-2803163510"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K23AG065438"],"award-info":[{"award-number":["K23AG065438"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["K24AG068312"],"award-info":[{"award-number":["K24AG068312"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P01AG066605"],"award-info":[{"award-number":["P01AG066605"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["P30AG044281"],"award-info":[{"award-number":["P30AG044281"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG079982"],"award-info":[{"award-number":["R01AG079982"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32\u2010AG000212"],"award-info":[{"award-number":["T32\u2010AG000212"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Distressing symptoms are common in the last year of life and contribute substantially to suffering for older adults and their families. While psychological resilience has been linked to better aging outcomes, its association with end\u2010of\u2010life symptom burden is not well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using nationally representative data from the Health and Retirement Study (2006\u20132022). The cohort included 4466 decedents aged \u2265\u200950\u2009years with next\u2010of\u2010kin\u2013reported symptoms in the last year of life and psychological resilience assessed on average 2\u2009years before death. Psychological resilience was measured using a validated 12\u2010item scale and categorized into quartiles. Outcomes included 12 end\u2010of\u2010life symptoms grouped into physical, neuropsychiatric, and functional domains. The primary outcome was high symptom burden, defined as seven or more symptoms. Associations were estimated using survey\u2010weighted Poisson regression with robust standard errors, adjusting for sociodemographic, clinical, and functional covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Decedents were on average 76\u2009years old, 50% female, and 16% non\u2010White. Resilience scores averaged 8.4 (SD, 1.91; median, 8.5). Higher resilience was associated with lower prevalence of end\u2010of\u2010life symptom burden. In adjusted models, high symptom burden was present in 31.1% (95% CI, 28.0\u201334.2) of those in the lowest resilience quartile and 19.6% (95% CI, 16.8\u201322.4) of those in the highest (\n                      <jats:italic>P<\/jats:italic>\n                      for trend &lt;\u20090.001). Predicted probabilities demonstrated notable gradients of symptom prevalence across quartiles for depression (57.9% vs. 36.5%), severe fatigue (66.1% vs. 56.7%), incontinence (45.0% vs. 35.0%), and pain (56.1% vs. 47.4%). Associations were absent for symptoms such as appetite loss and vomiting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this nationally representative cohort, high psychological resilience measured before death was associated with lower symptom burden across multiple domains in the last year of life. Resilience assessment may help identify individuals at risk for distressing end\u2010of\u2010life experiences and inform interventions to bolster late\u2010life resilience.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70631","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:59:06Z","timestamp":1787684346000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Psychological Resilience and End\u2010of\u2010Life Symptom Burden: Evidence From a National Cohort Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0705-2569","authenticated-orcid":false,"given":"Niousha Bastian Elio","family":"Omid","sequence":"first","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6137-8512","authenticated-orcid":false,"given":"Ashwin A.","family":"Kotwal","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5839-1070","authenticated-orcid":false,"given":"Irena","family":"Cenzer","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-9526","authenticated-orcid":false,"given":"John","family":"Boscardin","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"},{"name":"San Francisco Veterans Affairs Medical Center  San Francisco California USA"},{"name":"Department of Epidemiology and Biostatistics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-2173","authenticated-orcid":false,"given":"Lauren J.","family":"Hunt","sequence":"additional","affiliation":[{"name":"Philip R. Lee Institute for Health Policy Studies, University of California  San Francisco California USA"},{"name":"Global Brain Health Institute University of California  San Francisco California USA"},{"name":"Department of Physiological Nursing University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9276-0861","authenticated-orcid":false,"given":"Alexander K.","family":"Smith","sequence":"additional","affiliation":[{"name":"Division of Geriatrics University of California, San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003\u20104819\u2010153\u20109\u2010201011020\u201000005"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2005.06.007"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.291.1.88"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.300.14.1665"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0134"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/jco.2014.58.7824"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnu068"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/smi.3260"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2024.04.039"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1037\/0882\u20107974.19.4.637"},{"issue":"1","key":"e_1_2_11_12_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjment-2024-301064","article-title":"Association Between Psychological Resilience and All\u2010Cause Mortality in the Health and Retirement Study","volume":"27","author":"Zhang A.","year":"2024","journal-title":"BMJ Mental Health"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2008.03.007"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18388"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1037\/a0019384"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2017.04.009"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13060581"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1089\/jicm.2023.0328"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00432\u2010007\u20100195\u2010z"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.comppsych.2014.07.022"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00702\u2010013\u20101154\u20102"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1017\/s0954579423001293"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbae197"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102017\u2010017858"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2021.01.027"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.09.123"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/workar\/wax032"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00038\u2010011\u20100294\u20100"},{"issue":"2","key":"e_1_2_11_29_1","first-page":"165","article-title":"Development and Psychometric Evaluation of the Resilience Scale","volume":"1","author":"Wagnild G. 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