PONE-D-21-30179

Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP Project.

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript uses survey data from Spanish health centers to assess the sex differences in social support among older polymedicated adults. Overall, it is fairly well written and easy to follow. Please see below for my comments.

1. For the most part, the authors do well to use politically correct language when referring to older adults. However, on line 45, per the Gerontological Society of America’s policy on language regarding the older population, I suggest replacing the term ‘eldery people’ with a more neutral term (e.g., older adults, older people). See for (Lundebjerg et al., 2017) for details on this policy.

CITED SOURCE: Lundebjerg, Nancy E., Daniel E. Trucil, Emily C. Hammond, and William B. Applegate. 2017. “When It Comes to Older Adults, Language Matters: Journal of the American Geriatrics Society Adopts Modified American Medical Association Style.” Journal of the American Geriatrics Society 65(7):1386–88. doi: 10.1111/jgs.14941.

2. The authors do well to distinguish between social networks and social support (lines 56-65). However, after introducing the concept of networks (including size, density, homogeneity, etc) in the Introduction, it was a little disappointing to see structural social support later operationalized simply as marital status and number of cohabitants in the home (lines 122-123). While these measures are often indicative of social support, their mere presence does not automatically guarantee social support. For instance, poor marriages might actually cause more strain than support (de Jong Gierveld et al. 2009). I realize that data limitations are always going to be an issue, but it seems that it is at least acknowledging the lack of social network data and marital quality as limitations in this study.

CITED SOURCE: Jenny de Jong Gierveld, Marjolein Broese van Groenou, Adriaan W. Hoogendoorn, Johannes H. Smit, Quality of Marriages in Later Life and Emotional and Social Loneliness, The Journals of Gerontology: Series B, Volume 64B, Issue 4, July 2009, Pages 497–506, https://doi.org/10.1093/geronb/gbn043

3. In the Materials and Methods section, the authors choose to separate functional support into ‘confident support” and “affective support” (lines 131-133). If they are going to make this distinction methodologically, it should be preceded with conceptual justification in the Introduction section.

4. I don’t understand the values given in lines 175-178). They do not seem to match those in Table 3. The bivariate comparisons given in the text do not make sense to me because they are not dichotomous outcomes. Rather there appears to be three response categories to each outcome.

5. I am confused by the sentence on line 215 that reads “The increasing feminization of old age has meant that widowhood is a mostly female experience.” What does this mean? Are the authors trying to say that women are more likely to experience widowhood because they tend to live longer than men?

6. The sentence on lines 241-243 the authors say that their heterogeneous sample “is representative of the general multimorbid and polymedicated population, increasing its external validity.” But it seems to me that the external validity depends more on the sampling methodology (i.e., random sampling drawn from a representative sampling frame) rather than the sample demographics. It is difficult to tell if participants were randomly selected or if a convenience sampling method was used instead. Perhaps more importantly, however, the participants appear to have first been contacted in health centers, which—if true—would not make it a representative sample of the general population since only those who went to the health centers were eligible for being selected into the study. These distinctions should be noted in the manuscript.

Reviewer #2: I have just read the manuscript entitled "Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP Project", an interesting work exploring determinants of social support perceived by sex. The study is focused on polymedicated older adults with multimorbidity. After reading the manuscript, I have the following comments:

- The article is focused in older adults, although only in those aged 65-74 years. Why people older than 75 were not considered in the sample?

- All the instruments used in this study have been previously validated in other samples. I wonder whether the authors could provide data on internal consistency (e.g., Cronbach’s alpha for unidimensional scales) according to the sample considered in this study.

- In Table 4, the 95% CI associated to “Number of drugs” in men cannot provide a significant p-value. This would be checked and also revised in the Results section in the main text.

- The authors have found an association between lower perception of social support and multimorbidity in men. This result is not observed in women and should be discussed.

- Potential limitations of this study should be highlighted in the Discussion section.

Minor comments:

- Line 101: "Random sampling". Which type of random sampling was used?

- Lines 141-142: “Explanatory linear regression models”. Why explanatory?

- Lines 190-192: “In contrast, a higher number of diseases was associated with a lower social support score; it fell by 0.4 points (95% CI -0.87–0.30) for each disease”. Please revise the use of hyphen in confidence intervals when negative values are reported. On the other hand, it is not a significant result.

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Reviewer #1: No

Reviewer #2: No

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Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP Study.

PONE-D-21-30179R1

Dear Dr. Lozano Hernández,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: I have read the last version of the manuscript entitled "Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP Study" and the authors have adequately addressed all my previous comments.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

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Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No