A Conceptual Framework to Integrate Research Programs on Self-Regulation in Education.

The global population is aging at an accelerated pace, and the burden of chronic diseases among older adults is increasing. A 2025 meta-analysis of 49 studies involving 729,043 older adults reported a global pooled prevalence of multimorbidity of 46.0% (95% CI: 38.0%–55.0%) among individuals aged 60 years and older (). Traditional multimorbidity research has focused primarily on physical diseases (hypertension, type 2 diabetes, etc.); however, many older adults have not only multiple physical conditions but also psychological disorders or cognitive impairment. Therefore, focusing solely on single physical diseases or physical multimorbidity does not fully capture the complexity of health in older adults. To address this gap, the concept of physical–psychological–cognitive multimorbidity has gained increasing attention. A 2023 multinational cross-sectional study provided an early systematic investigation of physical–psychological–cognitive multimorbidity and found that individuals with low socioeconomic status had a 12.36-fold higher risk of PPC-MM compared to those with high socioeconomic status (). The important innovation of PPC-MM is that it explicitly requires the simultaneous presence of three domains: chronic physical condition, psychological disorder and cognitive impairment. PPC-MM differs from traditional multimorbidity in that traditional multimorbidity typically refers to two or more physical diseases (hypertension, type 2 diabetes, coronary heart disease, etc.), whereas PPC-MM adds psychological and cognitive dimensions. This definition is critical because longitudinal evidence indicates that the co-occurrence of physical disease, cognitive impairment, and psychological disorder is associated with a significant synergistic deterioration effect, which may contribute to faster functional decline, increased healthcare utilization, and higher mortality, while dyadic combinations show a much weaker effect (). This review aims to summarize and clarify the evolution of operational definitions of PPC-MM across different studies and to summarize its global epidemiological characteristics. It also aims to synthesize multidimensional evidence on sociodemographic factors, early-life experiences, lifestyle, and biological aging to identify key risk factors. Furthermore, it seeks to elucidate the potential pathophysiological network linking the concurrent decline in physical, psychological, and cognitive functions. Finally, it proposes an integrated care strategy grounded in the bio-psycho-social framework to address current challenges in clinical management. These efforts are intended to provide evidence-based support for the early identification of high-risk populations, elucidation of disease mechanisms, and development of precise interventions for PPC-MM.