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 

Objectives

To assess whether health-related quality of life is an independent prognostic factor for mortality or nursing home placement in frail elderly patients.

Design

A prospective, multicenter study with a 12-month follow-up.

Setting

Nine French hospitals.

Participants

A total of 1306 patients aged 75 and older hospitalized through an emergency department.

Measurements

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.

Conclusion

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.

Keywords: Elderly patients, health-related quality of life, mortality, institutionalization