title: Does a hospital admission in old age denote the beginning of life with a compromised health-related quality of life? A longitudinal study of men and women aged 65 years and above participating in the Stockholm Public Health Cohort.
abstract: The objective of this study was to analyse how hospitalisation after the age of 60 affected individuals' health-related quality of life (HRQoL). The main hypothesis was that a hospital admission in old age can be seen as a proxy of ill health and possibly as a health divider, separating life into a healthy and an unhealthy part. The extent to which this is true depends on which disease individuals face and how functional ability and HRQoL are affected.
  
  
  
  This was a longitudinal study, based on an older cohort of individuals who participated in the Stockholm Public Health Cohort (SPHC) survey in 2006; the survey took place in Stockholm, Sweden. Information regarding hospitalisations and deaths, which is available through Swedish administrative registers, was linked to the survey from the National Patient Register and Cause of Death Register.
  
  
  
  2101 individuals, 65+ years old at inclusion, with no previous hospitalisations at baseline (2006), were followed for 4 years until 2010 (end of follow-up).
  
  
  
  HRQoL was assessed through a utility index derived from the EuroQol 5D questionnaire, at baseline and at 2010. The change in HRQoL after admission(s) to the hospital was estimated as the difference between the 2010 and 2006 levels using linear regression, also considering several covariates.
  
  
  
  A single hospitalisation did not reduce individuals' HRQoL, either for men or women. On the other hand, multiple any-cause hospitalisations reduced HRQoL between 3.2% and 6.5%. When looking into hospitalisations for specific causes, such as hip fractures, a decrease in HRQoL was observed as well; however, conclusions regarding this were impeded by the small sample size.
  
  
  
  Hospital admissions in old age may indicate a shift from a healthy life to a life of compromised health when considering their frequency and cause over a period of time.
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Korinna
authors.initials: K
authors.lastname: Karampampa
authors.affiliation: Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Paolo
authors.initials: P
authors.lastname: Frumento
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ahlbom
authors.affiliation: Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Modig
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013548:Sweden
keywords: EQ5D; Sweden; hospitalization; morbidity; older people; quality of life