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Health‐Related Quality of Life at Admission Is Associated with Postdischarge Mortality, Functional Decline, and Institutionalization in Acutely Hospitalized Older Medical Patients
Author(s) -
Parlevliet Juliette L.,
MacNeilVroomen Janet,
Buurman Bianca M.,
Rooij Sophia E.,
Bosmans Judith E.
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.14050
Subject(s) - medicine , interquartile range , hazard ratio , confidence interval , odds ratio , quality of life (healthcare) , logistic regression , proportional hazards model , cohort study , gerontology , demography , prospective cohort study , nursing , sociology
Objectives To assess the independent association between health‐related quality of life ( HRQOL ) at admission and mortality, functional decline, and institutionalization 3 and 12 months after admission in acutely hospitalized older adults. Design Post hoc analysis of data from prospective cohort study, 2006 to 2009, 12‐month follow‐up. Setting Eleven medical wards in three hospitals in the Netherlands. Participants Medical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473). Measurements Outcomes: mortality, functional decline, and institutionalization, 3 and 12 months after admission. Main determinant was HRQOL (utility based on the EuroQol‐5D at admission, reflecting the relative desirability of a particular health state and is measured on a scale from 0 (death) to 1 (full health). Some health states are regarded as being worse than death, resulting in negative utilities, with a minimum of −0.330). Participants were split into two groups based on median utility at admission. Unadjusted and adjusted odds ratios ( OR s) and 95% confidence intervals ( CI s) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables. Results Median utility was 0.775 (interquartile range 0.399–0.861). Utility greater than 0.775, indicating high HRQOL , was associated with lower risk of mortality (hazard ratio = 0.38, 95% CI = 0.18–0.83) and functional decline ( OR = 0.47, 95% CI = 0.28–0.79) at 3 months in the adjusted models. At 12 months, these associations were statistically significant in the crude models but not in the adjusted models. Utility was not associated with risk of institutionalization at 3 or 12 months. Conclusion Higher HRQOL at admission was associated with lower risk of mortality and functional decline 3 months after admission. In older, acutely hospitalized individuals, the EQ ‐5D may provide a means of risk stratification and may ultimately guide individuals, their families, and professionals in treatment decisions during hospitalization.