Multidimensional trajectories of multimorbidity, functional status, cognitive performance, and depressive symptoms among diverse groups of older adults

Background

Inter-relationships between multimorbidity and geriatric syndromes are poorly understood. This study assesses heterogeneity in joint trajectories of somatic disease, functional status, cognitive performance, and depressive symptomatology.

Methods

We analyzed 16 years of longitudinal data from the Health and Retirement Study (HRS, 1998-2016) for n = 11,565 older adults (≥65 years) in the United States. Group-based mixture modeling identified latent clusters of older adults following similar joint trajectories across domains.

Results

We identified four distinct multidimensional trajectory groups: (1) Minimal Impairment with Low Multimorbidity (32.7% of the sample; mean = 0.60 conditions at age 65, 2.1 conditions at age 90) had limited deterioration; (2) Minimal Impairment with High Multimorbidity (32.9%; mean = 2.3 conditions at age 65, 4.0 at age 90) had minimal deterioration; (3) Multidomain Impairment with Intermediate Multimorbidity (19.9%; mean = 1.3 conditions at age 65, 2.7 at age 90) had moderate depressive symptomatology and functional impariments with worsening cognitive performance; (4) Multidomain Impairment with High Multimorbidity (14.1%; mean = 3.3 conditions at age 65; 4.7 at age 90) had substantial functional limitation and high depressive symptomatology with worsening cognitive performance. Black and Hispanic race/ethnicity, lower wealth, lower education, male sex, and smoking history were significantly associated with membership in the two Multidomain Impairment classes.

Conclusions

There is substantial heterogeneity in combined trajectories of interrelated health domains in late life. Membership in the two most impaired classes was more likely for minoritized older adults.

Spousal Support, Spousal Strain, and Loneliness in Older Mexican Couples

OBJECTIVES

A growing body of research has identified factors related to loneliness among older adults. Fewer have investigated predictors of loneliness within married couples. This analysis investigates how spousal support and strain relate with loneliness within older couples (age 50+), and whether these associations are modified by functional limitation. The study focuses on Mexico, a country experiencing rapid aging occurring alongside historically limited institutional support for older adults, and where traditional gender roles extend to marriage.

METHODS

The analytic sample consisted of 3,584 husband-wife dyads from the 2012 and 2015 Mexican Health and Aging Study. Loneliness was measured using the Three-Item Loneliness Scale. Associations between spousal support, strain, and loneliness were estimated within husband-wife dyads using the Actor-Partner Interdependence Model.

RESULTS

Experiencing more spousal support was associated with less loneliness, whereas experiencing spousal strain was associated with more loneliness 3 years later among married adults. The associations between spousal support/strain and loneliness were stronger among husbands with limitations in activities of daily living (ADL) when compared to their counterparts without ADL limitations.

DISCUSSION

Among married adults, spousal support and strain may be important factors to understand loneliness within marriage. Effects should be interpreted within the context of functional limitation.