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

Ana R Quiñones; Corey L Nagel; Anda Botoseneanu; Jason T Newsom; David A Dorr; Jeffrey Kaye; Stephen M Thielke; Heather G Allore

doi:10.1177/26335565221143012

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

J Multimorb Comorb. 2022 Nov 30:12:26335565221143012. doi: 10.1177/26335565221143012. eCollection 2022 Jan-Dec.

Authors

Ana R Quiñones^{1

2}, Corey L Nagel^{3

4}, Anda Botoseneanu^{5

6}, Jason T Newsom⁷, David A Dorr⁸, Jeffrey Kaye⁹, Stephen M Thielke¹⁰, Heather G Allore^{11

12}

Affiliations

¹ Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
² OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, USA.
³ College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁴ Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
⁵ Department of Health & Human Services, University of Michigan, Dearborn, MI, USA.
⁶ Institute of Gerontology, University of Michigan, Ann Arbor, MI, USA.
⁷ Department of Psychology, Portland State University, Portland, OR, USA.
⁸ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA.
⁹ Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
¹⁰ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
¹¹ Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA.
¹² Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA.

Abstract

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.

Keywords: Cognition; depression; joint trajectories; multimorbidity.

Abstract

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