How Does Multimorbidity Affect Self-Rated Health Among Older Adults in India: Mediating Role of Social, Functional...

The Longitudinal Ageing Survey of India (LASI) is a nationally representative survey among elderly adults which collected information on health morbidities, self-rated health (SRH) and several other parameters. The objective was to explore the relationship between multimorbidity and SRH and to investigate the role of various social, functional and behavioural mediators in this relationship.

Mediation analysis was performed using the paramed package of STATA. The total effect was decomposed into direct and indirect effects (i.e., mediational effect) and the proportion mediated was calculated for each mediator: limitations in Activities of Daily Living (ADL) or Instrumental ADL, mobility restriction, sleep problems, pain, depression, poor health care utilisation, food insecurity and social participation.

Multimorbidity-SRH association was mediated by functional health parameters such as ADL, IADL, sleep problems, restrictions in mobility, pain, poor health care utilisation and depression, with the proportion mediated (PM) being 21%, 19%, 12.5%, 22.7%, 17.5%, 22% and 7% respectively. There were no gender differences in the role of the mediators except for social participation, which was a significant mediator among older women (PM: 9%). Factors like smoking, alcohol, physical inactivity, food insecurity and poor life satisfaction did not mediate the association between multimorbidity and SRH.

Functional health parameters such as limitations in ADL and IADL, mobility restrictions, sleep problems, pain and poor health care utilisation are potential mediators in the relationship between multimorbidity and SRH and thus should be paid attention to while managing multimorbidity in order to improve the overall perception about their health.