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The prognostic signature of health-related quality of life in older patients admitted to the emergency department: a 6-month follow-up study

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Abstract

Background

The management of older and multimorbid patients with complex care requires a personalised and comprehensive approach. The main diagnosis is often registered as the cause of hospitalisation, yet poor health-related quality of life (HRQoL) as well as multimorbidity may represent the underlying cause and markedly influence prognosis.

Aims

To analyse the association of HRQoL and clinical prognosis over time as assessed by a Comprehensive Geriatric Assessment (CGA)-based Multidimensional Prognostic Index (MPI) in older patients admitted to the emergency department (ED).

Methods

We used data from the prospective MPI–HOPE (Influence of the MPI on the Hospitalisation of Older Patients admitted to the Emergency department) study. Data from 165 patients (≥ 75 years) admitted to the ED of the University Hospital of Cologne, Germany, between Oct 2017 and Jan 2018 were included. Clinical prognosis was calculated by the MPI and HRQoL by the EQ5D-5L. Follow-up interviews assessed HRQoL up to 6 months after discharge.

Results

Most patients were multimorbid and presented with several geriatric syndromes. At admission, HRQoL was highest in patients with the best clinical prognosis. The MPI showed a negative correlation with the EQ-Index at admission (rs(86) = − 0.50, p < 0.0001) and follow-up assessments after 3 and 6 months (rs(86) = − 0.55 and rs(86) = − 0.47, p < 0.0001).

Discussion

Our results suggest that patients’ self-perceived HRQoL in the ED is related to functional health status and clinical prognosis.

Conclusion

The MPI as a multidimensional snapshot provides information on clinical health indicators and informs about subjective HRQoL, thereby helping in identifying patients who would benefit from a specific treatment within the frame of a patient-centered, value-based care strategy geriatric treatment.

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Availability of data and material

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The study design and preliminary results of the study have been presented at the 2018 Conference of the German society of geriatrics in Cologne (oral presentation), the 16th EUGMS Congress in Berlin (2018, poster presentation) as well as the 17th EUGM Congress in Krakow (2019, oral presentation). We wish to thank Lena Sannemann for her assistance with the statistics used in this report and her critical revision.

Funding

The authors received no specific funding for this work.

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Author notes

  1. Volker Burst and Maria Cristina Polidori are equal supervisors.

Authors and Affiliations

  1. Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Marcel Pascal Rarek, Anna Maria Meyer, Lena Pickert, Thomas Benzing, Volker Burst & Maria Cristina Polidori

  2. Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy

    Alberto Pilotto

  3. Department of Interdisciplinary Medicine, University of Bari, Bari, Italy

    Alberto Pilotto

  4. Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany

    Thomas Benzing & Maria Cristina Polidori

  5. Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany

    Thomas Benzing & Volker Burst

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  1. Marcel Pascal Rarek
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Contributions

MPR, VB and MCP conceived and designed the clinical trial. VB provided resources. MPR. LP performed the experiments. MPR analysed the data. MPR wrote the paper. MRP, AMM and MCP were involved in the conception of the manuscript. AMM, LP, AP, TB, VB and MCP contributed to critical revisions.

Corresponding author

Correspondence to Maria Cristina Polidori.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Statement of human and animal rights

The study was registered at the German Clinical Trials Register (DRKS00012694) and complies with the ethical rules for human experimentation that are stated in the Declaration of Helsinki (1983). It was approved by the Ethical Committee of the University Hospital of Cologne, Germany.

Informed consent

Written informed consent was obtained from all individual participants or proxy respondent included in the study.

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Rarek, M.P., Meyer, A.M., Pickert, L. et al. The prognostic signature of health-related quality of life in older patients admitted to the emergency department: a 6-month follow-up study. Aging Clin Exp Res 33, 2203–2211 (2021). https://doi.org/10.1007/s40520-020-01732-8

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  • DOI: https://doi.org/10.1007/s40520-020-01732-8

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