Abstract
Background:Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17–19 year follow-up period.Methods:Participants completed questionnaire assessments of chronic conditions and functional limitations. Interleukin-6, C-reactive protein, and fibrinogen were assayed in serum. Structural equation models were used to predict increases in and onset of functional limitations associated with baseline multimorbidity status; mediation by inflammation was also determined.Results:Multimorbidity (versus 0–1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Significant indirect effects showed that inflammation partially mediated the link between multimorbidity and changes in, but not onset of, limitations.Discussion:These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling.
Highlights
Despite recent declines,[1,2] disability remains common in aging adults, resulting in substantial medical expenditures,[3] loss of quality of life,[4,5] and increased mortality.[6]
We recently examined the role of these three inflammatory proteins in mediating the cross-sectional association of multimorbidity and limitations in activities of daily living (ADLs) in the nationally representative Survey of Mid-Life Development in the United States (MIDUS)
The specific aim of this study was to test the possibility that inflammation would mediate the longitudinal association of multimorbidity and both onset and progression of disability
Summary
Despite recent declines,[1,2] disability remains common in aging adults, resulting in substantial medical expenditures,[3] loss of quality of life,[4,5] and increased mortality.[6]. The leading model for disease- and multimorbidity-related disability, the Disablement Process model,[8,10] focuses on the specific ways in which discrete conditions may impair function. Heart disease may limit physical exertion because of cardiovascular dysfunction, while chronic obstructive pulmonary disease may limit functional independence because of limited breathing capacity.[8] The current study takes a different approach, examining a biological process that many chronic conditions have in common (inflammation) as a potential mediator of the link between multimorbidity and disability. Using longitudinal data from the Survey of Mid-Life Development in the United States, this study examined the role of systemic inflammation in mediating the link between multimorbidity and increases in and onset of functional limitations over a 17–19 year followup period. Results: Multimorbidity (versus 0–1 conditions) predicted more functional limitations and greater odds of onset of limitations over time. Discussion: These results show that inflammation, a nonspecific marker of multiple disease conditions, explains in part the degree to which multimorbidity is disabling
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