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

Mobility restriction mediated the association between multimorbidity and self-rated health with the highest proportion mediated among the functional parameters examined.

• Mobility restriction had a proportion mediated (PM) of 22.7%
• Analysis used the paramed package of STATA to decompose total effect into direct and indirect effects
• Data source was the Longitudinal Ageing Survey of India (LASI), a nationally representative survey among elderly adults

Poor health care utilisation mediated the multimorbidity-SRH association with a proportion mediated of 22%.

• PM for poor health care utilisation was 22%
• This was among the stronger mediators identified alongside mobility restriction
• Mediation analysis decomposed total effect into direct and indirect (mediational) effects

Limitations in Activities of Daily Living (ADL) mediated the multimorbidity and self-rated health relationship.

• The proportion mediated (PM) for ADL limitations was 21%
• ADL was identified as one of the functional health parameters acting as a mediator
• Both ADL and Instrumental ADL (IADL) were examined as separate mediators

Instrumental Activities of Daily Living (IADL) limitations mediated the multimorbidity-SRH association with a proportion mediated of 19%.

• PM for IADL was 19%
• IADL was examined separately from ADL as a mediator in the relationship between multimorbidity and SRH
• Both ADL and IADL were classified as functional health parameters

Pain mediated the association between multimorbidity and self-rated health with a proportion mediated of 17.5%.

• PM for pain was 17.5%
• Pain was included among the functional health parameters examined as mediators
• Eight mediators were examined in total: ADL, IADL, mobility restriction, sleep problems, pain, poor health care utilisation, depression, and social participation

Sleep problems mediated the multimorbidity-SRH relationship with a proportion mediated of 12.5%.

• PM for sleep problems was 12.5%
• Sleep problems were classified among the functional health parameters acting as mediators
• Sleep problems showed a smaller mediating effect compared to mobility restriction, poor health care utilisation, and ADL

Depression mediated the multimorbidity and self-rated health association, though with the smallest proportion mediated among the significant mediators.

• PM for depression was 7%
• Depression was the weakest significant mediator among those identified
• Depression was included as a social/behavioural factor alongside functional parameters in the mediation analysis

Social participation was a significant mediator of the multimorbidity-SRH association only among older women, representing the sole gender difference found.

• PM for social participation among older women was 9%
• Social participation was not a significant mediator among older men
• There were no other gender differences identified in the role of any of the other mediators examined
• This was the only finding that differed by gender in the entire mediation analysis

Several behavioural and social factors did not mediate the association between multimorbidity and self-rated health.

• Smoking, alcohol use, physical inactivity, food insecurity, and poor life satisfaction were all non-significant mediators
• These factors were examined as potential mediators using the paramed package in STATA
• Food insecurity was included as a social determinant but showed no significant mediating role