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The prognostic fingerprint of quality of life in older inpatients

Relationship to geriatric syndromes’ and resources’ profile

Prognostischer Fingerabdruck der Lebensqualität älterer hospitalisierter Patienten

Assoziation mit Profilen geriatrischer Syndrome und Ressourcen

Abstract

Background

The Comprehensive Geriatric Assessment (CGA) provides essential information about older hospitalized patients but is either not systematically adopted or not adopted at all in clinical routine. As a consequence, critical factors influencing patients’ trajectories, like personal resources (geriatric resources, GR), geriatric syndromes (GS), health-related quality of life (HRQoL) and multidimensional prognosis often escape routine diagnostics.

Objective

To investigate the association between HRQoL and GR/GS as well as its prognostic signature.

Material and methods

In this study 165 inpatients older than 65 years admitted to an internal medicine department of a German large metropolitan hospital were assessed by a CGA-based calculation of the multidimensional prognostic index (MPI). Ten different GR and 17 GS, as well as HRQoL were collected. After 3, 6 and 12 months the patients were followed-up by telephone.

Results

The HRQoL was associated with MPI (p < 0.001), number of GS (p < 0.001) and survival days after discharge (p = 0.008). Additionally, significant associations were found between HRQoL and number of GR (p < 0.001). GS displaying risk for physical dependence like instability (p < 0.001) and chronic pain (p = 0.007) and single GR/GS that influence patient’s confidence like isolation (p < 0.001), depression (p < 0.001) and emotional resources (p = 0.002) were also associated with HRQoL.

Conclusion

The HRQoL is significantly associated to specific risk and protective factor profiles of GR and GS. To improve quality of life, targeted, patient-centered diagnostics and treatment of GS as well as stabilization of GR should be encouraged in the management of older, multimorbid patients outside geriatric settings.

Zusammenfassung

Hintergrund

Das multidimensionale Assessment (Comprehensive Geriatric Assessment, CGA) liefert entscheidende Informationen über hospitalisierte ältere Patienten, wird aber in nichtgeriatrischen Versorgungsstrukturen nicht konsequent angewendet. Als Folge werden kritische Faktoren für Patientenverläufe häufig nicht adressiert, wie persönliche Ressourcen, geriatrische Syndrome (GS), Lebensqualität und die multidimensionale Prognose.

Fragestellung

Untersuchung der Assoziation zwischen gesundheitsbezogener Lebensqualität („health-related quality of life, HRQoL“), GS und Ressourcen (GR) sowie multidimensionaler Prognose.

Patienten und Methoden

Bei 165 über 65-jährigen hospitalisierten Patienten unter Hochleistungsmedizin wurden der CGA-basierter multidimensionaler prognostischer Index (MPI), 10 GR, 17 GS sowie die HRQoL erhoben. Follow-up-Anrufe wurden 3, 6 und 12 Monate nach Entlassung durchgeführt.

Ergebnisse

Die HRQoL war mit dem MPI (p < 0,001), der Anzahl der GS (p < 0,001) und der Überlebenszeit nach Entlassung (p = 0,008) assoziiert. Zusätzlich ergaben sich signifikante Assoziationen zur Anzahl an GR (p < 0,001), zu GS, die gefährdete körperliche Selbstständigkeit anzeigen, wie Instabilität (p < 0,001) und chronische Schmerzen (p = 0,008), sowie GR und GS, die Einfluss auf das Wohlbefinden der Patienten haben, wie Isolation (p < 0,001), Depression (p < 0,001) und emotionale Ressourcen (p = 0,002).

Diskussion

Zum ersten Mal konnte gezeigt werden, dass Lebensqualität, gemessen mittels HRQoL, signifikant mit einem spezifischen Profil von Risiko- und protektiven Faktoren wie GS und GR assoziiert ist. Zur Verbesserung der Lebensqualität sollten eine gezielte und patientenzentrierte Diagnose und Therapie von GS sowie die Stabilisierung von GR auch in nichtgeriatrischen Versorgungsstrukturen angestrebt werden.

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Acknowledgements

The results were partly presented at the Annual Congress of the German Geriatrics Society 2019 in Frankfurt a.M. and the 2020 Annual Congress of German Internal Medicine Society in Wiesbaden. The authors are grateful to the patients who participated to this study.

Author information

Affiliations

Authors

Contributions

Conceived and designed the clinical trial: AH MCP. Performed the experiments: AH. Analyzed the data: AH IB MCP. Wrote the paper: AH. Conception of the manuscript: AH AMM MCP. Critical revisions: AH AMM MCP IB MR.

Corresponding author

Correspondence to M. C. Polidori MD PhD FRCP.

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Conflict of interest

A. Heeß, A.M. Meyer, I. Becker, N. Noetzel, J. Verleysdonk, M. Rarek, T. Benzing and M.C. Polidori declare that they have no competing interests.

This is a study on human participants which was ethically approved as explained in the methods section.

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Heeß, A., Meyer, A.M., Becker, I. et al. The prognostic fingerprint of quality of life in older inpatients. Z Gerontol Geriat (2021). https://doi.org/10.1007/s00391-021-01978-5

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Keywords

  • Comprehensive geriatric assessment (CGA)
  • Patient-centered medicine
  • Multidimensional prognosis
  • Frailty
  • Aging medicine

Schlüsselwörter

  • Comprehensive Geriatric Assessment (CGA)
  • Patientenzentrierte Medizin
  • Multidimensionale Prognose
  • Gebrechlichkeit
  • Altersmedizin