Early indications that low mental quality of life scores in recently unwell older people predict downstream functional decline

Abstract

Background

Accurately detecting markers of early functional decline (FD) are essential to support older people to successfully age in place; however, these markers are poorly understood. We tested the hypothesis that compromised mental quality of life after a minor health crisis could be an early predictor of FD.

Methods

This longitudinal observational cohort study was conducted in the emergency department (ED) of a large Australian hospital and in the community. Data were collected from 148 community-dwelling people aged 65+ years, who provided data at recruitment (baseline), and at 1 month and 3 months post discharge from the ED. Short Form-12 mental quality of life component scores (MCS) were regressed with patient descriptors taken at baseline (age, sex, socioeconomic status, education, Mini-Mental State Examination, and primary language), and over-time estimates of FD taken at baseline, and at 1 and 3 months post discharge (instrumental activities of daily living, frequency of falls and hospitalizations, use of gait aids, receipt of community services, living status, and requiring a carer).

Results

MCS at 1 month (MCS1) post ED discharge was significantly associated with instrumental activities of daily living at 1 (r=0.45, P<0.001) and 3 months (r=0.401, P=0.001) post ED discharge, but not at baseline (r=0.010, P>0.05). Subjects with lower than the population median MCS showed a significant linear decline in total instrumental activities of daily living scores over 3 months (P=0.025). There was no linear trend over time in the relationship between MCS1 with frequency of falls (P=0.20) or hospitalizations (P=0.42); however, there was a significant difference at 3 months post ED discharge for falls (P=0.036) and hospitalizations (P=0.039) between low and high MCS1 groups. There were no significant confounders.

Conclusion

Low MCS scores 1 month after a minor health crisis appear to significantly predict downstream FD. This finding needs to be tested in a larger sample.

Keywords:

• instrumental activities of daily living
• mental quality of life
• functional decline
• falls
• hospitalization

Acknowledgments

This paper was written from data collected as part of an Australian Research Council linkage grant, with funding from the Australian Research Council 2011–2012 and industry funding from the Central Northern Adelaide Health Service (via the Department of Health, South Australia). The authors would like to acknowledge the other grant investigators for their work in the Australian Research Council linkage grant, ie, John Forward, Louise Gordge, Saravana Kumar, and John Moss.

Author contributions

All authors contributed equally to the conceptualization of the study, and the final writing and preparation of the manuscript. KG and AA shared the statistical analysis.

Disclosure

The authors report no conflicts of interest in this work.