title: Personal mastery, multisystem physiological dysregulation and risk of functional decline in older adults: A prospective study in Taiwan.
abstract: OBJECTIVE
  Personal mastery has been associated with physical function maintenance later in life. Less is known about the relationship between lack of personal mastery and functional decline in Asian populations, and whether multisystem physiological dysregulation explains this relationship.
  
  
  METHODS
  Participants (n = 487) from the Social Environment and Biomarkers of Aging Study, a population-based prospective cohort study in Taiwan, received baseline measurements of personal mastery using the Pearlin Mastery Scale. Multisystem physiological dysregulation at baseline was assessed as a summary score based on the levels of 16 biomarkers of the hypothalamic-pituitary-adrenal axis, the sympathetic nervous system, the cardiovascular system, the metabolic system and the immune system functioning. Function in activities of daily living was determined at baseline and at a 7-year follow up.
  
  
  RESULTS
  Participants in the lowest quartile of the personal mastery score were more likely to experience functional decline than those in the higher quartiles (OR comparing the lowest with highest 3 quartiles 2.99, 95% CI 1.71-5.21). After adjusting for confounders, personal mastery remained significantly associated with functional changes (adjusted OR 2.09, 95% CI 1.05-4.14). Greater sense of personal mastery was associated with significantly less multisystem physiological dysregulation (P for trend = 0.001). When the levels of physiological dysregulation were added to the multivariate models, the association between a poor sense of personal mastery and functional decline was attenuated.
  
  
  CONCLUSIONS
  Lack of personal mastery is independently associated with an increased risk of functional decline in older adults. Multisystem physiological dysregulation partially explains this relationship.
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.|Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: I-Chien
authors.initials: IC
authors.lastname: Wu
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: Chao A
authors.initials: CA
authors.lastname: Hsiung
authors.affiliation: Institute of Cancer Research and Division of Biostatistics and Bioinformatics, National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: I-Shou
authors.initials: IS
authors.lastname: Chang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.
authors.forename: Ming-Shiang
authors.initials: MS
authors.lastname: Wu
authors.affiliation: Department of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Yu-Hung
authors.initials: YH
authors.lastname: Chang
authors.affiliation: Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan.|Department of Health Services Administration, China Medical University and Hospital, Taichung, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D026684:Personal Autonomy; D011446:Prospective Studies; D013624:Taiwan
keywords: aging; frail elderly; mental health; mobility limitation; physiology