A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy

Ana I. González-González, Andreas D. Meid, Truc S. Dinh, Jeanet W. Blom, Marjan van den Akker, Petra J.M. Elders, Ulrich Thiem, Daniela Küllenberg De Gaudry, Karin M.A. Swart, Henrik Rudolf, Donna Bosch-Lenders, Hans Joachim Trampisch, Joerg J. Meerpohl, Ferdinand M. Gerlach, Benno Flaig, Ghainsom Kom, Kym I.E. Snell, Rafael Perera, Walter E. Haefeli, Paul P. GlasziouChristiane Muth

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Objectives: To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. Study Design and Setting: We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3 L index score of ≥5% after 6-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally and by using internal–external cross-validation (IECV). Results: In 3,582 patients with complete data, of whom 1,046 (29.2%) showed deterioration in HRQoL, and 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being, and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (−0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. Conclusion: The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high risk of dHRQoL. Registration: PROSPERO ID: CRD42018088129.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalJournal of Clinical Epidemiology
Publication statusPublished - Feb 2021


  • Elderly
  • Functional status
  • Multimorbidity
  • Patient-centered care
  • Polypharmacy
  • Prognostic model
  • Quality of life

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