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成年人患有两种或两种以上的慢性疾病(“多发病”)，多发病与随后的残疾和死亡风险密切相关。人们越来越多地关注于确定哪些成年人最容易受到不良后果的影响，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病负担风险的因素以及多病导致功能下降的可能性上。这项拟议的研究旨在解决多发病文献中的两个重大空白。首先是心理资源在预防或延缓老年人多发病方面的潜在作用，以及在防止功能衰退和更高的死亡率方面的潜在作用，这些通常与多发病有关。第二种是生物心理社会观点，它认识到多发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。我们专注于两种心理社会资源--强烈的生活使命感和积极的社会关系--我们和其他人在临床样本和大型流行病学研究中发现，这两种资源与更好的健康结果和降低死亡率有关。我们建议研究心理社会资源对以下两方面的贡献：(A)减少和/或延缓多病负担的发展；(B)减少或延缓多病成人的功能和认知能力下降以及死亡率。我们还将研究心理社会资源在多大程度上与多发病、功能衰退和死亡率的减少有关，这些老年成年人由于社会人口风险因素(如年龄、女性、低教育程度)而出现所有这些结果的风险更高。最后，根据我们的综合观点，我们将审查明确定义的生物过程--炎症--的作用，作为(A)多病与功能和死亡结果之间的联系以及(B)多病与这些结果之间联系的心理社会调节的潜在介体。也就是说，我们假设心理社会资源将通过减少炎性蛋白的循环水平来作用，以削弱多发病和不良后果之间的联系，从而使老年人能够很好地生活在多发病中。我们将使用美国中年生活调查(MIDUS)的三波数据来检验这些假设。MIDUS是我们分析的理想论坛，因为它在一项基于人群的大型研究中汇集了对健康、心理社会功能和与健康相关的生物过程的高质量评估。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水平模型和温和的中介分析来提供对我们的关键假设的精确测试。最后，由于处于应用核心的心理社会资源是可以修改的，这项研究的结果将直接指向改善患有多发性疾病的成年人的健康和幸福感的新方法。

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.