Path Study of Social Networks in the Older Adults on Multimorbidity: the Mediating Effects of Physical Activity and Sleep

Abstract

Background In recent years, in the context of global aging, the number of patients with chronic diseases in China has increased significantly, and the the coexistence of multiple diseases has become more and more common, which seriously threatens the life safety and quality of life of the older adults in China. Objective To investigate the status of multimorbidity of older adults, and explore the relationship and pathways of action between sleep, physical activity, social network and multimorbidity of older adults, providing ideas for the effective prevention of multimorbidity and health improvement of older adults. Methods Elderly people aged≥60 years in the Community Health and Behavior of the Elderly Panel Study (CHBEPS) established by our team in 2021 were selected as the subjects of the survey, a questionnaire was used to investigate the study population, the research objects were investigated by questionnaire, and the general situation was collected by self-designed basic information collection form, IPAQ-S-C, LSNS-6 and PSQI were used to assess the physical activity, social network and sleep of the subjects. AMOS 28.0 statistical software was used to set up the structural equation model. Results A total of 3 392 valid questionnaires were collected from 3 531 people over 60 years old, with an effective recovery rate of 96.06%. The average score of physical activity was 2 426.42 (495.00, 3 060.00) MET-min/w, the average score of social network was (15.91±6.43), and the average score of sleep was (5.49±3.53). There were 788 (23.23%) older adults with insufficient social network and 353 (10.41%) older adults with fair or very poor sleep quality. The prevalence of multimorbidity among the survey respondents was 41.13% (1 395/3 392). The results of correlation analysis showed that social network was negatively correlated with sleep level (rs=-0.113, P<0.01) and multimorbidity (rs=-0.049, P<0.01), and was positively correlated with physical activity (rs=0.073, P<0.01). Multivariate Logistic regression analysis showed that physical activity of 0-600 MET-min/w (OR=0.576, 95%CI=0.342-0.970) and good sleep quality (OR=0.409, 95%CI=0.209-0.803) were protective factors for multimorbidity (P<0.05). The results of structural equation modeling showed that social networks could affect physical activity and sleep quality (standardized path coefficient=0.096, t=4.982, P<0.001; standardized path coefficient=-0.043, t=-5.981, P<0.001), physical activity and sleep quality could affect multimorbidity (standardized path coefficient=0.023, t=5.280, P<0.001; standardized path coefficient=0.111, t=9.409, P<0.001). Social network had no direct effect on multimorbidity, but an indirect effect on it through two mediators of physical activity and sleep. The indirect effect of social network on multimorbidity through physical activity accounted for 10% of the total effect, and the indirect effect of social network on multimorbidity through sleep accounted for 36.5% of the total effect. Conclusion The prevalence of multimorbidity is high in the older adults (41.13%). The social network of the elderly group should be appropriately expanded to encourage them to maintain a moderate amount of physical activity and a good quality of sleep, alleviate and prevent the occurrence of multimorbidity.

Keywords

• multimorbidity|aged|social network analysis|physical exertion|sleep quality|health management