Determinants of health-related quality of life in older patients after acute hospitalisation.
BACKGROUND
To assess the association between demographics, comorbidity, geriatric conditions, and three health-related quality of life (HRQOL) outcomes one year after acute hospitalisation in older patients.


METHODS
A prospective cohort study conducted between 2006 and 2009 with one-year follow-up in 11 medical wards at two university hospitals and one teaching hospital in the Netherlands. Participants were 473 patients of 65 years and older, acutely hospitalised for more than 48 hours. Demographics, Charlson Comorbidity Index (CCI), and data on 18 geriatric conditions were collected at baseline. At baseline and 12 months post-admission, the EuroQol-5D was administered. Based on a population-derived valuation (Dutch EuroQol-5D tariff), utilities (range -0.38-1.00) were determined, which were used to calculate quality-adjusted life years (QALY) over one year (max QALY score 1). The EuroQol-5D visual analogue scale (VAS) (range 0-100) was also used. Linear regression analyses were performed to explore the association between the independent variables and the three HRQOL outcomes.


RESULTS
CCI was most consistently significantly associated with HRQOL outcomes: Beta -0.05 (95% CI -0.06--0.03) for utility, -0.04 (95% CI -0.05-0.03) for QALY, -1.03 (95% CI -2.06-0.00) for VAS, p < 0.001, < 0.001, 0.05, respectively). Baseline utility was significantly associated with one-year utility (beta 0.25, 95% CI 0.11-0.39, p < 0.01) and QALY (beta 0.31, 95% CI 0.17-0.45, p < 0.001). The number of geriatric conditions at baseline was more strongly associated with one-year utility than any individual geriatric condition.


CONCLUSIONS
Less comorbidity, better utility and less geriatric conditions at baseline were associated with better HRQOL one year after acute hospitalisation in older patients.
Academic Medical Centre, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, the Netherlands.
J L
JL
Parlevliet
J L
JL
MacNeil-Vroomen
J E
JE
Bosmans
S E
SE
de Rooij
B M
BM
Buurman
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D015577:Geriatric Assessment; D006304:Health Status; D006305:Health Status Indicators; D006760:Hospitalization; D006784:Hospitals, Teaching; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years