A psychometric examination of multimorbidity and mental health in older adults

Objectives: Multimorbidity, the presence of multiple chronic medical conditions, is particularly prevalent in older adults. We examined the relationship of multimorbidity with mental health, social network and activity limitations in the National Health and Aging Trends Study, a nationally representative, age-stratified sample of older adults.

Method: After excluding participants who used a proxy to complete the survey and those who did not answer any of the depressive symptoms, anxiety symptoms and positive and negative affect items, the final sample was 7026. A disease count of 10 conditions (heart disease, hypertension, arthritis, osteoporosis, diabetes, lung disease, stroke, dementia, cancer, fracture) was used.

Results: Factor analysis indicated a one factor structure for disease count was tenable, although cancer did not appear to fit the model. Therefore, a count of the nine other diseases was used. Disease count was related to increased depressive symptoms, anxiety symptoms and negative affect and less positive affect. All individual diseases including cancer were related to worse mental health as was having two or more conditions. Disease count, having two or more conditions and several individual diseases (heart disease, hypertension, arthritis, cancer and fracture) were also related to increases in social network size while other individual diseases (osteoporosis, diabetes, lung disease, stroke and dementia) were related to decreases in social network size. All the measures of multimorbidity and individual diseases were associated with the increased odds of activity limitations.

Conclusions: Results support a broader focus for older adults with multimorbidity that includes mental health needs.