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Report: NIA Workshop on Measures of Physiologic Resiliencies in Human Aging
Open accessAbstract
BACKGROUND/OBJECTIVES: Resilience, the ability to resist or recover from adverse effects of a stressor, is of widespread interest in social, psychologic, biologic, and medical research and particularly salient as the capacity to respond to stressors becomes diminished with aging. To date, research on human resilience responses to and factors influencing these responses has been limited. METHODS: The National Institute on Aging convened a workshop in August 2015 on needs for research to improve measures to predict and assess resilience in human aging. Effects of aging-related factors in impairing homeostatic responses were developed from examples illustrating multiple determinants of clinical resilience outcomes. Research directions were identified by workshop participants. RESULTS: Research needs identified included expanded uses of clinical data and specimens in predicting or assessing resilience, and contributions from epidemiological studies in identifying long-term predictors. Better measures, including simulation tests, are needed to assess resilience and its determinants. Mechanistic studies should include exploration of influences of biologic aging processes on human resiliencies. Important resource and infrastructure needs include consensus phenotype definitions of specific resiliencies, capacity to link epidemiological and clinical resilience data, sensor technology to capture responses to stressors, better laboratory animal models of human resiliencies, and new analytic methods to understand the effects of multiple determinants of stress responses. CONCLUSIONS: Extending the focus of care and research to improving the capacity to respond to stressors could benefit older adults in promoting a healthier life span.
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“Interlinked and fundamental aging processes appear to be a root-cause contributor to many disorders and diseases.”
From Cellular senescence and senolytics: the path to the clinic (2022) · cites this paper as [17]
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“The Geroscience Hypothesis holds that these pillars of aging, including cellular senescence, tend to progress in concert and may be root-cause contributors to the pathophysiology of multiple diseases”
From Cellular senescence and senolytics: the path to the clinic (2022) · cites this paper as [17]
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Cited by
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Cellular senescence and senolytics: the path to the clinic
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Self-citationMurine single-cell RNA-seq reveals cell-identity- and tissue-specific trajectories of aging
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Wissler Gerdes, E. O., Zhu, Y., Tchkonia, T., & Kirkland, J. L. (2020) · The FEBS Journal · doi:10.1111/febs.15264 · Cited by 160
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Ferrucci, L., & Kuchel, G. A. (2021) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17011 · Cited by 159
“Aging can be conceptualized as a dynamic accumulation of molecular and cellular damage that is continuously counteracted by resilience strategies that have been evolutionarily selected for their ability to maintain homeostasis and function in the face of varied stressors.(9) This dynamic process is expressed across ma…”
BackgroundSelf-citationPhysical Resilience: Not Simply the Opposite of Frailty
Whitson, H. E., Cohen, H. J., Schmader, K. E., Morey, M. C., Kuchel, G. A., & Colon-Emeric, C. S. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15233 · Cited by 133
“physical resilience focuses on maintenance or recovery of function after biomedical or pathological challenges.(6) Physical resilience is presumed to reflect adaptive physiological responses at the level of organs, cells, and molecules (e.”
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The clinical impact and biological mechanisms of skeletal muscle aging
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“Resilience has been defined in the recent gerontological literature as “a characteristic which determines one’s ability to resist or recover from functional decline following health stressor(s)”(10) and “the ability to resist or recover from adverse effects of a stressor”.(11) An important distinction has been made be…”
Self-citationTargeting Cell Senescence and Senolytics: Novel Interventions for Age-Related Endocrine Dysfunction
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Resilience And Successful Aging
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“Although psychological and social stressors such as discrimination and bereavement are also associated with functional decline, recent work has focused on physical stressors to facilitate identification of underlying mechanisms of recovery (2).”
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Lima, G. S., Figueira, A. L. G., de Carvalho, E. C., Kusumota, L., & Caldeira, S. (2023) · Healthcare · doi:10.3390/healthcare11182491 · Cited by 59
“…also found, such as “resilience protective factors” [21], “resilience factors” [82], “physical resilience” [72,83–85], “biological re-silience” [84], “health resilience” [72], “resilience of quality of life” [71], “resilient reintegra-tion” [72], “spiritual resilience” [44], “cultural…”
System models for resilience in gerontology: application to the COVID-19 pandemic
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“In this issue of the Journal of Gerontology, Hadley, Kuchel, and Newman provide a summary of the National Institute on Aging (NIA) Workshop on Measures of Physiologic Resiliencies in Human Aging (2).”
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Resiliency Groups Following Hip Fracture in Older Adults
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“Resilience within the discussion of health is the ability to resist or recover from adverse events after an acute or chronic health stressor (Figure 1) (216, 573, 612, 613).”
Resilience and Intrinsic Capacity in Older Adults: A Review of Recent Literature
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“Resilience is defined as the ability of an organism to respond to stress (29,30).”
BackgroundResilience integrates concepts in aging research
Promislow, D., Anderson, R. M., Scheffer, M., Crespi, B. J., DeGregori, J. V., Harris, K., Natterson-Horowitz, B., Levine, M. E., Riolo, M. A., Schneider, D. S., et al. (2022) · iScience · doi:10.1016/j.isci.2022.104199 · Cited by 40
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“Recent interest in the development of protocols for measurement of dynamic physiological resilience introduces a challenge in standardization (ie, ensuring the stressor is physiologically equivalent for all demographics).(30,31) The data herein suggest that the physiological stressor posed by the active stand differs…”
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Self-citationThe aging bladder phenotype is not the direct consequence of bladder aging
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Goel, K., O’Leary, J., Barker, C. M., Levack, M. M., Rajagopal, V., Makkar, R., BAJWA, T. K., Kleiman, N. S., Linke, A. H.-P., Kereiakes, D. J., et al. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.017075 · Cited by 25
“16,17 Specifically, we evaluated gait speed at baseline and 1 year after TAVR, the predictors of change in gait speed, and the associations with mortality and hospitalizations between 1 and 2 years.”
Wu, C., Kim, D. H., Xue, Q., Lee, D. S. H., Varadhan, R., & Odden, M. C. (2018) · The Journals of Gerontology Series A · doi:10.1093/gerona/gly080 · Cited by 27
Self-citationAging-related Resiliency Theory Development
Feliciano, E. E., Feliciano, A., Palompon, D. R., & Boshra, A. (2021) · Belitung Nursing Journal · doi:10.33546/bnj.1631 · Cited by 25
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Self-citationCreating the Next Generation of Translational Geroscientists
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“Geroscience clinical trials, as envisaged by the Geroscience Network retreats, would target integrative, multisystem phenotypes of aging, such as geriatric syndromes,(8) multimorbidity, or resilience to acute health stressors.(9) The pathophysiology being targeted is aging, not a particular disease.”
BackgroundSelf-citationPathways, Contributors, and Correlates of Functional Limitation Across Specialties: Workshop Summary
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“As discussed at a 2015 National Institute on Aging workshop (23), a stressor such as an illness or accident causes functional decline from an initial level to a nadir, followed by some Journals of Gerontology: MEDICAL SCIENCES, 2019, Vol.”
BackgroundSelf-citationPredictive Validity of the Physical Resilience Instrument for Older Adults (PRIFOR)
Hu, F., Lin, C., Lin, C. H., et al. (2021) · The journal of nutrition health & aging · doi:10.1007/s12603-021-1667-6 · Cited by 22
Modelling physical resilience in ageing mice
Schosserer, M., Banks, G. T., Doğan, S., Dungel, P., Fernandes, A. M. A., Marolt, D., Matheu, A., Osuchowski, M. F., Potter, P. K., Sanfeliu, C., et al. (2018) · Mechanisms of Ageing and Development · doi:10.1016/j.mad.2018.10.001 · Cited by 21
“In our view, challenging ageing mice after administration of geroprotectors matches the clinical situation more closely than challenging young mice even if using harsher stressors as suggested by others (Hadley et al., 2017; Kirkland et al., 2016; LeBrasseur, 2017).”
BackgroundRikkert, M. G. M. O., & Melis, R. J. F. (2019) · Frontiers in Physiology · doi:10.3389/fphys.2019.00723 · Cited by 20
Coverage hole detection method of wireless sensor network based on clustering algorithm
Wang, F., & Hu, H. (2021) · Measurement · doi:10.1016/j.measurement.2021.109449 · Cited by 20
Risk Factors for Nonresilient Outcomes in Older Adults After Total Knee Replacement
Laskow, T. C., Zhu, J., Buta, B. J., et al. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab257 · Cited by 18
Self-citationExercise for patients with chronic kidney disease: from cells to systems to function
Gollie, J. M., Ryan, A. S., Sen, S., Patel, S. S., Kokkinos, P. F., Harris‐Love, M. O., Scholten, J. D., & Blackman, M. R. (2024) · American Journal of Physiology-Renal Physiology · doi:10.1152/ajprenal.00302.2023 · Cited by 21
Development of a person-centered conceptual model of perceived fatigability
Kratz, A. L., Murphy, S. L., Braley, T. J., Basu, N., Kulkarni, S., Russell, J., & Carlozzi, N. E. (2019) · Quality of Life Research · doi:10.1007/s11136-018-2093-z · Cited by 18
The older adult surgical patient: a review of optimization and gaps in clinical practice
Canales, C., Wann, L., Blitz, J. D., & Whittington, R. A. (2025) · Perioperative Medicine · doi:10.1186/s13741-025-00593-x · Cited by 20
“For years, perioperative clinicians have been calling for routine preoperative assessment of older adults, focusing on cognitive changes, frailty, and nutrition (Chow et al. 2012; Oresanya et al. 2014; McIsaac et al. 2017; Berger et al. 2018; Hadley et al. 2017; Persico et al. 2018).”
Koivunen, K., Sillanpää, E., von Bonsdorff, M. B., Sakari‐Rantala, R., Törmäkangas, T., & Rantanen, T. (2019) · The Journals of Gerontology Series A · doi:10.1093/gerona/glz251 · Cited by 17
Taylor, H. A., Washington-Plaskett, T., & Quyyumi, A. A. (2020) · Ethnicity & Disease · doi:10.18865/ed.30.2.365 · Cited by 17
Defining Resilience in Older People: Does a Subjective Definition of Stressor Work?
Pedone, C., Costanzo, L., Finamore, P., et al. (2020) · The Journals of Gerontology Series A · doi:10.1093/gerona/glaa189 · Cited by 17
“Resilience has been increasingly recognized as a fundamental determinant of successful aging (4), and the National Institute of Aging indicates it as a priority research topic (5).”
BackgroundSelf-citationReitz, K. M., Seymour, C. W., Vates, J., Quintana, M., Viele, K., Detry, M. A., Morowitz, M. J., Morris, A., Methé, B. A., Kennedy, J. N., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-037690 · Cited by 17
Self-citationKatsiferis, A., Bhatt, S., Mortensen, L. H., Mishra, S., & Westendorp, R. G. J. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282892 · Cited by 16
Cesari, M., Azzolino, D., LeBrasseur, N. K., Whitson, H. E., Rooks, D., Sourdet, S., Angioni, D., Fielding, R. A., Vellas, B. J., Rolland, Y., et al. (2022) · The Journal of Frailty & Aging · doi:10.14283/jfa.2022.62 · Cited by 16
Self-citationFunction Begets Function and Resilience in Old Age: Is Precision Gerontology Possible?
Kuchel, G. A. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14901 · Cited by 16
Self-citationSenescence in the lung: is this getting old?
Morty, R. E., & Prakash, Y. S. (2019) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.00081.2019 · Cited by 15
Farrell, S., Kane, A. E., Bisset, E. S., Howlett, S. E., & Rutenberg, A. D. (2022) · eLife · doi:10.7554/elife.77632 · Cited by 16
“Reduced resilience, or the decreasing ability to repair damage (or recover from stressors), is increasingly seen as a key manifestation of organismal aging (Ukraintseva et al., 2021; Kirkland et al., 2016; Hadley et al., 2017).”
BackgroundThe Quest for Eternal Youth: Hallmarks of Aging and Rejuvenating Therapeutic Strategies
Nunkoo, V. S., Cristian, A., Jurcău, A., Diaconu, R. G., & Jurcău, M. C. (2024) · Biomedicines · doi:10.3390/biomedicines12112540 · Cited by 15
Hladek, M. D., Zhu, J., Crews, D. C., McAdams‐DeMarco, M., Buta, B. J., Varadhan, R., Shafi, T., Walston, J. D., & Bandeen‐Roche, K. (2022) · Kidney International Reports · doi:10.1016/j.ekir.2022.06.009 · Cited by 14
“One potential way to improve mortality risk assessment is through physical resilience measurement.(7,8)”
BackgroundSelf-citationSchaaf, G. W., Justice, J. N., Quillen, E. E., & Cline, J. M. (2023) · GeroScience · doi:10.1007/s11357-023-00812-7 · Cited by 15
“Resilience is the dynamic property which enables cells, organs, and organisms to resist or recover from adverse effects of a stressor [13, 16–18].”
BackgroundMeasurement instruments for quantifying physical resilience in aging: a scoping review protocol
Peters, S., Cosco, T. D., Mackey, D. C., Sarohia, G. S., Leong, J., & Wister, A. (2019) · Systematic Reviews · doi:10.1186/s13643-019-0950-7 · Cited by 13
Social environment as a modulator of immunosenescence
Garrido, A., de Toda, I. M., Cerro, E. D., Félix, J., Ceprián, N., González-Sánchez, M., & la Fuente, M. D. (2022) · Expert Reviews in Molecular Medicine · doi:10.1017/erm.2022.24 · Cited by 14
Karlamangla, A. S., Almeida, D. M., Lachman, M. E., Merkin, S. S., Thomas, D., & Seeman, T. E. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105804 · Cited by 13
Using Physiological System Networks to Elaborate Resilience Across Frailty States
Hao, M., Zhang, H., Li, Y., Hu, X., Hu, Z., Jiang, X., Wang, J., Sun, X., Liu, Z., Davis, D., et al. (2024) · The Journals of Gerontology: Series A · doi:10.1093/gerona/glad243 · Cited by 12
Vigor to Frailty As a Continuum—A New Approach in the Study of Muscle, Mobility, and Aging Cohort
Newman, A. B., BLACKWELL, T. L., Mau, T., Cawthon, P. M., Coen, P. M., Cummings, S. R., Toledo, F. G. S., Goodpaster, B. H., Glynn, N. W., Hepple, R. T., et al. (2023) · The Journals of Gerontology Series A · doi:10.1093/gerona/glad244 · Cited by 12
Self-citationNewman, A. B., Kritchevsky, S. B., Guralnik, J. M., Cummings, S. R., Salive, M. E., Kuchel, G. A., Schrack, J. A., Morris, M. C., Weir, D. R., Baccarelli, A., et al. (2019) · The Journals of Gerontology Series A · doi:10.1093/gerona/glz230 · Cited by 12
“loss of these integrative functions with age, which may reveal changes in an individual long before loss of physical function is apparent, thus holding promise as early markers of aging (82, 83).”
BackgroundSelf-citationSkeletal muscle DNA methylation: Effects of exercise and HIV
Jankowski, C. M., Konigsberg, I. R., Wilson, M. P., Sun, J., Brown, T. T., Julian, C. G., & Erlandson, K. M. (2023) · Aging Cell · doi:10.1111/acel.14025 · Cited by 13
“…is therefore also possible that while aging with chronic HIV infec - tion (a long-term stressor), alternative mechanistic pathways in cells and tissues are activated and integrated in response to exercise training (repetitive acute stressor), suggesting biological resilience (Hadley et al., 2017 ).”
BackgroundKim, J., Park, S., & Lee, C. D. (2023) · Journal of Applied Gerontology · doi:10.1177/07334648231183772 · Cited by 14
“Re-silience refers to the ability to bounce back after a distressed event or adversity in life (Hadley et al., 2017).”
BackgroundDevelopment of the Clinical pHysical rEsilience assEssment Scale (CHEES) in Chinese Older Adults
Li, J., Liu, P., Zhang, Y., Wang, G., Zhou, Y., Xing, Y., Zhang, L., Li, Y., & Ma, L. (2024) · The Journal of Frailty & Aging · doi:10.14283/jfa.2024.24 · Cited by 10
“In contrast, those with lower physical resilience are more likely to experience poor physical functions and may even face death when exposed to stressors (4).”
Next steps: Operationalizing resilience research
Brown, L. L., Cohen, B., Costello, R. B., Brazhnik, O., & Galis, Z. S. (2023) · Stress and Health · doi:10.1002/smi.3256 · Cited by 11
Zhang, H., Hao, M., Li, Y., Hu, Z., Liu, Z., Jiang, S., Li, J., & Wang, X. (2023) · Innovation in Aging · doi:10.1093/geroni/igad118 · Cited by 9
“Hence, it is of great importance to assess PR in older adults to contribute to decision making in healthcare, such as therapeutic decision making, acute care management, rehabilitation therapy, and assessment of adverse medication effects (3).”
BackgroundO’Connor, J. D., O’Connell, M. D. L., Romero‐Ortuño, R., Hernández, B., Newman, L., Reilly, R. B., Kenny, R. A., & Knight, S. P. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2020.00261 · Cited by 9
Cohen, A. B., McAvay, G., Geda, M. E., Chattopadhyay, S., Lee, S., Acampora, D., Araujo, K. L. B., Charpentier, P. A., Gill, T. M., Hajduk, A. M., et al. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.18146 · Cited by 9
Carneiro, M. A. S., Júnior, G. N. D. O., Castro-e-Souza, P., de Oliveira, A. A., Nunes, P. R. P., Izquierdo, M., Cadore, E. L., & Cyrino, E. S. (2022) · Ageing Research Reviews · doi:10.1016/j.arr.2022.101673 · Cited by 8
Loss of resilience contributes to detrusor underactivity in advanced age
Ramasamy, R., Baker, D. S., Lemtiri‐Chlieh, F., Rosenberg, D. A., Woon, E., Al‐Naggar, I. M., Hardy, C. C., Levine, E. S., Kuchel, G. A., Bartley, J. M., et al. (2023) · Biogerontology · doi:10.1007/s10522-022-10005-y · Cited by 8
“By re-casting DU as a failure of resilient aging rather than as a detrusor disease, this mouse model offers a valuable research methodology for clinical detrusor/voiding disorders (Kirkland et al. 2016; Hadley et al. 2017).”
MethodSelf-citationMADRID+90 study on factors associated with longevity: Study design and preliminary data
Fernández‐Blázquez, M. A., del Ser, T., Payo, B. F., Ávila‐Villanueva, M., Valentí, M., Benítez-Robredo, M. T., Acuña, A. B., Pérez, E. J. P., Quilis-Sancho, J., Pastor, A. B., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0251796 · Cited by 8
“For example, evidence suggests that longevity is associated with a heterogeneous set of factors such as genetic background [4], physical exercise, especially when the Body Mass Index is between 20 and 25 kg/ m2 [5], effectiveness in managing daily stress [6], social support [7], having a purpose in life [8], first-deg…”
BackgroundLin, C., Ou, C.-H., Chang, C., & Hu, F. (2023) · The Journal of Frailty & Aging · doi:10.14283/jfa.2023.8 · Cited by 7
“Indeed, successful aging often depends on a person’s response to the inevitability of latelife stressors (1).”
BackgroundResilience, Survival, and Functional Independence in Older Adults Facing Critical Illness
Cobert, J. M., Jeon, S. Y., Boscardin, J., Chapman, A. C., Espejo, E., Maley, J. H., Lee, S. J., & Smith, A. K. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.04.039 · Cited by 7
Ravi, D. K., Heimhofer, C., Taylor, W. R., & Singh, N. B. (2021) · Frontiers in Neuroscience · doi:10.3389/fnins.2021.678965 · Cited by 9
Epigenetic Aging Helps Explain Differential Resilience in Older Adults
Klopack, E. T., & Crimmins, E. M. (2024) · Demography · doi:10.1215/00703370-11466635 · Cited by 8
Cost trajectories as a measure of functional resilience after hospitalization in older adults
Colon-Emeric, C. S., Huang, J., Pieper, C. F., et al. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01481-8 · Cited by 7
Self-citationLee, G. C., Moreira, A. G., Hinojosa, C. A., Benavides, R., Winter, C., Anderson, A. C., Chen, C.-J., Borsa, N., Hastings, G., Black, C. A., et al. (2022) · Frontiers in Aging · doi:10.3389/fragi.2022.736835 · Cited by 7
Fan, C.-W., Li, Y., Chang, C., et al. (2023) · Aging Clinical and Experimental Research · doi:10.1007/s40520-023-02547-z · Cited by 7
Metadata
- Authors
- Hadley, E. C., Kuchel, G. A., Newman, A. B., Allore, H. G., Bartley, J. M., Bergeman, C. S., Blinov, M. L., Colon-Emeric, C. S., Dabhar, F. S., Dugan, L. L., Dutta, C., Eldadah, B. A., Ferrucci, L., Kirkland, J. L., Kritchevsky, S. B., Lipsitz, L. A., Nadkarni, N. K., Reed, M. J., Schmader, K. E., Sierra, F., Studenski, S. A., Varadhan, R., Walston, J. D., Whitson, H. E., & Yung, R.
- Affiliations
- National Institutes of Health (US)
- UConn Health (US)
- University of Pittsburgh (US)
- Yale University (US)
- University of Notre Dame (US)
- University of Connecticut (US)
- Duke University (US)
- Stanford Medicine (US)
- Vanderbilt University (US)
- Mayo Clinic (US)
- Wake Forest University Health Sciences (US)
- Beth Israel Deaconess Medical Center (US)
- University of Washington (US)
- Johns Hopkins University (US)
- University of Michigan (US)
- Corresponding author
- Newman, Anne B
- ORCID
- Kuchel, George A
- Newman, Anne B
- Allore, Heather G
- Bartley, Jenna M
- Bergeman, Cindy S
- Blinov, Michael L
- Colon-Emeric, Cathleen S
- Dugan, Laura L
- Ferrucci, Luigi
- Kirkland, James L
- Kritchevsky, Stephen B
- Lipsitz, Lewis A
- Nadkarni, Neelesh K
- Reed, May J
- Schmader, Kenneth E
- Sierra, Felipe
- Studenski, Stephanie A
- Varadhan, Ravi
- Walston, Jeremy D
- Whitson, Heather E
- Yung, Raymond
- Venue
- The Journals of Gerontology: Series A
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-05-05
- Volume
- 72
- Issue
- 7
- Pages
- 980-990
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC5861884
- OpenAlex
- W2611341457
- Semantic Scholar
- 8a4b73ffa8c7090642e3d117a7432fc9e395e304
- Cited by
- 173
- References
- 32
- Citations by year
- 2026: 22 · 2025: 20 · 2024: 16 · 2023: 22 · 2022: 29 · 2021: 17 · 2020: 13 · 2019: 20 · 2018: 11 · 2017: 3
- FWCI
- 15.90
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- The Journals of Gerontology Series A (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion)
- University of Michigan Library
- Funders
- National Institute on Aging
- Topics
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Aging › Genetics, Aging, and Longevity in Model Organisms
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- resilience, human aging, stress response, homeostatic responses, older adults, biological aging, sensor technology
- MeSH terms
- Adaptation, Psychological, Aged, Aging, Consensus Statements as Topic, Female, Humans, Male, Stress, Psychological, Geriatric Assessment, Behavioral Research, Resilience, Psychological
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