Research Article: Chronic multimorbidity impairs role functioning in middle-aged and older individuals mostly when non-partnered or living alone

Date Published: February 2, 2017

Publisher: Public Library of Science

Author(s): Fabiola Müller, Mariët Hagedoorn, Marrit A. Tuinman, Hemachandra Reddy.


Due to the aging of the population, society includes a growing proportion of older individuals prone to chronic morbidity. This study aimed to investigate the adverse effects of single and multiple chronic morbidity on psychosocial health and whether these effects are more pronounced in individuals who are non-partnered or living alone.

Baseline data from the ‘Lifelines Cohort Study’ collected between 2006 and 2013 in the Netherlands were used. Individuals aged 50+ (n = 25,214) were categorized according to their health status (healthy, single chronic morbidity, multiple chronic morbidity), relationship status (partnered, non-partnered), and living arrangement (living with someone, living alone). Analyses of covariance (ANCOVA) were performed to study the main- and the interaction-effects on mental health and role functioning as assessed with the RAND-36.

Irrespective of having chronic morbidity, having a partner was associated with better mental health when partners shared a home. Individuals with single and especially multiple chronic morbidity had impaired role functioning. Having a partner mitigated the adverse effects of multimorbidity on role functioning, but only in individuals who shared a home with their partner. Non-partnered individuals with multimorbidity and those not sharing a home with their partner demonstrated impaired role functioning.

The results demonstrate that multimorbidity negatively affects role functioning, but not the mental health, of middle-aged and older individuals. Sharing a home with a partner can mitigate these adverse effects, while other combinations of relationship status and living arrangement do not. Offering intervention to those individuals most vulnerable to impaired functioning may relieve some of the increasing pressure on the health care system. An individual’s relationship status along with one’s living arrangement could foster the identification of a target group for such interventions attempting to sustain physical functioning or to adapt daily goals.

Partial Text

Due to the aging of the population, society is confronted with a growing proportion of individuals suffering from single and multiple chronic morbidity. At the same time, a substantial number of older individuals do not have a partner or live on their own. As is the case with having a chronic disease, being non-partnered and living alone have been associated with poorer psychosocial health outcomes. This study aimed to investigate whether individuals with single and multiple chronic morbidity are especially vulnerable to impaired mental health and role functioning when they are non-partnered or live alone. By identifying and targeting those individuals who have the greatest need for additional care, the increasing pressure on the health care system could be reduced.

This study has shown that middle-aged and older individuals with single and especially multiple chronic morbidity have impaired role functioning compared to healthy individuals. Regardless of their health status, individuals reported better mental health if they had a partner with whom they shared a home. In individuals with multiple chronic morbidity, living with a partner was beneficial in terms of role functioning. In other words, living together with a partner seemed to mitigate the adverse effects of multiple chronic morbidity. Having a partner who lives somewhere else or being non-partnered while living with someone else, did not mitigate these adverse effects.