Measuring the impact of hospitalization for infectious diseases on the quality of life of older patients in four European countries: the AEQUI longitudinal matched cohort study (2020-2023)

Abstract

Objectives: To evaluate the impact of hospitalization for infectious diseases on the Health-Related Quality of life (HRQOL), multidimensional frailty, and functioning of older patients, we conducted a longitudinal matched cohort study in four European countries.

Methods: HRQOL, frailty, and functioning were assessed using validated questionnaires at inclusion, at discharge, and up to 6 months later in patients aged over 65 years hospitalized for severe acute respiratory or bloodstream infections, and matched controls hospitalized for non-infectious conditions. Comparative analyses employed multilevel mixed-effect linear or logistic models to assess changes from inclusion.

Results: Between 2020 and 2023, 1968 patients aged 65-100 years (mean, 81) were included; 1064 (54.1%) were male and 59 (3%) were institutionalized. Of these 1968 patients, 826 were hospitalized for infectious diseases and 1142 for non-infectious conditions. At inclusion, European Quality of Life 5 Dimensions and 3 Lines scores ranged from -0.7 to 1 (full HRQOL), with a median of 0.7 across all visits and groups. Compared with controls, patients hospitalized for infectious diseases had lower scores on the Activities of Daily Living (ADL) scale (median, 4.5 vs. 5.0; p 0.020) and the Instrumental ADL scale (median, 3.0vs. 4.0; p < 0.001). At discharge, Instrumental ADL scores were lower in patients hospitalized for infectious diseases than in controls (median, 4.0 vs. 5.0, p 0.003), indicating reduced functioning. The proportion of frail patients, determined by a Multidimensional Prognostic Index score between 0.67 and 1, was significantly higher among patients hospitalized for infectious diseases (n = 113/801, 14.1%) than controls (n = 108/1111, 9.7%; p 0.012). At six months, no statistically significant differences were observed between groups in changes from inclusion in HRQOL (European Quality of Life 5 Dimensions and 3 Lines, p 0.436), frailty (Multidimensional Prognostic Index, p 0.269), and functioning (ADL, p 0.993).

Discussion: Hospitalization for infectious diseases and non-infectious diseases or conditions had a similar impact on HRQOL in non-institutionalized older adults.

Keywords: Aged; Frailty; Functioning; Hospitalization; Infectious disease; Quality of life.