Volker Burst1,2, Maria Cristina Polidori3,4, Marcel Pascal Rarek1, Anna Maria Meyer1, Lena Pickert1, Alberto Pilotto5,6, Thomas Benzing1,7,2. 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. 2. Emergency Department, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 3. 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. maria.polidori-nelles@uk-koeln.de. 4. Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany. maria.polidori-nelles@uk-koeln.de. 5. Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genoa, Italy. 6. Department of Interdisciplinary Medicine, University of Bari, Bari, Italy. 7. Faculty of Medicine and University Hospital Cologne, CECAD, University of Cologne, Cologne, Germany.
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.
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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