Department of Epidemiology and Biostatistics, Western University, London, Canada.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Qual Life Res. 2024 Jan;33(1):169-181. doi: 10.1007/s11136-023-03508-9. Epub 2023 Sep 30.
The increased burden of multimorbidity is restricting individuals' ability to live autonomously, leading to a poorer quality of life. This study estimated trajectories of functional limitation and quality of life among middle-aged (ages 50 to 64 years) and older (aged 65 years and older) individuals with and without multimorbidity. We also assessed differences in the relationship between these two trajectories by multimorbidity status and separately for each age cohort.
Data originated from the Survey of Health, Ageing, and Retirement in Europe (SHARE). In Luxembourg, data were obtained between 2013 and 2020, involving 1,585 respondents ≥ 50 years of age. Multimorbidity was defined as a self-reported diagnosis of two or more out of 16 chronic conditions; functional limitation was assessed by a combined (Instrumental) Activities of Daily Living (ADL/IADLI) scale; and to measure quality of life, we used the Control, Autonomy, Self-Realization, and Pleasure (CASP-12) scale. Latent growth curve modelling techniques were used to conduct the analysis where repeated measures of quality of life and functional limitation were treated as continuous and zero-inflated count variables, respectively. The model was assessed separately in each age cohort, controlling for the baseline covariates, and the estimates from the two cohorts were presented as components of a synthetic cohort covering the life course from the age of 50.
Middle-aged and older adults living with multimorbidity experienced poorer quality of life throughout the life course and were at a higher risk of functional limitation than those without multimorbidity. At baseline, functional limitation had a negative impact on quality of life. Furthermore, among middle-aged adults without multimorbidity and older adults with multimorbidity, an increase in the number of functional limitations led to a decline in quality of life. These results imply that the impact of multimorbidity on functional limitation and quality of life may vary across the life course.
Using novel methodological techniques, this study contributes to a better understanding of the longitudinal relationship between functional limitation and quality of life among individuals with and without multimorbidity and how this relationship changes across the life course. Our findings suggest that lowering the risk of having multimorbidity can decrease functional limitation and increase quality of life.
多种疾病负担的增加限制了个人的自主生活能力，导致生活质量下降。本研究旨在评估患有和不患有多种疾病的中年（50-64 岁）和老年（65 岁及以上）个体的功能障碍和生活质量轨迹，并比较两种轨迹在多种疾病状态下以及在每个年龄队列中的差异。
数据来自欧洲健康、老龄化和退休调查（SHARE）。在卢森堡，2013 年至 2020 年期间共获得了 1585 名年龄≥50 岁的受访者的数据。多种疾病定义为自我报告的两种或多种 16 种慢性疾病的诊断；功能障碍通过综合（工具性）日常生活活动（IADL）量表评估；生活质量使用控制、自主、自我实现和愉悦（CASP-12）量表测量。使用潜在增长曲线模型技术进行分析，将生活质量和功能障碍的重复测量分别视为连续和零膨胀计数变量。该模型在每个年龄队列中进行评估，控制基线协变量，两个队列的估计值作为涵盖 50 岁生命历程的综合队列的组成部分呈现。
患有多种疾病的中年和老年成年人在整个生命历程中生活质量较差，且功能障碍的风险高于无多种疾病的成年人。在基线时，功能障碍对生活质量有负面影响。此外，在无多种疾病的中年成年人和有多种疾病的老年成年人中，功能障碍数量的增加导致生活质量下降。这些结果表明，多种疾病对功能障碍和生活质量的影响可能在生命历程中有所不同。
本研究使用新颖的方法学技术，更好地理解了患有和不患有多种疾病的个体功能障碍和生活质量之间的纵向关系，以及这种关系在生命历程中的变化。我们的研究结果表明，降低患有多种疾病的风险可以减少功能障碍，提高生活质量。
