When disability begins: psychological functioning profiles and their association with current psychological adaptation among older adults with new-onset disability

Psychological strain and personal and social resources may coexist in different configurations after new-onset disability (NOD). This study identified psychological functioning profiles among older adults with NOD, examined their associations with current psychological adaptation, and explored characteristics associated with profile membership. This cross-sectional study included 254 previously independent adults aged ≥ 60 years with first-onset disability within the preceding three months and a Barthel Index score ≤ 60. Participants were recruited from three tertiary hospitals in Jiangsu Province, China. Guided by stress–coping and social ecological perspectives, latent profile analysis used seven indicators covering illness appraisal, personal resources, affective burden, and perceived social context. Psychological Adaptation Scale (PAS) scores were compared using the Bolck–Croon–Hagenaars (BCH) procedure, and profile correlates were explored using R3STEP multinomial logistic regression. Sensitivity analyses examined an alternative three-profile solution and a cerebrovascular-related NOD subgroup. A four-profile solution was retained: high strain–low resources (C1, 25.2%), low strain–moderate resources (C2, 30.3%), low strain–high resources (C3, 27.6%), and high strain–high resources (C4, 16.9%). C1 had lower PAS total and domain scores than each of the other profiles after Holm adjustment, with BCH-adjusted total-score differences of 16.6–21.6 points. No statistically significant PAS differences were detected among C2, C3, and C4. Functional status, sex, prognosis awareness, income, and rural residence showed exploratory associations with selected profile contrasts. Lower adaptation in the high strain–low resources configuration was also observed in the three-profile solution and broadly supported in the cerebrovascular subgroup. Psychological functioning after NOD was heterogeneous, and elevated strain coexisted with differing resources and levels of current adaptation. These findings may inform early rehabilitation assessment that considers emotional difficulties alongside personal and social resources. Not applicable.