Evaluation of Health-Related Quality of Life in Geriatric Patients in A Tertiary Care Hospital

Health-related quality of life (HRQOL) is increasingly acknowledged as a vital measure for assessing the impact of health conditions on individuals. HRQOL specifically focuses on aspects of a person's life influenced by health, illness, or medical care and incorporates subjective perceptions of emotional, physical, and social well-being. It reflects an individual’s personal evaluation and response to their health status .^{1, 2}

Geriatrics is the medical specialty concerned with the clinical, preventive, therapeutic, and social aspects of illness in older adults. While individuals aged 55 years and above are generally classified as geriatrics, this threshold is somewhat arbitrary, as physiological changes associated with aging are gradual and continuous rather than abrupt at a specific age. In some contexts, the geriatric population is defined as those aged 60 years and above. ^{4, 8}

Aging poses one of the most significant health challenges globally, increasingly so due to advancements in medical therapies and technologies that has extended life expectancy. Notably, approximately 90% of elderly Americans report using at least one medication, underscoring the importance of pharmacological management in this group ⁹ Age-related alterations in pharmacokinetics and pharmacodynamics necessitate adjustments in medication use to accommodate changes in drug absorption, metabolism, distribution, and excretion .⁴

Age-associated physiological changes include slow muscle atrophy, with lean body mass declining by 20–30% between ages 30 and 80. Fat-free mass may decrease by 60–80%, while body fat percentage increases, particularly in men aged 18 to 36. Cellular mass diminishes by 30–65%, accompanied by a 20% reduction in the albumin pool. Cognitive decline begins around age 20 and progresses gradually until approximately 75 years of age. Motor function deterioration elevates the risk of accidents, and sensory impairments such as visual and auditory decline contribute to confusion. Collectively, these changes contribute to complex conditions commonly referred to as “old age syndromes” .^{4, 5}

HRQOL has emerged as an essential outcome measure for evaluating the efficacy of medical interventions. It is defined as an individual’s perception of their position in life within the cultural, social, and environmental contexts in which they live, relative to their goals, expectations, and concerns.^{2, 3}The World Health Organization (WHO) developed the WHOQOL-100 to provide a comprehensive, cross-cultural quality of life assessment. Due to its length, a shorter instrument, the WHOQOL-BREF, comprising 26 items across four domains (physical health, psychological health, social relationships, and environment), was developed for practical application in large-scale studies.³

The possible raw score ranges for each domain are as follows:

• Physical Health=17
• Psychological=19
• Social Relationships=12
• Environment=30

The WHOQOL-BREF domains evaluate multiple dimensions: physical health includes mobility, pain, energy, and dependence on medical treatment; psychological health covers body image, self-esteem, and cognitive functions; social relationships assess sexual activity, social support, and interpersonal relations; and the environmental domain addresses safety, leisure activities, access to health services, and the physical environment.³

Need for study

India is experiencing a demographic transition with a rapidly aging population. In 2011, the elderly (60 years and above) comprised 8.6% of the population, a figure projected to reach 11.6% by 2026. Currently, the elderly population in India stands at approximately 153 million, representing about 10.51% of the total population. Given this demographic shift, evaluating the HRQOL among India’s elderly population is imperative to inform health policy and ensure effective resource allocation.

MATERIALS AND METHOD:

The study protocol was reviewed and approved by the Institutional Ethics Committee of MVJ Medical College and Research Hospital (Approval No. MVJMC&RH/IEC-122/2024, dated 21-02-2024).

Study Design

Cross-sectional observational study conducted on 120 geriatric patients admitted to general medicine, orthopedics, psychiatry, and general surgery departments.

Inclusion Criteria:

• Patients aged 60 years and above
• Patients admitted to the selected departments
• Both male and female patients
• Patients providing written informed consent

Exclusion Criteria:

• Patients unwilling to participate
• Patients with severe cognitive impairment unable to answer the questionnaire
• Patients with terminal illness or in critical condition
• Patients admitted for less than 24 hours

Data Collection:

Quality of life of a patient was asked through questionnaire. Continuous data were introduced as Mean ± Standard deviation. Categorical data were given as frequencies rates for examination of quality of life; non-parametric test was done trailed by post-hoc investigation.

Data analysis was performed using Wilcoxon signed-rank test in SAS 9.4 through the univariate procedure and MS Excel was used to compare domain using a boxplot. Descriptive summary statistics are presented either as mean SD or as median (minimum and maximum). Statistical significance of the comparison in response proportions was determined using a univariate procedure with QQ PLOT.

RESULT

Descriptive Summary of Demographics:

About 40.83%of the studied population were males, whereas 59.17% were females. Out of 120 patients studied ,50.83% were between the age of 60-69years, 28.33% were between 70-79years, 15% were between  80 - 89years ,and 5% were between 90- 99years,0.83% were between 100-105years

Assessment of health-related quality of life WHO-BREF

While the WHO-QOL-100 has 100 questionnaires, the WHO-BREF scale only contains 26 verified questionnaires. Therefore, the WHO-BREF raw scores must be translated using the formula below to provide a value between 1 and 100:

Transformed score = (Score-4) × (100/ 16).

Logistic linear regression models were used to identify clear determinants of domain scores on the WHO BREF scale. The following variables were taken into account as the independent predictors of domain scores for creating logistic linear regression models. To identify the predictors, the WHO-BREF scales' domain scores 1, 2, 3, and 4 were each individually regressed against the factors regarded as independent.

Table 1: Age wise distribution

Out of 120 patients, 61 patients (50.83%) were in the age group of 60-69years, 34 patients (28.33%) were in the age group of 70-79 years, 18 patients (15%) were in the age group of

80-89 years, 6 patients (5%) were in the age group of 90–99-year, 1 patient (0.83%) were in the age group of 100 years

Table 2: Gender wise distribution

Out of selected 120 patients, 49 patients (40.83%) were male and the remaining 71 patients (59.17%) were female

WHOQOL-BREF domains

1. Daily tasks related to physical well-being that depend on medications and medical equipment job competence, mobility, energy consumption, pain, discomfort, sleep, and rest.
2. Emotional reactions to one's physical attributes, including positive and negative feelings, self-worth, spirituality, religion, and personal beliefs concentration, memory, learning, and reasoning.
3. Sexual activity, interpersonal relationships, social support, and social connections.
4. Funding for environmental freedom, physical safety, and security possibilities to learn new things, opportunities to participate in and discover leisure activities, accessibility and a decent living environment, and the physical environment (pollution, noise, traffic, and climate).

Table: 3 Domain score

The following things were evaluated in Domain 1, which deals with physical health:

• 58 patients (48.3%) reported that they are unable to perform their daily tasks due to moderate physical pain.
• According to 63 patients (52.5%), they need a moderate amount of medical care on a daily basis.
• Sixty patients (50%) reported having a moderate quantity of energy for day-to-day activities.
• According to 69 patients (57.5%), they are neither poor nor adept at getting around.
• A quarter of the patients, or thirty, expressed dissatisfaction with their sleep.
• 56 patients, or 46.6%, said they are neither happy nor unhappy with their ability to work.

Domain 2: Psychological

The following things were evaluated in Domain 2, which deals with psychological health:

• 66 (55%) of the patients said they enjoy life to a moderate degree.
• 75 patients (62.5%) reported feeling that their lives have a moderate amount of purpose.
• 56 patients (46.6%) reported having moderate amounts and having trouble focusing.
• 74 patients, or 80.6%, said they accept their physical appearance to a moderate degree.
• 67 patients, or 55.8%, said they were neither happy nor unhappy with themselves.
• 71 (59.1%) patients stated that have negative Feelings such as blue moon despair, anxiety, depression quite often.

Domain 3: Social relationship

The following things were evaluated in Domain 3, which deals with Social relationship

• 69 patients, or 57.5 percent, said they were neither happy nor unhappy with their personal connection.
• 104 (86.6%) of the patients said they were neither happy nor unhappy with their sexual lives.
• 71 patients, or 59.1%, say they are happy with their buddy support.

Domain 4: Environment

The following things were evaluated in Domain 4, which deals with Environment