Family resilience, dyadic coping, and health-related quality of life among primary caregivers of hospitalized older adults with multimorbidity in Xinjiang, China: a latent profile and mediation analysis

BackgroundOlder adults with multiple chronic conditions impose a heavy caregiving burden on their families. However, little is known about how family resilience and dyadic coping are associated with caregivers' health-related quality of life (HRQoL). This study aimed to identify latent profiles of family resilience among primary family caregivers of hospitalized older adults with multimorbidity and to examine whether dyadic coping was indirectly associated with the relationship between family resilience and caregiver HRQoL within a hypothesized mediation model.MethodsFrom October 2025 to June 2026, 572 primary family caregivers of older inpatients with multimorbidity were recruited from three tertiary hospitals in Xinjiang, China. Participants completed the Chinese version of the Family Resilience Assessment Scale (FRAS-C), the Dyadic Coping Inventory (DCI), and the 12-item Short Form Health Survey (SF-12). Latent profile analysis (LPA) was used to identify distinct profiles of family resilience. Univariate and multivariate logistic regression analyses were performed to determine factors distinguishing these profiles. Hypothesized mediation models using the bootstrap method were tested to estimate statistical indirect associations, with caregiver age, education level, monthly income, daily caregiving hours, and self-rated health as covariates.ResultsThree distinct family resilience profiles were identified: low (33.9%), middle (41.6%), and high (24.5%) family resilience. Using the low resilience group as the reference, statistically significant indirect associations through dyadic coping were observed between moderate resilience and physical HRQoL (indirect effect = 0.5825, 95% CI: 0.3317–0.8801), moderate resilience and mental HRQoL (indirect effect = 0.5103, 95% CI: 0.2701–0.7663), high resilience and physical HRQoL (indirect effect = 1.2105, 95% CI: 0.8039–1.7050), and high resilience and mental HRQoL (indirect effect = 1.0605, 95% CI: 0.6858–1.5003). Multivariate logistic regression showed that caregiver education level, monthly income, daily caregiving hours, self-rated health, and caregiver age were independent factors distinguishing the resilience profiles. Stratified analyses further showed that the positive associations between dyadic coping and HRQoL were consistent across spousal, child, and other caregiver subgroups.DiscussionFindings were consistent with the hypothesized mediation model, showing indirect associations between family resilience and both physical and mental HRQoL through dyadic coping. Strengthening family resilience and promoting dyadic coping may be a promising approach to supporting caregivers' health outcomes.