How older adults psychologically appraise their health while managing multiple chronic conditions is a behavioral-science question as much as a clinical one. This study estimated the weighted prevalence of favorable mental-health self-appraisal, identified its behavioral, social, and functional correlates, and compared the relative salience of diagnosed-condition burden and functional limitation among U.S. adults aged ≥ 50 years with multimorbidity. This retrospective cross-sectional secondary analysis used the 2023 Medical Expenditure Panel Survey (MEPS) Full Year Consolidated Data File (HC-251). Multimorbidity was defined as at least two diagnosed chronic priority conditions. The primary outcome represents favorable mental-health self-appraisal, derived from MNHLTH53 (excellent/very good/good vs. fair/poor). Covariates were organized using Andersen’s Behavioral Model and health-psychology concepts of adaptation, resources, and lived functional burden. Weighted prevalence estimates and survey-weighted logistic regression models were fitted using PERWT23F, VARSTR, and VARPSU. Robustness checks examined a stricter outcome threshold, proxy adjustment/non-proxy restriction, and a physical-health extension model. The analytic sample included 5523 respondents, representing approximately 77.9 million U.S. adults aged ≥ 50 years with multimorbidity. The weighted prevalence of favorable perceived mental-health self-appraisal was 86.6% (95% CI 85.4–87.7). In the fully adjusted core model (complete-case n = 5330), age 65–74 years (aOR 1.52, 95% CI 1.17–1.98) and age ≥ 75 years (aOR 1.79, 95% CI 1.36–2.36) were associated with higher odds of favorable appraisal. Lower odds were observed for Hispanic respondents, non-Hispanic Asian respondents, lower educational attainment, lower income, non-employment, ≥4 diagnosed conditions, and any functional limitation. The strongest inverse association was limitation status (aOR 0.32, 95% CI 0.27–0.39). Sensitivity analyses were directionally consistent. Favorable mental-health self-appraisal remained common in this medically complex older population, but it was socially and functionally patterned. Functional limitation appeared more behaviorally salient than diagnosis count alone. Because the analysis was cross-sectional and based on household-interview reported measures, these results should be interpreted as associations rather than causal effects.
Zhang et al. (Fri,) studied this question.