title: Is health-related quality of life an independent prognostic factor for 12-month mortality and nursing home placement among elderly patients hospitalized via the emergency department?
abstract: OBJECTIVE
  To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients.
  
  
  METHODS
  A prospective, multicenter study with a 12-month follow-up.
  
  
  METHODS
  Nine French hospitals.
  
  
  METHODS
  A total of 1306 patients aged 75 and older hospitalized through an emergency department.
  
  
  METHODS
  Data obtained from sociodemographic characteristics, Comprehensive Geriatric Assessment and the Duke Health Profile (DHP) were used into a Cox model to identify prognostic variables for 12-month mortality and institutionalization.
  
  
  RESULTS
  Crude mortality and nursing home placement rates were 34.1% (n = 445) and 16.1% (n = 210), respectively. Independent prognostic factors identified for mortality were: Comorbidity level (moderate: hazard ratio [HR] [95% confidence interval (CI)] = 1.40 [1.09-1.78]; severe: 2.70 [1.63-4.46]), dependence for activities of daily living (1.68 [1.06-2.67]), pressure sore risk (1.49 [1.16-1.90]), risk of malnutrition (2.09 [1.46-3.00]), delirium (2.25 [1.75-2.90]), and 10-point increase in the DHP perceived health score (0.96 [0.93-0.99]). Independent prognostic factors identified for nursing home placement were the following: living alone at home (1.82 [1.30-2.55]), having 2 children or more (0.71 [0.51-0.99]), dependence for activities of daily living (2.48 [1.39-4.44]), dementia (1.93 [1.39-2.69]), unplanned hospital readmission during follow-up (2.05 [1.45-2.91]), and 10-point increase in the DHP social health score (0.90 [0.83-0.99]). Balance troubles and risk of malnutrition were no more significant when adjusted for the DHP scores and other clinical variables.
  
  
  CONCLUSIONS
  The perceived health and social health scores of the DHP were independent prognostic factors of survival and nursing home placement among hospitalized elderly patients, respectively. When associated with Comprehensive Geriatric Assessment, they could help screen frail patients to set up as early as possible targeted interventions to restore/maintain modifiable prognostic factors, such as nutritional status, functional ability, and social support.
authors.affiliation: University of Reims Champagne-Ardenne, Faculty of Medicine, EA3797, Reims, France. gaelle.dhaussy@wanadoo.fr
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Dhaussy
authors.forename: Moustapha
authors.initials: M
authors.lastname: Dramé
authors.forename: Damien
authors.initials: D
authors.lastname: Jolly
authors.forename: Rachid
authors.initials: R
authors.lastname: Mahmoudi
authors.forename: Coralie
authors.initials: C
authors.lastname: Barbe
authors.forename: Lukshe
authors.initials: L
authors.lastname: Kanagaratnam
authors.forename: Pierre
authors.initials: P
authors.lastname: Nazeyrollas
authors.forename: François
authors.initials: F
authors.lastname: Blanchard
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Novella
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005602:France / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D009026:Mortality; D009735:Nursing Homes; D010360:Patient Transfer; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors