Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Department of Internal Medicine, University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands.
J Am Geriatr Soc. 2016 Apr;64(4):761-8. doi: 10.1111/jgs.14050.
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.
Post hoc analysis of data from prospective cohort study, 2006 to 2009, 12-month follow-up.
Eleven medical wards in three hospitals in the Netherlands.
Medical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473).
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 (ORs) and 95% confidence intervals (CIs) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables.
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.
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.
评估入院时健康相关生活质量（HRQOL）与死亡率、功能下降和入院后 3 个月和 12 个月时的机构化之间的独立关联。
对前瞻性队列研究数据的事后分析，2006 年至 2009 年，12 个月随访。
荷兰三家医院的 11 个内科病房。
年龄在 65 岁及以上、急性住院 48 小时或以上的内科患者（N=473）。
入院后 3 个月和 12 个月的死亡率、功能下降和机构化。主要决定因素是 HRQOL（入院时基于 EuroQol-5D 的效用，反映特定健康状况的相对可取性，并在 0（死亡）至 1（完全健康）的范围内进行测量。一些健康状况被认为比死亡更差，导致负效用，最小值为-0.330）。根据入院时的中位数效用将参与者分为两组。使用 Cox 和逻辑回归分析，调整了社会人口统计学和健康变量，估计了未调整和调整后的优势比（OR）和 95%置信区间（CI）。
中位数效用为 0.775（四分位距 0.399-0.861）。大于 0.775 的效用表明 HRQOL 较高，与死亡率（危险比=0.38，95%CI=0.18-0.83）和 3 个月时的功能下降（OR=0.47，95%CI=0.28-0.79）的风险降低相关在调整后的模型中。在 12 个月时，这些关联在粗模型中具有统计学意义，但在调整后的模型中没有。入院时的效用与 3 个月或 12 个月的机构化风险无关。
入院时较高的 HRQOL 与入院后 3 个月时的死亡率和功能下降风险降低相关。在年龄较大、急性住院的个体中，EQ-5D 可能提供一种风险分层的手段，并最终指导个体、他们的家人和专业人员在住院期间的治疗决策。
