The prognostic fingerprint of quality of life in older inpatients : Relationship to geriatric syndromes' and resources' profile.

Abstract

The Comprehensive Geriatric Assessment (CGA) provides essential information about older hospitalized patients but is either not systematically adopted or not adopted at all in clinical routine. As aconsequence, critical factors influencing patients' trajectories, like personal resources (geriatric resources, GR), geriatric syndromes (GS), health-related quality of life (HRQoL) and multidimensional prognosis often escape routine diagnostics. To investigate the association between HRQoL and GR/GS as well as its prognostic signature. In this study 165 inpatients older than 65years admitted to an internal medicine department of aGerman large metropolitan hospital were assessed by aCGA-based calculation of the multidimensional prognostic index (MPI). Ten different GR and 17GS, as well as HRQoL were collected. After 3, 6 and 12months the patients were followed-up by telephone. The HRQoL was associated with MPI (p < 0.001), number of GS (p < 0.001) and survival days after discharge (p = 0.008). Additionally, significant associations were found between HRQoL and number of GR (p < 0.001). GS displaying risk for physical dependence like instability (p < 0.001) and chronic pain (p = 0.007) and single GR/GS that influence patient's confidence like isolation (p < 0.001), depression (p < 0.001) and emotional resources (p = 0.002) were also associated with HRQoL. The HRQoL is significantly associated to specific risk and protective factor profiles of GR and GS. To improve quality of life, targeted, patient-centered diagnostics and treatment of GS as well as stabilization of GR should be encouraged in the management of older, multimorbid patients outside geriatric settings.