Personal mastery, multisystem physiological dysregulation and risk of functional decline in older adults: A prospective study in Taiwan.

Abstract

Personal mastery has been associated with physical function maintenance later in life. Less is known about the relationship between lack of personal mastery and functional decline in Asian populations, and whether multisystem physiological dysregulation explains this relationship. Participants (n = 487) from the Social Environment and Biomarkers of Aging Study, a population-based prospective cohort study in Taiwan, received baseline measurements of personal mastery using the Pearlin Mastery Scale. Multisystem physiological dysregulation at baseline was assessed as a summary score based on the levels of 16 biomarkers of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system, the cardiovascular system, the metabolic system and the immune system functioning. Function in activities of daily living was determined at baseline and at a 7-year follow up. Participants in the lowest quartile of the personal mastery score were more likely to experience functional decline than those in the higher quartiles (OR comparing the lowest with highest 3 quartiles 2.99, 95% CI 1.71-5.21). After adjusting for confounders, personal mastery remained significantly associated with functional changes (adjusted OR 2.09, 95% CI 1.05-4.14). Greater sense of personal mastery was associated with significantly less multisystem physiological dysregulation (P for trend = 0.001). When the levels of physiological dysregulation were added to the multivariate models, the association between a poor sense of personal mastery and functional decline was attenuated. Lack of personal mastery is independently associated with an increased risk of functional decline in older adults. Multisystem physiological dysregulation partially explains this relationship.