Functional dependency and cardiometabolic multimorbidity in older people: pooled analysis of individual-level data from 20 countries.

This article examines the temporal relationship between functional dependency (FD)—defined as difficulty performing basic and instrumental activities of daily living—and cardiometabolic multimorbidity (CMM), characterized by the co-occurrence of diabetes, heart disease, and stroke. Using pooled longitudinal data from over 150,000 older adults across 20 countries in the USA, China, and Europe, the study found that FD is significantly associated with increased risk of developing CMM. Mediation analyses identified hypertension and depressive symptoms as key factors explaining 8%–18% of this association, with stronger effects observed among smokers, excessive drinkers, and those with lower physical activity. The findings suggest that integrated interventions targeting hypertension, mental health, and lifestyle factors are important for preventing CMM in older populations, particularly in resource-limited settings.