Determinants of health-related quality of life in older primary care patients: results of the longitudinal observational AgeCoDe Study.
BACKGROUND
In older patients with chronic diseases, focusing on subjective, patient-relevant outcomes, such as health-related quality of life (HRQoL), is more pertinent than pursuing clinical or laboratory target values.


OBJECTIVE
To investigate factors influencing the course of HRQoL in older (aged ≥78 years) primary care patients and to derive non-pharmacological recommendations for improving their quality of life.


METHODS
A population-based prospective longitudinal observational study featuring data analysis from waves 2 to 5 of the AgeCoDe study, which was conducted in six cities in Germany.


METHODS
The HRQoL of 1968 patients over the course of 4.5 years was observed. Patients were, on average, aged 82.6 (±3.4) years and their HRQoL was measured using the EQ-5D visual analogue scale in a face-to-face assessment. Fixed-effects regression models were calculated to examine impact of change in potential influencing factors. This method allows unobserved heterogeneity to be controlled.


RESULTS
The course of the participants' HRQoL declined with increasing age, walking and incident hearing impairment. Increasing the number of physical activities improved the HRQoL. These findings were modified by sex, education level, and depression. Especially in females and patients with rather low education levels, increased physical activity improved the subjects' HRQoL, while hearing impairment decreased it. Moving to an institution only improved the HRQoL in patients without depression or those with a low level of education (primary education).


CONCLUSIONS
Motivating patients to increase their weekly physical activity and to focus on preserving their ability to walk are promising approaches to improving HRQoL in older age. Less-educated patients and those without depression can also benefit from moving into an institution (for example, a care or retirement home).
Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Marion
M
Eisele
Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany.
Hanna
H
Kaduszkiewicz
University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Hamburg, Germany.
Hans-Helmut
HH
König
Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Carolin
C
Lange
Institute of General Practice, Hannover Medical School, Germany.
Birgitt
B
Wiese
Institute of General Practice, Hannover Medical School, Germany.
Jana
J
Prokein
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
Siegfried
S
Weyerer
Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
Jochen
J
Werle
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany.
Steffi G
SG
Riedel-Heller
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany.
Melanie
M
Luppa
Department of Psychiatry, University of Bonn, Germany.
Kathrin
K
Heser
Department of Psychiatry, University of Bonn, Germany; German Centre for Neurodegenerative Diseases, Bonn, Germany.
Alexander
A
Koppara
Department of Psychiatry, Technical University of Munich, Germany.
Edelgard
E
Mösch
Department of Psychiatry, Technical University of Munich, Germany.
Dagmar
D
Weeg
Institute of General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
Angela
A
Fuchs
Institute of General Practice, Medical Faculty, Heinrich Heine University Düsseldorf, Germany.
Michael
M
Pentzek
Department of Psychiatry, University of Bonn, Germany; German Centre for Neurodegenerative Diseases, Bonn, Germany.
Wolfgang
W
Maier
Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Martin
M
Scherer
André
A
Hajek
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D004522:Educational Status; D005260:Female; D005858:Germany / Q000453:epidemiology; D006299:Health Services for the Aged; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011320:Primary Health Care; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology
aged ≥80 years; institutionalisation; mobility limitation; nursing homes; primary health care; quality of life; walking