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Open Access 17-06-2024

Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial

Authors: Eirin Guldsten Robinson, Hanna Gyllensten, Anne Gerd Granas, Kjell H. Halvorsen, Beate Hennie Garcia

Published in: Quality of Life Research

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Abstract

Purpose

To describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults ≥ 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change.

Methods

The EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or ≥ 14 days.

Results

EQ-5D-3L index scores significantly declined after 12 months (β −0.06 [95% confidence interval (CI:) −0.10–−0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (β 0.05 [0.00–0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (β 4.02 [0.11–7.93], p = 0.044).

Conclusion

We observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services.

Trial registration

The trial was registered in clinicaltrials.gov on 28/06/2016 before enrolment started (NCT02816086).
Appendix
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Footnotes
1
Anxiety/Depression dimension: OR1.099 = 2.17 and Usual activities dimension: OR1.24.9 = 6.93.
 
2
EQ-5D-3L index score: β-0.02 × 9 = −0.18 and EQ-VAS: β-1.00 × 9 = −9.
 
Literature
1.
go back to reference Mangen, M.-J.J., Bolkenbaas, M., Huijts, S. M., van Werkhoven, C. H., Bonten, M. J. M., & de Wit, G. A. (2017). Quality of life in community-dwelling Dutch elderly measured by EQ-5D-3L. Health and Quality of Life Outcomes, 15, 3.CrossRefPubMedPubMedCentral Mangen, M.-J.J., Bolkenbaas, M., Huijts, S. M., van Werkhoven, C. H., Bonten, M. J. M., & de Wit, G. A. (2017). Quality of life in community-dwelling Dutch elderly measured by EQ-5D-3L. Health and Quality of Life Outcomes, 15, 3.CrossRefPubMedPubMedCentral
3.
go back to reference Montiel-Luque, A., Núñez-Montenegro, A. J., Martín-Aurioles, E., Canca-Sánchez, J. C., Toro-Toro, M. C., González-Correa, J. A., Polipresact Research Group. (2017). Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PLoS ONE, 12, e0171320.CrossRefPubMedPubMedCentral Montiel-Luque, A., Núñez-Montenegro, A. J., Martín-Aurioles, E., Canca-Sánchez, J. C., Toro-Toro, M. C., González-Correa, J. A., Polipresact Research Group. (2017). Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PLoS ONE, 12, e0171320.CrossRefPubMedPubMedCentral
4.
go back to reference Romskaug, R., Skovlund, E., Straand, J., Molden, E., Kersten, H., Pitkala, K., Lundqvist, C., & Wyller, T. B. (2020). Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy: A cluster randomized clinical trial. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2019.5096CrossRefPubMed Romskaug, R., Skovlund, E., Straand, J., Molden, E., Kersten, H., Pitkala, K., Lundqvist, C., & Wyller, T. B. (2020). Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy: A cluster randomized clinical trial. JAMA Internal Medicine. https://​doi.​org/​10.​1001/​jamainternmed.​2019.​5096CrossRefPubMed
6.
go back to reference Wilk, P., Ruiz-Castell, M., Stranges, S., et al. (2023). Relationship between multimorbidity, functional limitation, and quality of life among middle-aged and older adults: Findings from the longitudinal analysis of the 2013–2020 Survey of Health, Ageing, and Retirement in Europe (SHARE). Qual Life Res Int J Qual Life Asp Treat Care Rehabil. https://doi.org/10.1007/s11136-023-03508-9CrossRef Wilk, P., Ruiz-Castell, M., Stranges, S., et al. (2023). Relationship between multimorbidity, functional limitation, and quality of life among middle-aged and older adults: Findings from the longitudinal analysis of the 2013–2020 Survey of Health, Ageing, and Retirement in Europe (SHARE). Qual Life Res Int J Qual Life Asp Treat Care Rehabil. https://​doi.​org/​10.​1007/​s11136-023-03508-9CrossRef
7.
go back to reference Wallace, E., McDowell, R., Bennett, K., Fahey, T., & Smith, S. M. (2017). Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72, 271–277.CrossRefPubMed Wallace, E., McDowell, R., Bennett, K., Fahey, T., & Smith, S. M. (2017). Impact of potentially inappropriate prescribing on adverse drug events, health related quality of life and emergency hospital attendance in older people attending general practice: A prospective cohort study. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 72, 271–277.CrossRefPubMed
8.
go back to reference O’Connor, M. N., O’Sullivan, D., Gallagher, P. F., Eustace, J., Byrne, S., & O’Mahony, D. (2016). Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons’ prescriptions and screening tool to alert to right treatment criteria: A cluster randomized controlled trial. Journal of the American Geriatrics Society, 64, 1558–1566.CrossRefPubMed O’Connor, M. N., O’Sullivan, D., Gallagher, P. F., Eustace, J., Byrne, S., & O’Mahony, D. (2016). Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons’ prescriptions and screening tool to alert to right treatment criteria: A cluster randomized controlled trial. Journal of the American Geriatrics Society, 64, 1558–1566.CrossRefPubMed
9.
go back to reference O’Sullivan, D., O’Mahony, D., O’Connor, M. N., Gallagher, P., Gallagher, J., Cullinan, S., O’Sullivan, R., Eustace, J., & Byrne, S. (2016). Prevention of adverse drug reactions in hospitalised older patients using a software-supported structured pharmacist intervention: A cluster randomised controlled trial. Drugs and Aging, 33, 63–73.CrossRefPubMed O’Sullivan, D., O’Mahony, D., O’Connor, M. N., Gallagher, P., Gallagher, J., Cullinan, S., O’Sullivan, R., Eustace, J., & Byrne, S. (2016). Prevention of adverse drug reactions in hospitalised older patients using a software-supported structured pharmacist intervention: A cluster randomised controlled trial. Drugs and Aging, 33, 63–73.CrossRefPubMed
10.
go back to reference Lea, M., Mowé, M., Molden, E., Kvernrød, K., Skovlund, E., & Mathiesen, L. (2020). Effect of medicines management versus standard care on readmissions in multimorbid patients: A randomised controlled trial. British Medical Journal Open, 10, e041558. Lea, M., Mowé, M., Molden, E., Kvernrød, K., Skovlund, E., & Mathiesen, L. (2020). Effect of medicines management versus standard care on readmissions in multimorbid patients: A randomised controlled trial. British Medical Journal Open, 10, e041558.
11.
go back to reference Gillespie, U., Alassaad, A., Henrohn, D., Garmo, H., Hammarlund-Udenaes, M., Toss, H., Kettis-Lindblad, A., Melhus, H., & Mörlin, C. (2009). A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Archives of Internal Medicine, 169, 894–900.CrossRefPubMed Gillespie, U., Alassaad, A., Henrohn, D., Garmo, H., Hammarlund-Udenaes, M., Toss, H., Kettis-Lindblad, A., Melhus, H., & Mörlin, C. (2009). A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: A randomized controlled trial. Archives of Internal Medicine, 169, 894–900.CrossRefPubMed
13.
go back to reference Rankin, A., Cadogan, C. A., In Ryan, C., Clyne, B., Smith, S. M., & Hughes, C. M. (2018). Core outcome set for trials aimed at improving the appropriateness of polypharmacy in older people in primary care. Journal of the American Geriatrics Society, 66, 1206–1212.CrossRefPubMed Rankin, A., Cadogan, C. A., In Ryan, C., Clyne, B., Smith, S. M., & Hughes, C. M. (2018). Core outcome set for trials aimed at improving the appropriateness of polypharmacy in older people in primary care. Journal of the American Geriatrics Society, 66, 1206–1212.CrossRefPubMed
14.
go back to reference Beuscart, J.-B., Knol, W., Cullinan, S., et al. (2018). International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. BMC Medicine, 16, 21.CrossRefPubMedPubMedCentral Beuscart, J.-B., Knol, W., Cullinan, S., et al. (2018). International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. BMC Medicine, 16, 21.CrossRefPubMedPubMedCentral
15.
go back to reference Johansen, J. S., Havnes, K., Halvorsen, K. H., Haustreis, S., Skaue, L. W., Kamycheva, E., Mathiesen, L., Viktil, K. K., Granås, A. G., & Garcia, B. H. (2018). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): Study protocol for a randomised controlled trial. British Medical Journal Open, 8, e020106. Johansen, J. S., Havnes, K., Halvorsen, K. H., Haustreis, S., Skaue, L. W., Kamycheva, E., Mathiesen, L., Viktil, K. K., Granås, A. G., & Garcia, B. H. (2018). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): Study protocol for a randomised controlled trial. British Medical Journal Open, 8, e020106.
16.
go back to reference Johansen, J. S., Halvorsen, K. H., Svendsen, K., Havnes, K., Robinson, E. G., Wetting, H. L., Haustreis, S., Småbrekke, L., Kamycheva, E., & Garcia, B. H. (2022). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study)—a randomized controlled trial. BMC Health Services Research, 22, 1290.CrossRefPubMedPubMedCentral Johansen, J. S., Halvorsen, K. H., Svendsen, K., Havnes, K., Robinson, E. G., Wetting, H. L., Haustreis, S., Småbrekke, L., Kamycheva, E., & Garcia, B. H. (2022). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (The IMMENSE study)—a randomized controlled trial. BMC Health Services Research, 22, 1290.CrossRefPubMedPubMedCentral
17.
go back to reference Johansen, J. S., Halvorsen, K. H., Havnes, K., Wetting, H. L., Svendsen, K., & Garcia, B. H. (2022). Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients. Journal of Clinical Pharmacy and Therapeutics, 47, 619–627.CrossRefPubMed Johansen, J. S., Halvorsen, K. H., Havnes, K., Wetting, H. L., Svendsen, K., & Garcia, B. H. (2022). Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients. Journal of Clinical Pharmacy and Therapeutics, 47, 619–627.CrossRefPubMed
19.
21.
go back to reference Hosmer, D. W., & Lemeshow, S. (2013). Sturdivant RX Applied Logistic Regression (3rd ed.). John Wiley & Sons.CrossRef Hosmer, D. W., & Lemeshow, S. (2013). Sturdivant RX Applied Logistic Regression (3rd ed.). John Wiley & Sons.CrossRef
22.
go back to reference Griffiths, A., Paracha, N., Davies, A., Branscombe, N., Cowie, M. R., & Sculpher, M. (2017). Analyzing health-related quality of life data to estimate parameters for cost-effectiveness models: An example using longitudinal EQ-5D data from the SHIFT randomized controlled trial. Advances in Therapy, 34, 753–764.CrossRefPubMedPubMedCentral Griffiths, A., Paracha, N., Davies, A., Branscombe, N., Cowie, M. R., & Sculpher, M. (2017). Analyzing health-related quality of life data to estimate parameters for cost-effectiveness models: An example using longitudinal EQ-5D data from the SHIFT randomized controlled trial. Advances in Therapy, 34, 753–764.CrossRefPubMedPubMedCentral
23.
go back to reference Twisk, J., de Boer, M., de Vente, W., & Heymans, M. (2013). Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. Journal of Clinical Epidemiology, 66, 1022–1028.CrossRefPubMed Twisk, J., de Boer, M., de Vente, W., & Heymans, M. (2013). Multiple imputation of missing values was not necessary before performing a longitudinal mixed-model analysis. Journal of Clinical Epidemiology, 66, 1022–1028.CrossRefPubMed
24.
go back to reference Gabrio, A., Plumpton, C., Banerjee, S., & Leurent, B. (2022). Linear mixed models to handle missing at random data in trial-based economic evaluations. Health Economics, 31, 1276–1287.CrossRefPubMedPubMedCentral Gabrio, A., Plumpton, C., Banerjee, S., & Leurent, B. (2022). Linear mixed models to handle missing at random data in trial-based economic evaluations. Health Economics, 31, 1276–1287.CrossRefPubMedPubMedCentral
25.
go back to reference Faria, R., Gomes, M., Epstein, D., & White, I. R. (2014). A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. PharmacoEconomics, 32, 1157–1170.CrossRefPubMedPubMedCentral Faria, R., Gomes, M., Epstein, D., & White, I. R. (2014). A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. PharmacoEconomics, 32, 1157–1170.CrossRefPubMedPubMedCentral
26.
go back to reference StataCorp. (2021). Stata Statistical Software: Release 17. StataCorp LLC. StataCorp. (2021). Stata Statistical Software: Release 17. StataCorp LLC.
27.
go back to reference Stavem, K., Augestad, L. A., Kristiansen, I. S., & Rand, K. (2018). General population norms for the EQ-5D-3 L in Norway: Comparison of postal and web surveys. Health and Quality of Life Outcomes, 16, 204.CrossRefPubMedPubMedCentral Stavem, K., Augestad, L. A., Kristiansen, I. S., & Rand, K. (2018). General population norms for the EQ-5D-3 L in Norway: Comparison of postal and web surveys. Health and Quality of Life Outcomes, 16, 204.CrossRefPubMedPubMedCentral
28.
go back to reference König, H.-H., Heider, D., Lehnert, T., et al. (2010). Health status of the advanced elderly in six european countries: Results from a representative survey using EQ-5D and SF-12. Health and Quality of Life Outcomes, 8, 143.CrossRefPubMedPubMedCentral König, H.-H., Heider, D., Lehnert, T., et al. (2010). Health status of the advanced elderly in six european countries: Results from a representative survey using EQ-5D and SF-12. Health and Quality of Life Outcomes, 8, 143.CrossRefPubMedPubMedCentral
29.
go back to reference König, H.-H., Brettschneider, C., Lühmann, D., et al. (2020). EQ-5D-3L health status and health state utilities of the oldest-old (85 +) in Germany: Results from the AgeCoDe-AgeQualiDe study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 29, 3223–3232.CrossRef König, H.-H., Brettschneider, C., Lühmann, D., et al. (2020). EQ-5D-3L health status and health state utilities of the oldest-old (85 +) in Germany: Results from the AgeCoDe-AgeQualiDe study. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 29, 3223–3232.CrossRef
30.
go back to reference Wæhler, I. S., Saltvedt, I., Lydersen, S., Fure, B., Askim, T., Einstad, M. S., & Thingstad, P. (2021). Association between in-hospital frailty and health-related quality of life after stroke: The Nor-COAST study. BMC Neurology, 21, 100.CrossRefPubMedPubMedCentral Wæhler, I. S., Saltvedt, I., Lydersen, S., Fure, B., Askim, T., Einstad, M. S., & Thingstad, P. (2021). Association between in-hospital frailty and health-related quality of life after stroke: The Nor-COAST study. BMC Neurology, 21, 100.CrossRefPubMedPubMedCentral
31.
go back to reference Comans, T. A., Peel, N. M., Gray, L. C., & Scuffham, P. A. (2013). Quality of life of older frail persons receiving a post-discharge program. Health and Quality of Life Outcomes, 11, 58.CrossRefPubMedPubMedCentral Comans, T. A., Peel, N. M., Gray, L. C., & Scuffham, P. A. (2013). Quality of life of older frail persons receiving a post-discharge program. Health and Quality of Life Outcomes, 11, 58.CrossRefPubMedPubMedCentral
32.
go back to reference Luo, N., Johnson, J., & Coons, S. J. (2010). Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Medical Care, 48, 365–371.CrossRefPubMed Luo, N., Johnson, J., & Coons, S. J. (2010). Using instrument-defined health state transitions to estimate minimally important differences for four preference-based health-related quality of life instruments. Medical Care, 48, 365–371.CrossRefPubMed
33.
go back to reference Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 14, 1523–1532.CrossRef Walters, S. J., & Brazier, J. E. (2005). Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 14, 1523–1532.CrossRef
34.
go back to reference Sunde, S., Hesseberg, K., Skelton, D. A., Ranhoff, A. H., Pripp, A. H., Aarønæs, M., & Brovold, T. (2021). Associations between health-related quality of life and physical function in older adults with or at risk of mobility disability after discharge from the hospital. Eur Geriatr Med, 12, 1247–1256.CrossRefPubMedPubMedCentral Sunde, S., Hesseberg, K., Skelton, D. A., Ranhoff, A. H., Pripp, A. H., Aarønæs, M., & Brovold, T. (2021). Associations between health-related quality of life and physical function in older adults with or at risk of mobility disability after discharge from the hospital. Eur Geriatr Med, 12, 1247–1256.CrossRefPubMedPubMedCentral
35.
36.
go back to reference Grochtdreis, T., Dams, J., König, H.-H., & Konnopka, A. (2019). Health-related quality of life measured with the EQ-5D-5L: Estimation of normative index values based on a representative German population sample and value set. Eur J Health Econ HEPAC Health Econ Prev Care, 20, 933–944.CrossRef Grochtdreis, T., Dams, J., König, H.-H., & Konnopka, A. (2019). Health-related quality of life measured with the EQ-5D-5L: Estimation of normative index values based on a representative German population sample and value set. Eur J Health Econ HEPAC Health Econ Prev Care, 20, 933–944.CrossRef
37.
go back to reference Janssen, M. F., Szende, A., Cabases, J., Ramos-Goñi, J. M., Vilagut, G., & König, H. H. (2019). Population norms for the EQ-5D-3L: A cross-country analysis of population surveys for 20 countries. Eur J Health Econ HEPAC Health Econ Prev Care, 20, 205–216.CrossRef Janssen, M. F., Szende, A., Cabases, J., Ramos-Goñi, J. M., Vilagut, G., & König, H. H. (2019). Population norms for the EQ-5D-3L: A cross-country analysis of population surveys for 20 countries. Eur J Health Econ HEPAC Health Econ Prev Care, 20, 205–216.CrossRef
38.
go back to reference Keramat, S. A., Lee, V., Patel, R., Hashmi, R., & Comans, T. (2023). Cognitive impairment and health-related quality of life amongst older Australians: Evidence from a longitudinal investigation. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 32, 2911–2924.CrossRef Keramat, S. A., Lee, V., Patel, R., Hashmi, R., & Comans, T. (2023). Cognitive impairment and health-related quality of life amongst older Australians: Evidence from a longitudinal investigation. Qual Life Res Int J Qual Life Asp Treat Care Rehabil, 32, 2911–2924.CrossRef
Metadata
Title
Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial
Authors
Eirin Guldsten Robinson
Hanna Gyllensten
Anne Gerd Granas
Kjell H. Halvorsen
Beate Hennie Garcia
Publication date
17-06-2024
Publisher
Springer International Publishing
Published in
Quality of Life Research
Print ISSN: 0962-9343
Electronic ISSN: 1573-2649
DOI
https://doi.org/10.1007/s11136-024-03689-x