Sieber Stefan, Roquet Angélique, Lampraki Charikleia, Jopp Daniela S
LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Lausanne, Switzerland.
Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
Innov Aging. 2023 Jun 4;7(4):igad047. doi: 10.1093/geroni/igad047. eCollection 2023.
The ubiquity of multimorbidity makes it crucial to examine the intermediary factors linking it with quality of life (QoL). The objective was to examine to what extent the association between multimorbidity and QoL was mediated by functional and emotional/mental health and how these mediation pathways differed by sociodemographic factors (age, gender, education, and financial strain).
Data from Waves 4 to 8 of 36,908 individuals from the Survey of Health, Aging, and Retirement in Europe (SHARE) were included. Multimorbidity (exposure) was defined as having 2 or more chronic conditions. Mediators included limitations with (instrumental) activities of daily living (ADL and IADL), loneliness, and depressive symptoms. QoL (outcome) was assessed with the CASP-12 scale. Longitudinal model-based causal mediation analyses were performed to decompose the total association between multimorbidity and QoL into direct and indirect effects. Moderated mediation analyses tested for differences in mediation pathways by sociodemographic factors.
Multimorbidity was significantly associated with lower QoL (direct effect: = -0.66). This association was mediated by ADL limitations (percentage mediated 0.97%), IADL limitations (3.24%), and depressive symptoms (16.70%), but not by loneliness. The mediation pathways were moderated by age, education, financial strain, and gender.
ADL, IADL, and depressive symptoms are crucial intermediary factors between multimorbidity and QoL in older European adults, with changing importance according to age, education, financial strain, and gender. The findings may help to increase the QoL of individuals with multimorbidity and redirect care efforts to these factors.
多重疾病的普遍存在使得研究将其与生活质量（QoL）联系起来的中介因素至关重要。目的是研究多重疾病与生活质量之间的关联在多大程度上由功能以及情绪/心理健康介导，以及这些中介途径如何因社会人口学因素（年龄、性别、教育程度和经济压力）而有所不同。
纳入了来自欧洲健康、老龄化与退休调查（SHARE）的36908名个体第4至8轮的数据。多重疾病（暴露因素）被定义为患有两种或更多种慢性病。中介因素包括（工具性）日常生活活动受限（ADL和IADL）、孤独感和抑郁症状。生活质量（结果）用CASP - 12量表进行评估。进行基于纵向模型的因果中介分析，以将多重疾病与生活质量之间的总关联分解为直接效应和间接效应。调节中介分析检验社会人口学因素在中介途径上的差异。
多重疾病与较低的生活质量显著相关（直接效应：=-0.66）。这种关联由ADL受限（中介百分比0.97%）、IADL受限（3.24%）和抑郁症状（16.70%）介导，但不由孤独感介导。中介途径因年龄、教育程度、经济压力和性别而有所不同。
ADL、IADL和抑郁症状是欧洲老年成年人多重疾病与生活质量之间的关键中介因素，其重要性会因年龄、教育程度、经济压力和性别而变化。这些发现可能有助于提高患有多重疾病个体的生活质量，并将护理工作重新导向这些因素。
