Living Well with Later Life Multimorbidity: a Biopsychosocial Approach

描述（由申请人提供）：大多数65岁以上的成年人和越来越多的中年人患有两种或两种以上的慢性疾病（“多重疾病”），而多重疾病与随后的残疾和死亡风险密切相关。越来越多的注意力被投入到识别那些最容易受到不良后果影响的成年人，并有效地治疗他们的多种疾病，到目前为止，这项研究的大部分集中在增加多重疾病负担风险的因素上，以及多重疾病导致功能下降的可能性。拟议的研究旨在解决多病文献中的两个重要空白。首先是心理资源在预防或延缓老年人多重疾病以及防止功能衰退和更高死亡率方面的潜在作用，这些通常与多重疾病有关。第二种是生物-心理-社会视角，认为多病及其后果可能涉及社会、心理和生物过程的复杂相互作用。我们重点关注两种社会心理资源——强烈的生活目标感和积极的社会关系——在临床样本和大型流行病学研究中，我们和其他人将其与更好的健康结果和降低死亡率联系起来。我们建议研究心理社会资源在以下方面的作用：(a)减少和/或延迟多病负担的发展；(b)减少或延迟多病成人的功能和认知能力以及死亡率的下降。我们还将研究社会人口风险因素（如年龄、女性性别、受教育程度低）导致的老年人多病、功能衰退和死亡率风险的降低与心理社会资源的关联程度。最后，与我们的综合观点一致，我们将研究一个定义明确的生物学过程-炎症-作为(a)多病与功能和死亡率结果之间的联系以及(b)多病与这些结果之间联系的社会心理调节的潜在中介的作用。也就是说，我们假设社会心理资源将通过降低炎症蛋白的循环水平来减弱多重疾病和不良后果之间的联系，从而使老年人能够更好地生活在多重疾病中。我们将使用来自美国中年调查（MIDUS）的三波数据来检验这些假设。MIDUS是我们分析的理想论坛，因为它汇集了高质量的健康评估，心理社会功能，以及与健康相关的生物过程，这是一项基于大规模人群的研究。MIDUS的纵向结构将使我们能够检查预测因素、结果及其关联随时间的变化，我们的分析方法将使用多层次模型和适度的中介分析，为我们的关键假设提供精确的检验。最后，由于应用程序的核心心理社会资源是可修改的，因此本研究的结果将直接指出改善多重疾病成人健康和福祉的新方法。

DESCRIPTION (provided by applicant): Most adults over the age of 65 and a growing number in mid-life are living with two or more chronic medical conditions ("multimorbidity"), and multimorbidity is strongly associated with risk of subsequent disability and mortality. Increasing attention is being devoted to identifying those adults who are most vulnerable to adverse outcomes and to treating their multiple conditions effectively, and by far the bulk of this researc centers on factors that increase the risk of multimorbidity burden and the likelihood that multimorbidity will result in functional declines. The proposed research is designed to address two significant gaps in the multimorbidity literature. The first is the potential role of psychosocal resources in preventing or delaying multimorbidity in aging adults and in protecting against functional declines and greater mortality that are typically associated with multimorbidity. The second is a biopsychosocial perspective that recognizes that multimorbidity and its consequences are likely to involve complex interactions of social, psychological, and biological processes. We focus on two psychosocial resources - a strong sense of purpose in life and positive social relationships - that we and others have linked to better health outcomes and reduced mortality in clinical sample and large epidemiological studies. We propose to examine the contribution of psychosocial resources to (a) reduced and/or delayed development of multimorbidity burden and (b) reduced or delayed declines in functional and cognitive abilities and in mortality in adults with multimorbidity. We will also examine the extent to which psychosocial resources are linked to reductions in multimorbidity, functional declines, and mortality in aging adults at greater risk of all of these outcomes due to sociodemographic risk factors (e.g. age, female gender, low educational attainment). Finally, consistent with our integrative perspective, we will examine the role of a well-defined biological process - inflammation - as a potential mediator of (a) the links between multimorbidity and functional and mortality outcomes and (b) psychosocial moderation of the links between multimorbidity and these outcomes. That is, we hypothesize that psychosocial resources will act through reduced circulating levels of inflammatory proteins to weaken the link between multimorbidity and adverse outcomes, thereby enabling aging adults to live well with multimorbidity. We will test these hypotheses using data from three waves of the Survey of Mid-Life in the United States (MIDUS). MIDUS is the ideal forum for our analyses, as it brings together high quality assessments of health, psychosocial functioning, and biological processes related to health in a large population-based study. The longitudinal structure of MIDUS will enable us to examine change over time in predictors, outcomes, and their associations, and our analytical approach will use multilevel models and moderated mediation analyses to provide precise tests of our key hypotheses. Finally, as the psychosocial resources that lie at the heart of the application are modifiable, the results of this study will point directly to novel ways to improve health and well-being in adults with multimorbidity.