Multimorbidity and Quality of Life: The Mediating Role of ADL, IADL, Loneliness, and Depressive Symptoms

Abstract

Background and Objectives The ubiquity of multimorbidity makes it crucial to examine the intermediary factors linking it with quality of life (QoL). The objective was to examine to what extent the association between multimorbidity and QoL was mediated by functional and emotional/mental health and how these mediation pathways differed by sociodemographic factors (age, gender, education, financial strain). Research Design and Methods Data from waves 4 to 8 of 36,908 individuals from the Survey of Health, Aging and Retirement in Europe (SHARE) were included. Multimorbidity (exposure) was defined as having two or more chronic conditions. Mediators included limitations with (instrumental) activities of daily living (ADL and IADL), loneliness, and depressive symptoms. QoL (outcome) was assessed with the CASP-12 scale. Longitudinal model-based causal mediation analyses were performed to decompose the total association between multimorbidity and QoL into direct and indirect effects. Moderated mediation analyses tested for differences in mediation pathways by sociodemographic factors. Results Multimorbidity was significantly associated with lower QoL (direct effect: b = -0.66). This association was mediated by ADL limitations (percentage mediated 0.97%), IADL limitations (3.24%), and depressive symptoms (16.70%), but not by loneliness. The mediation pathways were moderated by age, education, financial strain, and gender. Discussion and Implications ADL, IADL, and depressive symptoms are crucial intermediary factors between multimorbidity and QoL in older European adults, with changing importance according to age, education, financial strain, and gender. The findings may help to increase the QoL of individuals with multimorbidity and redirect care efforts to these factors.

Influence of comorbidity of chronic diseases on basic activities of daily living among older adults in China: a propensity score-matched study

“…In this study, the participants were 60 years and older, whereas Connolly's study focused on individuals aged >65 years. According to a previous study (24), age has been identified as an influencing factor of BADL among older adults, which aligns with the present study. Tissues and organs, including the brain, tend to exhibit signs of aging as a person grows older.…”

The relationship between health behaviors and quality of life: the mediating roles of activities of daily living and psychological distress

“…The mediating effect model shows that ADLs have multiple mediating effects on the relationship between health behaviors and QOL, and the incidence of ADL restriction in older adults is negatively correlated with reported results on QOL, which is consistent to some extent with previous studies ( 29 ). At the same time, several previous studies have concluded that limited ADL capacity in older adults with advanced disease is significantly associated with QOL ( 8 , 41 , 42 ).…”

“…IADLs were assessed in this study using the Functional Activities Questionnaire (FAQ) ( 28 ), which consists of 10 items to assess whether respondents are able to perform the following activities independently: shopping, cooking, using communication tools, cleaning, washing, purchasing medicines, using public transportation, managing finances, working, and hobbies. Each items is scored on a 3-point scale, from 0 (normal or not done, but can do) to 3 (completely dependent on others); a higher FAQ score indicates worse function ( 29 , 30 ). The normal standard is less than 5 points; a score greater than or equal to 5 is an anomaly, indicating that respondents has difficulty being independent in their families and communities ( 31 ).…”

Multimorbidity and associated informal care receiving characteristics for US older adults: a latent class analysis

“…Previous research indicated that different multimorbidity combinations were associated with differential risks of disability, measured by a combined ADL-IADL index [ 12 ]. Other studies also reported that both ADL and IADL were crucial intermediary factors on the pathway between multimorbidity and quality of life [ 45 , 46 ], and IADL was a key indicator in assessing the autonomy of community-dwelling older adults [ 35 ]. The current study explored the different care-receiving characteristics in ADL/IADL items associated with multimorbidity patterns, and could serve as a bridge between multimorbidity patterns and quality of life, for both care-recipients and caregivers.…”