Living Well With Later Life Multimorbidity: A Biopsychosocial Approach

Specific Aims Living past age 65 increasingly means living with two or more chronic medical conditions, and while multiple conditions (multimorbidity) typically increase the risk of (a) subsequent declines in physical and mental functioning and (b) mortality, many older adults retain functional independence in spite of multimorbidity. Drawing upon multiple theoretical perspectives we propose to test the novel hypotheses that psychosocial resources (purpose in life, positive social relationships) will moderate (a) the risk of developing multimorbidity in vulnerable sociodemographic groups and (b) the extent to which multimorbidity results in functional limitations (instrumental activities of daily living – IADLs), cognitive impairments (executive function; episodic memory) and mortality over time. In addition, building on our empirical research showing discrete links between positive psychological functioning and favorable profiles of disease-related biological processes, we will test the hypothesis that psychosocial resources act through a well-defined biological pathway (inflammation) to predict decreased risk of functional and cognitive declines and mortality in adults with multimorbidity. We will pursue the proposed aims using three waves of data collection from the Survey of Mid-Life in the United States (MIDUS) spanning two decades; two waves are complete, and the third will be completed by Year 3 of the proposed study. The combined assessments of psychosocial functioning and cross-time measurement of multiple aspects of health and functional abilities make MIDUS uniquely appropriate for examining the interplay of social, psychological, and biological factors related to multimorbidity and its consequences. As psychosocial strengths are modifiable, the proposed research will highlight novel approaches to improving outcomes in adults with multimorbidity.