Patients’ perspective on Geriatric Syndromes and their Relation with Quality of Life: a cross-sectional Study

Patients’ perspective on Geriatric Syndromes and their Relation with Quality of Life: a cross-sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patients’ perspective on Geriatric Syndromes and their Relation with Quality of Life: a cross-sectional Study Aline Schönenberg, Konstantin G. Heimrich, Annika Sternkopf, Paul Lochbihler, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7426749/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Purpose Many older patients suffer from multimorbidity, rendering disease-specific approaches moot. Instead, overarching geriatric syndromes (GS) can be used to describe patients’ experiences above and beyond concrete diagnoses. However, little is known about how patients themselves perceive these GS. Methods We collected self-reported data on N = 511 geriatric in- and N = 155 outpatients on the occurrence of nine GS: reduced mobility, falls, problems with cognition, depressiveness, loneliness, pain, incontinence, problems with sleep, and problems with swallowing. We additionally asked about the perceived restriction and expectations regarding improvement of the GS. Using descriptive statistics, group comparisons and linear regression, we describe patients’ perception of the GS and their association with mental and physical quality of life (QoL) while controlling for cognition, functional status and health. Results On average, patients report 3.4 (SD = 1.8) different GS, while 47.2% reported ≥ 4. The most frequent GS were mobility problems, falls, and pain; these were also perceived as most restrictive in daily life. A higher number of GS significantly reduces mental and physical QoL, above and beyond physical health. For physical QoL, mobility problems, falls, and pain are most influential, while mental QoL is linked with depressiveness, loneliness and sleep problems. These associations were even stronger in out- than in inpatients. Conclusion GS are highly prevalent and lead to reduced mental and physical QoL. As they impact QoL above and beyond physical health and functionality, GS and their association with age-related expectations should be incorporated in clinical care to improve well-being. geriatric syndromes multimorbidity patient-centered older adults geriatrics geriatric assessment Figures Figure 1 Figure 2 Figure 3 Key summary points Aim: How do geriatric patients experience geriatric syndromes, and how are they related to quality of life? Findings: A higher number of concurrent geriatric syndromes is linked with worse physical and mental quality of life. Mobility problems and pain are most frequent and most restrictive to patients in daily life Message: Geriatric Syndromes are frequent; they reduce physical and mental quality of life above and beyond objective health measures and should thus be targeted in clinical interventions Introduction Geriatric medicine has undergone a notable shift in its approach, away from the management of individual diseases towards a comprehensive focus on overall geriatric syndromes (GS) [ 1 – 3 ]. This shift is driven by the high prevalence of multimorbidity, wherein patients frequently present with multiple, interrelated health concerns rather than a single condition [ 2 , 4 – 6 ]. GS can be interpreted as cumulative effects of multiple impairments, leading to increased overall vulnerability of older adults [ 1 ]. Consequently, healthcare providers are confronted with the challenge of managing the intricacies of these GS, which encompass a range of issues including mobility difficulties, cognitive decline, incontinence, depressive mood, polypharmacy, malnutrition, sleep disorders and others that collectively impact the quality of life (QoL) of older patients [ 5 – 8 ]. Of note, no concrete definition of GS exists due to their highly heterogeneous and multifaceted nature [ 9 , 10 ]. These heterogeneous definitions leave the selection of GS open to the respective researchers. Despite this heterogeneity in the included GS, their impact on well-being and QoL is unmistakable across studies [ 11 ]. The presence of GS may lead to hospitalization or institutionalization [ 2 , 8 , 12 ] and may even increase mortality rates [ 13 ]. In patients with diabetes for example, GS have a negative impact on both physical and mental QoL [ 14 ]. In patients with chronic kidney diseases, this association between QoL and GS even remained present when taking concrete illnesses into account [ 15 ]. Despite the clinical importance of GS, research on prevalence and impact of those GS is rare, potentially due to the challenges of scientific recruitment in geriatric patients and the overall underrepresentation of geriatric patients in medical studies [ 16 ]. There remains a gap in understanding how geriatric patients themselves perceive these GS. While GS may pose a challenge for healthcare providers, as they do not allow for a differentiation between the overlapping causes of the GS, they may aid older patients in describing their actual daily challenges. For example, a patient may suffer from Parkinson’s disease, polyneuropathy, osteoporosis, and a fracture after a fall; while it is important for medical staff to understand the causes of each GS, the primary issue experienced by this patient is a restriction in mobility, irrespective of the underlying illnesses. Thus, it is imperative to comprehend the patient perspective in order to develop patient-centered care strategies that integrate both the clinical aspects of GS and the patients' own experiences. This is especially important as the prevalence of GS rises with advancing age [ 2 , 5 , 17 ], cumulating in as many as 90% of geriatric patients reporting any GS, while most report multiple [ 6 , 7 , 18 ]. This manuscript aims to explore how geriatric patients experience selected GD, including their perceptions of the presence, limitations in daily life, and potential for improvement. For this purpose, we asked geriatric patients about their perception of nine GS including mobility problems, falls, cognitive problems, depressiveness, loneliness, pain, incontinence, sleep disturbances, and dysphagia. Through this lens, we seek to provide insights into improved delivery of geriatric care by incorporating the patients’ voices into the management of their health. Methods Patients and Recruitment Data was collected as part of the SelfManGer – Self-management of geriatric patients in Germany study [ 19 ] conducted at geriatric wards in two hospitals (trial registration: DRKS00031016) in Saxony-Anhalt and the related JenaGer Study conducted in Thuringia. While having differing overall aims, the SelfManGer and JenaGer studies were designed in concordance with overlapping instruments to ensure two comparable core datasets. In addition, for SelfManGer , patients were recruited from two collaborating GP practices in urban areas. Data collection took place between February 2023 and August 2024. We included 1) older inpatients receiving comprehensive geriatric care within the German Operation and Procedure Classification System (OPS 8-550) and 2) older outpatients (65 years and older with multimorbidity). Exclusion criteria were severe dementia or acute delirium, severe depression, and being fully dependent in activities in daily living according to the Barthel Index[ 20 ]. Except for diagnosed dementia and acute delirium, we did not specify a cut-off for cognitive tests as an exclusion criterion but instead included patients if study staff felt they were able to hold a meaningful conversation and comprehend the questionnaires [ 21 ]. All patients were screened based on their medical records, and then trained study staff approached eligible patients and informed them about the study. The study was approved by the local ethics committee of Halle University Hospital, the State Chamber of Physicians of Saxony-Anhalt (Landesärztekammer; approval number: 2022-026), and the ethics committee of Jena University Hospital (2023-2923-BO). If the patients gave their written informed consent, study staff proceeded going through the questionnaires together [ 21 ]. The study included both questionnaires and medical information obtained from the geriatric assessments performed as part of routine inpatient care. The following questions were covered in a questionnaire; the translation is available along with the data [ 22 ][Link for review: https://osf.io/a68x5/?view_only=6d092e9330e046a49b043271d57cb0a4 ] - Sociodemographic information: age, gender, living situation (alone – not alone), martial state (married or in partnership – single – widowed or divorced), education (low: less than 8 years, middle = 8 to 10 years, high = more than 10 years); - GS: Presence of (yes/no): impaired mobility , falls , problems with cognition , sadness/ depressiveness , loneliness , pain , incontinence , problems with sleep , problems with swallowing ( dysphagia) Which of the above mentioned syndromes is the most restrictive to you in your daily life? (single choice) On a scale of 0 to 100, how restricted are you in your daily life because of this problem? (100 indicates no restriction at all, 0 indicates fully restricted) On a scale of 0 = sure that it will not improve to 100 = sure that it will definitely improve , how confident are you that the problem will improve? - QoL according to the WHOQOL-Bref questionnaire [ 23 ]; in this analysis we focus on the physical and mental QoL subscales. In addition to this questionnaire, the following variables were extracted from each inpatients’ medical record: Geriatric depression scale, GDS [ 24 , 25 ], ranging between 0 and 15 points with higher scores indicating higher levels of depressiveness Barthel Index[ 20 ], ranging between 0 and 100 points with higher scores indicating independence in daily activities Geriatric screening according to Lachs [ 26 ] depicting 15 areas of potential restriction in daily tasks such as movement, cognition, incontinence or mood, with higher scores indicating a higher level of pathology Cognition according to the Montreal Cognitive Assessment, MoCA or the Mini Mental Status Test MMST [ 27 , 28 ]. Of note, for reasons of comparability, the MoCA was transformed to match the MMST according to the conversion described in Fasnacht et al. [ 29 ]. For both assessments, higher scores indicate better cognitive performance Number of different medications taken daily, Nmeds For the outpatients recruited from GP practices, no routine geriatric assessment was available. To describe their mental and cognitive characteristics, we performed the GDS and the MiniCog [ 30 ]. The MiniCog combines word recall and clock test. A score below three indicates cognitive impairment. In total, N = 666 patients were recruited and completed the questionnaire of interest on GS, N = 511 of which were inpatients and N = 155 outpatients recruited from the GP practices. Statistical Analysis We described the included patients grouped by location (inpatient vs outpatient) with descriptive statistics using mean (M) and standard deviation (SD) as well as Median (MD) and interquartile range (IQR) in case of non-normal distribution as assessed by Shapiro-Wilk-Test. For group comparisons regarding gender and GS, we used Chi² test for categorical variables as well as Mann Whitey U test or Kruskal Wallis Test with Dunn Test and Bonferroni correction. Effect sizes for metric data were calculated as rank biserial correlation r and for Chi2 Test as Cohen’s ω. Values for both can be considered low between |0.1| – < |0.3|, medium between |0.3| - |0.5| [ 31 , 32 ]. Initially, we describe the presence of the respective GS as well as their co-occurrence, the amount of limitation patients experience due to the respective GS, and expectations regarding improvement. Lastly, we assessed the impact of GS on physical and mental QoL using the WHOQOL-Bref questionnaire. Using regression analysis, we first defined Number of Syndromes as a single independent variable in a simple model, followed by the inclusion of age and gender, and then we determined the robustness of the association with the addition of the objective health-related covariates GDS, MMST/MiniCog, and for inpatients Lachs. Using group comparison, we analyzed differences in patients’ QoL depending on the presence of each GS. All analyses were performed in R Version 4.3.0 with a significance value of .05 and a two-sided approach. Results Descriptive Statistics The characteristics of the cohort is given in Table 1 . We included N = 511 geriatric inpatients and geriatric N = 155 outpatients. The inpatients were 83.0 years old (SD = 5.96), ranging from 67 to 96 years, while outpatients were younger at 79 years (SD = 6.42). Most patients were female, lived alone as widows, and had at least 10 years of education. With a GDS score of 4.09, the patients did not show signs of a depressive disorder, and an average of 25.20 points in the MMST (range = 10–30) indicates mild cognitive deficits. Table 1 Descriptive statistics of the included patients Inpatient Outpatient Comparison* Variable M (SD) MD (IQR) M (SD) MD (IQR) p , r Age 83.0 (5.96) 83 (8) 79.0 (6.42) 80 (9) < .001, 0.35 Number of Syndromes 3.61 (1.79) 4 (3) 2.74 (1.85) 2 (3) < .001, 0.29 Number of Medications 10.4 (4.72) 10 (6) 7.8 (4.12) 7 (7) < .001, 0.32 MMST/MiniCog 25.2 (3.31) 26 (5) 3.16 (1.56) 4 (2) GDS 4.09 (3.00) 4 (4) 4.4 (3.46) 4 (4) .454, -0.04 Barthel Index (admission) 46.3 (18.8) 45 (25) Lachs 6.72 (2.12) 7 (3) WHO_physical 53.1 (21.5) 53.6 (28.6) 61.5 (20.1) 64.3 (31.2) < .001, -0.26 WHO_mental 68.3 (16.7) 70.8 (20.8) 67.0 (16.9) 70.8 (25) .596, 0.03 Variable Count % Count % p , W Gender .242, .049 Female 335 65.56 93 40 Male 176 34.44 62 60 Marital Status .027, .104 Married 183 35.88 73 47.71 Single 34 6.67 10 6.54 Widowed/Separated 293 57.45 70 45.75 Living Situation .099, .083 Alone 261 51.08 65 42.48 Not Alone 204 39.92 76 49.67 Other 46 9.00 12 7.84 Education < .001, .193 Low 17 3.35 0 0 Middle 246 48.43 108 70.13 High 245 48.23 46 29.87 Care level < .001, .264 0 195 38.69 99 67.81 1 50 9.92 16 10.96 2 154 30.56 19 13.01 3 92 18.25 12 8.22 4 11 2.18 0 0 5 2 0.40 0 0 Health Satisfaction 5 413 85.51 101 66.45 < .001, .207 *Group Comparison between in- and outpatients MMST = Mini mental status test (cognition), GDS = geriatric depression scale, WHO_ = WHOQOL-Bref quality of life questionnaire, mental and physical scale Effect size: Wilcoxon Rank Sum/Mann Whitney Test for metric data: r = rank biserial correlation Chi2 Test: Cohen’s ω Occurrence of Geriatric Syndromes On average, patients reported to have 3.41 (SD = 1.84) of the nine GS. Inpatients had more GS (M = 3.61) compared to outpatients (M = 2.74) (Table 1 ) . 53.23% of inpatients reported 4 or more GS. Only 10% of inpatients and 21% of outpatients reported a singular GS (Fig. 1 A). The most common GS were problems with mobility, pain, falls, and sleep (Fig. 1 B, Supplement Table 1 ). Regarding gender, we found significant differences in the occurrence of GS only for pain (p = .009), with 57.94% of females reporting pain compared to 47.06% of males; dysphagia ( p = .017) was more commonly reported by men (11.34%) than women (5.84%). A similar pattern remained after splitting by recruitment location (Supplement Table 2 ). Perceived restrictions because of geriatric syndromes Of all the GS, 271 (44.7%) patients selected mobility problems as the most restrictive GS in their daily lives, followed by pain (95, 15.7%) and falls (91, 15.0%). When looking at in- and outpatient separately, 53.2% of inpatients with mobility problems selected those as most impactful; this association was even stronger in outpatients where 63.2% rated their mobility problems as most restrictive (Supplement Table 1 ). Almost a third of outpatients rated their cognitive impairments as most restrictive while only 10.0% of inpatients did so (Fig. 2 A), despite a higher mean restriction in inpatients (M = 37.3) than outpatients (M = 24.9). In contrast, inpatients rated incontinence (29.3%) and dysphagia (38.2%) as more restrictive as outpatients did (12.6% and 22.5%, respectively). The amount of perceived restriction was lower in outpatients than inpatients for most GS except loneliness (Supplement Table 1 , Fig. 2 B). As shown in Fig. 2 B and Supplement Table 1 , there is considerable heterogeneity in the restriction patients experience due to the GS, especially in outpatients. Most patients who selected mobility and pain-related GS experience those as rather restrictive while problems with cognition, swallowing and sleep are considered relatively less restrictive. Perceptions of potential for improvement In addition to inquiring about the restriction, patients were asked to indicate whether they expected the respective GS to improve ( 0 = sure it will not improve , 100 = sure it will definitely improve ). Substantial heterogeneity in the patients' responses was observed when utilizing a cutoff of 50 (50 = undecided, 50). For mobility problems as the most prevalent GS, 41.6% of inpatients but only 15% of outpatients expected the GS to improve. A similar pattern unfolds for the other GS, with outpatients reporting more pessimistic expectations regarding falls, pain, and sleep (Fig. 3 , Supplement Table 3). Both in- and outpatients are pessimistic regarding improvements in age-related GS such as loneliness, cognition and incontinence; however, due to small sample sizes, these results should be interpreted with caution. Geriatric Syndromes and Quality of Life Finally, we assessed the influence of the number of GS and in detail of each GS on physical and mental QoL. An increasing number of GS was correlated with worse physical (r = -0.53, p < .001) and mental QoL (r = -0.43, p < .001). Notably, this association was even stronger for outpatients (physical r = -0.74, p < .001, mental r = -0.64, p < .001) than for inpatients (physical r = -0.45, p < .001, mental r = -0.40, p < .001). According to Fisher’s Z test, the strength of the correlation is significantly higher in outpatients (p < .01).We performed regression analyses to understand the link between GS and QoL separately for inpatients and outpatients. For both patient groups, a higher number of GS was associated with lower physical QoL, even when controlling for covariates such as age, gender, GDS, cognition, and Lachs. For inpatients, a higher number of GS (ß = -5.37, 95% CI [-6.35; -4.40], p < .001) alone explained 19.5% of the QoL variance; neither gender (ß = 0.37, 95% CI [-3.30; 4.04], p = .844) nor age (ß = 0.25, 95% CI [-0.05; 0.55], p = .10) mitigated this effect (ß = -5.42, 95% CI [-6.40; -4.44], p < .001). With covariates, a higher number of GS remained significantly associated with worse physical QoL (ß = -4.15, 95% CI [-5.20, -3.10], p < .001) in addition to GDS, MMST and Lachs (Table 2 ). For outpatients, a similar picture emerged, with a higher number of GS (ß = -8.26, 95% CI [-9.72, -6.81], p < .001) explaining 49.3% of the variance of lower QoL; this association remained (ß = -8.11, 95% CI [-9.65; -6.57], p < .001) when adding gender (ß = 0.46, 95% CI [-4.84; 5.75], p = .864) and age (ß = -0.09, 95% CI [-0.50; 0.32], p = .667) to the model. With covariates, a higher number of GS remained a significant predictor of lower physical QoL (ß = -5.49, 95% CI [-7.36, -3.63], p < .001). The same picture was found for mental QoL (Table 2 ), with a higher number of GS alone explaining 16.7% of QoL variance for inpatients and 42.2% for outpatients. This association remained significant in the second model irrespective of age and gender, and in model 3 after including the other covariates. Table 2 Regression analysis on association between Number of Syndromes and Quality of Life Inpatients – Physical QOL Outpatients – Physical QOL Predictors Est CI P Predictors Est CI ß (Intercept) 85.41 56.23–114.6 < 0.001 (Intercept) 75.91 44.77–107.05 < 0.001 SyndromNum -4.15 -5.20 – -3.10 < 0.001 SyndromNum -5.49 -7.36 – -3.63 < 0.001 age 0.24 -0.05–0.53 0.106 age 0.03 -0.35–0.42 0.862 gender [male] 0.29 -3.27–3.85 0.872 gender [male] 1.56 -3.44–6.56 0.537 GDS -1.23 -1.84 – -0.62 < 0.001 GDS -2.07 -3.10 – -1.03 < 0.001 MMST -0.84 -1.35 – -0.33 0.001 MiniCog 1.26 -0.41–2.94 0.137 LACHS -1.63 -2.47 – -0.79 < 0.001 N = 474, R2 / R2 adjusted0.269 / 0.260 N = 124, R2 / R2 adjusted0.567 / 0.549 Inpatients – Mental QOL Outpatients – Mental QOL (Intercept) 64.85 42.03–87.67 < 0.001 (Intercept) 75.38 54.62–96.14 < 0.001 SyndromNum -2.72 -3.53 – -1.91 < 0.001 SyndromNum -1.71 -2.87 – -0.56 0.004 age 0.25 0.02–0.48 0.030 age 0.11 -0.15–0.36 0.414 gender [male] -0.21 -3.00–2.57 0.880 gender [male] 1.34 -1.98–4.65 0.427 GDS -1.80 -2.28 – -1.32 < 0.001 GDS -3.15 -3.79 – -2.52 < 0.001 MMST 0.10 -0.31–0.51 0.634 Minicog 0.30 -0.78–1.38 0.581 LACHS -0.40 -1.06–0.25 0.230 N = 472, R2 / R2 adjusted0.278 / 0.269 N = 139, R2 / R2 adjusted0.682 / 0.670 GDS = Geriatric Depresson Scale, MMST = Mini Mental Status Test, Minicog = Mini Cognitive Assessment, Lachs = Geriaric Screening accoding to Lachs, SyndromNum = Number of geriatric syndromes Lastly, we aimed to assess the influence of individual GS on QoL, repeating the regression analyses separately with each GS and the covariates as predictors for mental or physical QoL. Due to the small sample size of certain GS in outpatients, we report detailed analyses on the impact of specific GS on QoL primarily for inpatients (Supplement Table 4A). For the same reason, no results are reported for dysphagia. For inpatients, all GS except cognition were significantly associated with lower physical QoL, with mobility problems (p < .001, r = .44), pain (p < .001, r = .37), sleep problems (p < .001, r = .30), and falls (p < .001, r = .29) showing moderate effect sizes (Supplement Table 4). For mental QoL, the associations were weaker, with highest effect sizes found for loneliness (p < .001, r = .37), depressiveness (p < .001, r = .35), and cognition (p < .001, r = .27). In outpatients, the association between mobility problems, falls, pain, and sleep as most prevalent GS was even higher (Supplement Table 4B). Discussion GS represent disease-overarching syndromes that frequently occur in older age [ 1 ]. In the present analysis from the SelfManGer project [ 19 ], we aimed to gather an insight into GS from the perspective of geriatric patients. For this purpose, we collected data on nine common GS, the amount of limitation patients perceive, the potential they see for improvement, and lastly their association with QoL. For both inpatients and outpatients, we found mobility-related problems to be perceived as most impactful on patients’ daily lives. Even after controlling for sociodemographic information, cognition, mental health and functional status, a higher number of GS remained linked to worse physical and mental QoL. The presence of each GS negatively impacts QoL, of which mobility problems and pain yielded the strongest impact on physical QoL while depressiveness, loneliness and cognitive decline strongly influence mental QoL. Notably, although they were on average younger and healthier than inpatients, the association between GS and QoL was even stronger in outpatients. Several previous studies aimed to assess the prevalence of GS, however, due to a lack of consensus on their definition different studies assessed different GS. For example, Verstraeten et al. [ 18 ] looked at polypharmacy and multimorbidity, cognitive deficits, depressive symptoms, nutrition, frailty and falls. In contrast, Sanford et al. [ 5 ] solely looked at frailty, weight loss, sarcopenia, and dementia, and Möller et al. [ 8 ] further included incontinence, insomnia, and vision impairments. Likewise, many studies combine different sources, combining interviews, standardized questionnaires, and routine data [ 7 ]. This heterogeneity in the included GS makes a comparison of studies difficult; however, across all studies, the high prevalence of GS has been confirmed: In line with Wang et al. [ 6 ] and Bell et al. [ 7 ], 90% of our inpatients and 79% of outpatients reported more than one GS. In two cohorts with a comparable age profile to our study, Verstraeten et al. [ 18 ] confirmed the high prevalence of GS, stating that most patients had 5 or more GS that rarely occurred in isolation. In our study, nearly half the patients reported four or more GS. Likewise, Alhalaseh et al. [ 17 ] found almost all geriatric patients to have GS, ranging from 2.56 GS in younger patients to 3.55 in the oldest patients, matching the responses of our on average younger outpatients and older inpatients. The increasing prevalence of GS with age is confirmed in other studies [ 2 , 5 ], highlighting the need to understand and address GS in the light of the demographic shift. In addition to determining their presence, the key aim of the present study was to assess the impact GS have on patients. Thus, we asked patients to self-select the GS they experience and also asked about the restriction and the potential for improvement regarding the GS. To the best of our knowledge, this has not yet been done before. From this patient perspective, considerable heterogeneity is present in the interpretation of GS. Some patients report to be strongly impacted by their GS to the point where normal daily activity was no longer possible, whereas other patients are less restricted by the respective GS. This heterogeneity again indicates that a patient-focused approach is needed to individually understand each patients’ experience and expectations. Notably, both in- and outpatients selected mobility-related problems as most frequent and most impactful. This influence of mobility has been confirmed in previous studies showing that falls were amongst the most prevalent GS [ 7 , 13 , 18 ] and were related to increased mortality [ 13 ]. The influence of mobility may be rooted in its connection to daily activities: older adults often cite the ability to perform daily tasks independently as crucial for their well-being and QoL, which rises and falls with mobility [ 34 ]. Additionally, mobility is a pre-requisite for social participation as well as for physical activity [ 35 , 36 ], all of which are related to physical and mental QoL [ 37 – 39 ], underlining the importance of mobility interventions in clinical care. While much variability exists in the restriction due to cognitive problems, depressiveness, incontinence and sleep, pain and falls were further described as relatively restrictive. In inpatients, improvement was expected mostly for pain, while patients were torn for mobility-related problems. In outpatients, both mobility problems and pain were assessed more pessimistically. For other GS, patients’ expectations vary. Again, these results indicate that each patient has their own set of GS accompanied by individual expectations and experiences. Notably, both in- and outpatients showed pessimistic expectations regarding cognitive deficits, loneliness and incontinence, all of which are typically perceived as age-related issues. As expectations regarding aging and health may influence health behaviour [ 40 – 42 ], it is crucial to uncover and target these perceptions in clinical care. In addition to mobility, other frequently reported GS in our study were pain, mentioned by about 60% of patients, sleep problems mentioned by 42–48%, and incontinence reported by about 35% of inpatients. Little data exists on pain as a GS in particular, with Bell et al. [ 7 ] describing a prevalence of 22.3% for moderate to severe pain; notably, their patients were on average younger. While Liu et al. [ 14 ] report a comparable prevalence of 56.4% for sleep problems, Möller et al. [ 8 ] present a slightly higher rate of 60% for insomnia. Regarding urinary incontinence, similar rates between 24 and 40% have previously been reported [ 7 , 8 , 14 , 17 ]. Notably, Liu et al. [ 14 ] show a significant relation between incontinence and QoL. Depressiveness as a GS was present in 40% of our inpatients but less so in outpatients, which matches the rate of 45% found by Verstraeten et al. [ 18 ]. Other studies provide prevalence rates of 60% [ 13 ], 30% [ 7 ], 28% [ 17 ], or 11% when using a questionnaire with a strict cut-off score for severe depression[ 8 ]. According to Möller et al. [ 8 ], depressive symptoms as GS are linked to increased healthcare utilization. Cognitive restrictions were present in almost a third of both in- and outpatients, and again a third of outpatients perceived these as the most impactful GS. Wang et al. [ 12 ] link cognitive deficits with hospitalization and nursing home admission, and Gómez-Ramos et al. [ 13 ] even propose a link to increased mortality. Presence of cognitive deficits is often based upon cognitive tests [ 8 , 18 ], leading to higher prevalence rates compared to our study, although Bell et al. [ 7 ] report similar rates of 25.5%. The differences in prevalence of cognitive deficits may be based on different tests and cut-off scores. Of note, due to the nature of the overall study, persons with severe cognitive deficits and insomnia were excluded from participation. Overall, GS are an important cornerstone in geriatric care not only due to their increasing prevalence in advancing age, but also due to their relation with health outcomes and QoL [ 12 – 14 , 43 ]. Using regression analysis, we showed a higher number of GS to be associated with worse physical and mental QoL even when controlling for age, gender, cognition, mood, and functional health. In a similar fashion, Liu et al. [ 15 ] found GS to be linked with QoL even when considering concrete illnesses. Likewise, in their review, Wang et al. [ 12 ] link GS with hospital admission even when controlling for specific diseases. These results suggest that GS contribute to well-being above and beyond simple health status and carry information that is not covered in singular illnesses or specific assessments. The impact of GS further becomes evident in the comparably high variance explanation, ranging from 15 to 20% for mental and physical QoL in inpatients and even higher in outpatients [ 14 ]. In addition to a higher number of GS overall contributing to lower QoL, we looked at the influence of individual GS. Similar to Liu et al. [ 14 ], our patients reported lower physical and mental QoL for all GS in comparison to those patients without the respective GS. For physical QoL, effect sizes were moderate for mobility-related problems, pain, and sleep, whereas mental QoL was most closely related to depressiveness, cognition and loneliness. In previous studies, individual GS such as depressiveness, cognition, and insomnia have been linked to lower QoL [ 11 , 14 , 43 ]. These results indicate a relation between the presence of overarching GS and worse well-being in older patients. Psychological theories may aid in the interpretation of these results. Notably, in contrast to concrete illnesses which may be attributed to a specific cause and interpreted as out of control, overarching GS cannot be assigned to a singular cause, making them more diffuse in their control perception and attribution[ 44 ]. Likewise, their global impact on various areas of life may further reduce functionality and thus affect QoL more broadly than singular illnesses with a restricted set of symptoms. This approach of attribution and aging expectations should be explored in depth in future studies to understand the mechanisms with which GS impact health and well-being of geriatric patients. Notably, despite lower prevalence rates, the association between GS and QoL was even stronger in objectively younger and healthier outpatients. Both the Social Cognitive Theory [ 45 ] and the Social Comparison Theory [ 46 ] propose an influence of the surrounding social network on well-being and attitudes, such as the interpretation of health and age-related changes. A comparison with the health and ability of peers may be influential in the sense that at a certain age, most peers also suffer from age-related decline and illness, thus normalizing this decline. In contrast, at a relatively younger age, peers may not yet show a decline in functional ability and health, leading to a more detrimental interpretation of one’s own worsening health [ 47 ]. Self-perceptions of ageing may change over time, shifting towards a perspective of physical and social losses with advancing age [ 48 ]. This is also evident in the fact that while our outpatients have improved physical health, less medications and diagnoses, and better physical QoL than our inpatients, their GDS and mental QoL are comparable. This suggests that the presence of GS may be related to a negative mood and interpretation of younger patients’ health status. These findings highlight the need to incorporate attitudes towards aging in clinical care, as these may shape well-being and behaviour in negative ways, but also provide potential for growth and protection [ 48 – 50 ]. Limitations This study provides patient-centered information on prevalence, perception and influence of GSs on QoL and thus enriches previous research by providing a patient perspective on a highly prevalent but not yet understood cornerstone of geriatric healthcare. Still, the study is not free of limitations. Its cross-sectional design does not allow for an interpretation of causality. Although the association between GS and QoL has been confirmed in previous studies, longitudinal data is required to fully understand their link. Likewise, the mechanisms by which GS influence QoL on top of objective health cannot be uncovered from the present data; instead, information on aging attitudes, coping and attribution should be included in future studies to provide an encompassing understanding of GS and their relation with psycho-social and health-related variables. Additionally, the data was collected in German clinical care, thus its generalizability to other regions and nations is limited. Cultural expectations as well as healthcare standards may influence the perception of GS for patients across the globe. As the data is based on patients’ experiences, some sample sizes – for example for dysphagia – are small, hindering robust analyses. Thus, some results should be interpreted with caution. Instead, this study aims to guide future research in the area of patient-centered approaches on GS and their impact by providing first insights into an under-explored topic. Likewise, across studies a different interpretation of GS exists due to a lack of consensus on which GS should be included. Therefore, when interpreting the results and comparing them with other research, a potential variation in included GS must be kept in mind. Certain differences in prevalence and impact of GS may stem from differing types of included GS. Lastly, although the primary goal of our study was to provide a patient perspective on GS, self-reported information always carries a risk of bias. The presented GS are not based on medical expertise but rather on patients’ own perception of their health. While the patient perspective is essential in clinical research[ 21 , 51 , 52 ], the results may differ from previous studies where GS were assessed with standardized measures. Future studies should compare expert- and patient-given assessments to understand how they relate to each other and to QoL. Conclusion GS are disease-unspecific, overarching symptom clusters that may be useful in the treatment of older adults, where multimorbidity renders a disease-focused approach ineffective. From a patient’s perspective, GS are common, with mobility-related problems, sleep disturbances, pain and cognitive impairment being particularly prevalent in older patients. Although much variability exists regarding the amount of restriction patients experience and the potential they see for improvement, a higher number of GS is associated with worse physical and mental QoL even when controlling for sociodemographic and health-related information. A deeper understanding of the most impactful GS and their associations with well-being can guide geriatric care in a more effective and patient-centered manner. Declarations Acknowledgements We would like to thank Elisabeth Dobkowitz, Undine Germo, Julia Kemp, Sophie Kretschmar, Oscar Lieder, Pauline Otto, Nathalie Schaaf, Kirsten Scharr, Ulrich Spanaus, Ulrike Teschner, and Rebecca Wientzek for their help with study organization and data collection. We further acknowledge data sharing and support by the Data Integration Center of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg and the University Hospital Halle (Saale). Study data were collected and managed using REDCap electronic data capture tools. Funding This project was supported by a BMBF grant to TP (grant number 01GY2301). Author Contributions AS : Supervision, Study Conceptualization, Data Collection, Data Curation, Data Analysis, Writing: First Draft KGH : Supervision, Study Conceptualization, Data Collection, Data Curation, Data Analysis, Writing: Review and Editing ASt : Data Collection, Data Curation, Writing: Review and Editing PL : Data Collection, Data Curation, Writing: Review and Editing TP : Funding Acquisition, Supervision, Study Conceptualization, Data Analysis, Writing: Review and Editing All authors read and approved of the present manuscript. Competing Interests None Ethics Approval and Consent All patients gave written informed consent Data Availability All study materials are available from Schönenberg, A., Heimrich, K. G., Prell, T., et al. (2025). Data on Self-Management of Geriatric Syndromes. osf.io/a68x5 [22]. 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J Biomed Inform 95:103208. https://doi.org/10.1016/j.jbi.2019.103208 Supplementary Files GerSynSupplement.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Major revisions 03 Sep, 2025 Reviewers agreed at journal 27 Aug, 2025 Reviewers invited by journal 27 Aug, 2025 Editor assigned by journal 26 Aug, 2025 First submitted to journal 21 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7426749","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":506264840,"identity":"f053b038-647a-476c-b42a-772a07269d68","order_by":0,"name":"Aline Schönenberg","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABQ0lEQVRIie2QPUvDQBiA33CQLIlZL0Sav3BHocVB/CspDi6CaweJhcB1iXSN0J/g0KnodnKQLnGvkCFdMlWoS1HQ4qUV/DgrjoL3wHHvvdzD+wGg0fxFLKO3vsnmyeVBXOY47Fgytr9RkKqY4Vox0Tbl7f6g2ORHxY0RKxcQBW0rzsqHq6LRHlwuvRSKwESIw7yrKFgYfZqCoNdJdkQv8qq5O70feyOoKEOyw2GulhEG823gIZket3yHiU6Kb8febCXzyCbIYYoR1MozRFI5WfovTJylOK+8EsQBQ+4COStFIbUil1BXMX2DiRC7iSkbEx1ZBZDTUxQqFS8hgo7yrOWds4qm2GzuyekO5SzkZpgpSmPSr/BjNwrIJK7wEysC7IrZXQJif2DFs3J+qo6/ae/TEsP3mG8RvuD+8p9Go9H8G14BcfduA20H9I4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-2913-9535","institution":"University Hospital Halle: Universitatsklinikum Halle","correspondingAuthor":true,"prefix":"","firstName":"Aline","middleName":"","lastName":"Schönenberg","suffix":""},{"id":506264841,"identity":"2512352f-ff6b-4220-b12e-5c32e23e987a","order_by":1,"name":"Konstantin G. Heimrich","email":"","orcid":"https://orcid.org/0000-0001-9997-2202","institution":"Jena University Hospital: Universitatsklinikum Jena","correspondingAuthor":false,"prefix":"","firstName":"Konstantin","middleName":"G.","lastName":"Heimrich","suffix":""},{"id":506264842,"identity":"072fd12e-87fc-425a-8d24-81e085043aaf","order_by":2,"name":"Annika Sternkopf","email":"","orcid":"","institution":"University Hospital Halle: Universitatsklinikum Halle","correspondingAuthor":false,"prefix":"","firstName":"Annika","middleName":"","lastName":"Sternkopf","suffix":""},{"id":506264843,"identity":"d361d198-4cb1-419b-a6f8-ebd00afc4dee","order_by":3,"name":"Paul Lochbihler","email":"","orcid":"","institution":"University Hospital Halle: Universitatsklinikum Halle","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Lochbihler","suffix":""},{"id":506264844,"identity":"2baa4bd3-2ab0-4556-9d4c-8989361bc0ca","order_by":4,"name":"Tino Prell","email":"","orcid":"https://orcid.org/0000-0002-6423-3108","institution":"University Hospital Halle: Universitatsklinikum Halle","correspondingAuthor":false,"prefix":"","firstName":"Tino","middleName":"","lastName":"Prell","suffix":""}],"badges":[],"createdAt":"2025-08-21 13:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7426749/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7426749/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90545023,"identity":"72a13554-e930-48bb-9814-864359564402","added_by":"auto","created_at":"2025-09-04 00:25:16","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":243091,"visible":true,"origin":"","legend":"\u003cp\u003eAbsolute Syndrome number and presence for in- and outpatients\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7426749/v1/0cbf92531c95735adc667789.png"},{"id":90542942,"identity":"930b9302-e96a-414c-9349-1698b53b17e4","added_by":"auto","created_at":"2025-09-04 00:09:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":247306,"visible":true,"origin":"","legend":"\u003cp\u003eSyndrome restrictions\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7426749/v1/489a57a6436c0409017c52d9.png"},{"id":90544205,"identity":"e7358a20-5021-48ba-a51b-ea691157f183","added_by":"auto","created_at":"2025-09-04 00:17:16","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":383871,"visible":true,"origin":"","legend":"\u003cp\u003eExpectations regarding improvement of syndromes\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7426749/v1/3bfa4ed68f41493e8b349ea5.png"},{"id":90545192,"identity":"58d09586-671a-4640-a855-652929e31357","added_by":"auto","created_at":"2025-09-04 00:33:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1634513,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7426749/v1/f5df6fa0-3b2d-41b5-889a-4587a41e8077.pdf"},{"id":90544207,"identity":"4a8c03d2-8a06-4c8e-aec5-9f1fff77de15","added_by":"auto","created_at":"2025-09-04 00:17:16","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":35423,"visible":true,"origin":"","legend":"","description":"","filename":"GerSynSupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-7426749/v1/1d6bfa6e115819de530f3e6e.docx"}],"financialInterests":"","formattedTitle":"Patients’ perspective on Geriatric Syndromes and their Relation with Quality of Life: a cross-sectional Study","fulltext":[{"header":"Key summary points","content":"\u003cp\u003eAim: How do geriatric patients experience geriatric syndromes, and how are they related to quality of life?\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFindings: A higher number of concurrent geriatric syndromes is linked with worse physical and mental quality of life. Mobility problems and pain are most frequent and most restrictive to patients in daily life \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMessage: Geriatric Syndromes are frequent; they reduce physical and mental quality of life above and beyond objective health measures and should thus be targeted in clinical interventions\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eGeriatric medicine has undergone a notable shift in its approach, away from the management of individual diseases towards a comprehensive focus on overall geriatric syndromes (GS) [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This shift is driven by the high prevalence of multimorbidity, wherein patients frequently present with multiple, interrelated health concerns rather than a single condition [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. GS can be interpreted as cumulative effects of multiple impairments, leading to increased overall vulnerability of older adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Consequently, healthcare providers are confronted with the challenge of managing the intricacies of these GS, which encompass a range of issues including mobility difficulties, cognitive decline, incontinence, depressive mood, polypharmacy, malnutrition, sleep disorders and others that collectively impact the quality of life (QoL) of older patients [\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Of note, no concrete definition of GS exists due to their highly heterogeneous and multifaceted nature [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These heterogeneous definitions leave the selection of GS open to the respective researchers. Despite this heterogeneity in the included GS, their impact on well-being and QoL is unmistakable across studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The presence of GS may lead to hospitalization or institutionalization [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] and may even increase mortality rates [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In patients with diabetes for example, GS have a negative impact on both physical and mental QoL [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In patients with chronic kidney diseases, this association between QoL and GS even remained present when taking concrete illnesses into account [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite the clinical importance of GS, research on prevalence and impact of those GS is rare, potentially due to the challenges of scientific recruitment in geriatric patients and the overall underrepresentation of geriatric patients in medical studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. There remains a gap in understanding how geriatric patients themselves perceive these GS. While GS may pose a challenge for healthcare providers, as they do not allow for a differentiation between the overlapping causes of the GS, they may aid older patients in describing their actual daily challenges. For example, a patient may suffer from Parkinson\u0026rsquo;s disease, polyneuropathy, osteoporosis, and a fracture after a fall; while it is important for medical staff to understand the causes of each GS, the primary issue experienced by this patient is a restriction in mobility, irrespective of the underlying illnesses. Thus, it is imperative to comprehend the patient perspective in order to develop patient-centered care strategies that integrate both the clinical aspects of GS and the patients' own experiences. This is especially important as the prevalence of GS rises with advancing age [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], cumulating in as many as 90% of geriatric patients reporting any GS, while most report multiple [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis manuscript aims to explore how geriatric patients experience selected GD, including their perceptions of the presence, limitations in daily life, and potential for improvement. For this purpose, we asked geriatric patients about their perception of nine GS including mobility problems, falls, cognitive problems, depressiveness, loneliness, pain, incontinence, sleep disturbances, and dysphagia. Through this lens, we seek to provide insights into improved delivery of geriatric care by incorporating the patients\u0026rsquo; voices into the management of their health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003ePatients and Recruitment\u003c/h2\u003e\n\u003cp\u003eData was collected as part of the \u003cem\u003eSelfManGer \u0026ndash; Self-management of geriatric patients in Germany\u003c/em\u003e study [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e] conducted at geriatric wards in two hospitals (trial registration: DRKS00031016) in Saxony-Anhalt and the related \u003cem\u003eJenaGer\u003c/em\u003e Study conducted in Thuringia. While having differing overall aims, the \u003cem\u003eSelfManGer\u003c/em\u003e and \u003cem\u003eJenaGer\u003c/em\u003e studies were designed in concordance with overlapping instruments to ensure two comparable core datasets. In addition, for \u003cem\u003eSelfManGer\u003c/em\u003e, patients were recruited from two collaborating GP practices in urban areas.\u003c/p\u003e\n\u003cp\u003eData collection took place between February 2023 and August 2024. We included 1) older inpatients receiving comprehensive geriatric care within the German Operation and Procedure Classification System (OPS 8-550) and 2) older outpatients (65 years and older with multimorbidity). Exclusion criteria were severe dementia or acute delirium, severe depression, and being fully dependent in activities in daily living according to the Barthel Index[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. Except for diagnosed dementia and acute delirium, we did not specify a cut-off for cognitive tests as an exclusion criterion but instead included patients if study staff felt they were able to hold a meaningful conversation and comprehend the questionnaires [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eAll patients were screened based on their medical records, and then trained study staff approached eligible patients and informed them about the study. The study was approved by the local ethics committee of Halle University Hospital, the State Chamber of Physicians of Saxony-Anhalt (Landes\u0026auml;rztekammer; approval number: 2022-026), and the ethics committee of Jena University Hospital (2023-2923-BO). If the patients gave their written informed consent, study staff proceeded going through the questionnaires together [\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. The study included both questionnaires and medical information obtained from the geriatric assessments \u003cem\u003eperformed\u003c/em\u003e as part of routine inpatient care.\u003c/p\u003e\n\u003cp\u003eThe following questions were covered in a questionnaire; the translation is available along with the data [\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e][Link for review: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://osf.io/a68x5/?view_only=6d092e9330e046a49b043271d57cb0a4\u003c/span\u003e\u003c/span\u003e]\u003c/p\u003e\n\u003cp\u003e- Sociodemographic information: age, gender, living situation (alone \u0026ndash; not alone), martial state (married or in partnership \u0026ndash; single \u0026ndash; widowed or divorced), education (low: less than 8 years, middle\u0026thinsp;=\u0026thinsp;8 to 10 years, high\u0026thinsp;=\u0026thinsp;more than 10 years);\u003c/p\u003e\n\u003cp\u003e- GS:\u003c/p\u003e\n\u003c/div\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003ePresence of (yes/no): impaired \u003cem\u003emobility\u003c/em\u003e, \u003cem\u003efalls\u003c/em\u003e, problems with \u003cem\u003ecognition\u003c/em\u003e, sadness/\u003cem\u003edepressiveness\u003c/em\u003e, \u003cem\u003eloneliness\u003c/em\u003e, \u003cem\u003epain\u003c/em\u003e, \u003cem\u003eincontinence\u003c/em\u003e, problems with \u003cem\u003esleep\u003c/em\u003e, problems with swallowing (\u003cem\u003edysphagia)\u003c/em\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eWhich of the above mentioned syndromes is the most restrictive to you in your daily life? (single choice)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOn a scale of 0 to 100, how restricted are you in your daily life because of this problem? (100 indicates no restriction at all, 0 indicates fully restricted)\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eOn a scale of 0\u0026thinsp;=\u0026thinsp;\u003cem\u003esure that it will not improve\u003c/em\u003e to 100\u0026thinsp;=\u0026thinsp;\u003cem\u003esure that it will definitely improve\u003c/em\u003e, how confident are you that the problem will improve?\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cem\u003e- QoL\u003c/em\u003e according to the WHOQOL-Bref questionnaire [\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e]; in this analysis we focus on the physical and mental QoL subscales.\u003c/p\u003e\n\u003cp\u003eIn addition to this questionnaire, the following variables were extracted from each inpatients\u0026rsquo; medical record:\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003e\n\u003cp\u003eGeriatric depression scale, \u003cem\u003eGDS\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e], ranging between 0 and 15 points with higher scores indicating higher levels of depressiveness\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003e\u003cem\u003eBarthel\u003c/em\u003e Index[\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e], ranging between 0 and 100 points with higher scores indicating independence in daily activities\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eGeriatric screening according to \u003cem\u003eLachs\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e] depicting 15 areas of potential restriction in daily tasks such as movement, cognition, incontinence or mood, with higher scores indicating a higher level of pathology\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eCognition according to the Montreal Cognitive Assessment, \u003cem\u003eMoCA\u003c/em\u003e or the Mini Mental Status Test \u003cem\u003eMMST\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e]. Of note, for reasons of comparability, the MoCA was transformed to match the MMST according to the conversion described in Fasnacht et al. [\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e]. For both assessments, higher scores indicate better cognitive performance\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNumber of different medications taken daily, \u003cem\u003eNmeds\u003c/em\u003e\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFor the outpatients recruited from GP practices, no routine geriatric assessment was available. To describe their mental and cognitive characteristics, we performed the \u003cem\u003eGDS\u003c/em\u003e and the \u003cem\u003eMiniCog\u003c/em\u003e [\u003cspan class=\"CitationRef\"\u003e30\u003c/span\u003e]. The MiniCog combines word recall and clock test. A score below three indicates cognitive impairment.\u003c/p\u003e\n\u003cp\u003eIn total, N\u0026thinsp;=\u0026thinsp;666 patients were recruited and completed the questionnaire of interest on GS, N\u0026thinsp;=\u0026thinsp;511 of which were inpatients and N\u0026thinsp;=\u0026thinsp;155 outpatients recruited from the GP practices.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eWe described the included patients grouped by location (inpatient vs outpatient) with descriptive statistics using mean (M) and standard deviation (SD) as well as Median (MD) and interquartile range (IQR) in case of non-normal distribution as assessed by Shapiro-Wilk-Test. For group comparisons regarding gender and GS, we used Chi\u0026sup2; test for categorical variables as well as Mann Whitey U test or Kruskal Wallis Test with Dunn Test and Bonferroni correction. Effect sizes for metric data were calculated as rank biserial correlation \u003cem\u003er\u003c/em\u003e and for Chi2 Test as Cohen\u0026rsquo;s \u0026omega;. Values for both can be considered low between |0.1| \u0026ndash; \u0026lt; |0.3|, medium between |0.3| - \u0026lt; |.05|, and high when \u003cem\u003e\u0026gt;\u003c/em\u003e |0.5| [\u003cspan class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eInitially, we describe the presence of the respective GS as well as their co-occurrence, the amount of limitation patients experience due to the respective GS, and expectations regarding improvement.\u003c/p\u003e\n\u003cp\u003eLastly, we assessed the impact of GS on physical and mental QoL using the WHOQOL-Bref questionnaire. Using regression analysis, we first defined Number of Syndromes as a single independent variable in a simple model, followed by the inclusion of age and gender, and then we determined the robustness of the association with the addition of the objective health-related covariates GDS, MMST/MiniCog, and for inpatients Lachs. Using group comparison, we analyzed differences in patients\u0026rsquo; QoL depending on the presence of each GS.\u003c/p\u003e\n\u003cp\u003eAll analyses were performed in R Version 4.3.0 with a significance value of .05 and a two-sided approach.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eDescriptive Statistics\u003c/h2\u003e\u003cp\u003eThe characteristics of the cohort is given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. We included N\u0026thinsp;=\u0026thinsp;511 geriatric inpatients and geriatric N\u0026thinsp;=\u0026thinsp;155 outpatients. The inpatients were 83.0 years old (SD\u0026thinsp;=\u0026thinsp;5.96), ranging from 67 to 96 years, while outpatients were younger at 79 years (SD\u0026thinsp;=\u0026thinsp;6.42). Most patients were female, lived alone as widows, and had at least 10 years of education. With a GDS score of 4.09, the patients did not show signs of a depressive disorder, and an average of 25.20 points in the MMST (range\u0026thinsp;=\u0026thinsp;10\u0026ndash;30) indicates mild cognitive deficits.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDescriptive statistics of the included patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eInpatient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eOutpatient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eComparison*\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMD (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM (SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMD (IQR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e, r\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83.0 (5.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83 (8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e79.0 (6.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e80 (9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, 0.35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Syndromes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.61 (1.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.74 (1.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2 (3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, 0.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Medications\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.4 (4.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.8 (4.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7 (7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, 0.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMST/MiniCog\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.2 (3.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26 (5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.16 (1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.09 (3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.4 (3.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4 (4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.454, -0.04\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBarthel Index (admission)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.3 (18.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" morerows=\"1\" nameend=\"c6\" namest=\"c4\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLachs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.72 (2.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHO_physical\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53.1 (21.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53.6 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.5 (20.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e64.3 (31.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, -0.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWHO_mental\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68.3 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.8 (20.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e67.0 (16.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.8 (25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.596, 0.03\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eVariable\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eCount\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003eCount\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cb\u003ep\u003c/b\u003e, \u003cb\u003eW\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e.242, .049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e335\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e.027, .104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSingle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWidowed/Separated\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLiving Situation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e.099, .083\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e261\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e51.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e42.48\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot Alone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e49.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, .193\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e70.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e48.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e29.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCare level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, .264\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e67.81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e10.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001. .218\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 very dissatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 dissatisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e165\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e33.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 neither\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e17.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.45\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 very satisfied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of Medications\u0026thinsp;\u0026gt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e101\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e66.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001, .207\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003e*Group Comparison between in- and outpatients\u003c/p\u003e\u003cp\u003eMMST\u0026thinsp;=\u0026thinsp;Mini mental status test (cognition), GDS\u0026thinsp;=\u0026thinsp;geriatric depression scale, WHO_ = WHOQOL-Bref quality of life questionnaire, mental and physical scale\u003c/p\u003e\u003cp\u003eEffect size:\u003c/p\u003e\u003cp\u003eWilcoxon Rank Sum/Mann Whitney Test for metric data: r\u0026thinsp;=\u0026thinsp;rank biserial correlation\u003c/p\u003e\u003cp\u003eChi2 Test: Cohen\u0026rsquo;s ω\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOccurrence of Geriatric Syndromes\u003c/h2\u003e\u003cp\u003eOn average, patients reported to have 3.41 (SD\u0026thinsp;=\u0026thinsp;1.84) of the nine GS. Inpatients had more GS (M\u0026thinsp;=\u0026thinsp;3.61) compared to outpatients (M\u0026thinsp;=\u0026thinsp;2.74) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. 53.23% of inpatients reported 4 or more GS. Only 10% of inpatients and 21% of outpatients reported a singular GS (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA). The most common GS were problems with mobility, pain, falls, and sleep (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, Supplement Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eRegarding gender, we found significant differences in the occurrence of GS only for pain (p\u0026thinsp;=\u0026thinsp;.009), with 57.94% of females reporting pain compared to 47.06% of males; dysphagia (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.017) was more commonly reported by men (11.34%) than women (5.84%). A similar pattern remained after splitting by recruitment location (Supplement Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePerceived restrictions because of geriatric syndromes\u003c/h3\u003e\n\u003cp\u003eOf all the GS, 271 (44.7%) patients selected mobility problems as the most restrictive GS in their daily lives, followed by pain (95, 15.7%) and falls (91, 15.0%). When looking at in- and outpatient separately, 53.2% of inpatients with mobility problems selected those as most impactful; this association was even stronger in outpatients where 63.2% rated their mobility problems as most restrictive (Supplement Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Almost a third of outpatients rated their cognitive impairments as most restrictive while only 10.0% of inpatients did so (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA), despite a higher mean restriction in inpatients (M\u0026thinsp;=\u0026thinsp;37.3) than outpatients (M\u0026thinsp;=\u0026thinsp;24.9). In contrast, inpatients rated incontinence (29.3%) and dysphagia (38.2%) as more restrictive as outpatients did (12.6% and 22.5%, respectively). The amount of perceived restriction was lower in outpatients than inpatients for most GS except loneliness (Supplement Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB).\u003c/p\u003e\u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB \u003cb\u003eand\u003c/b\u003e Supplement Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, there is considerable heterogeneity in the restriction patients experience due to the GS, especially in outpatients. Most patients who selected mobility and pain-related GS experience those as rather restrictive while problems with cognition, swallowing and sleep are considered relatively less restrictive.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003ePerceptions of potential for improvement\u003c/h3\u003e\n\u003cp\u003eIn addition to inquiring about the restriction, patients were asked to indicate whether they expected the respective GS to improve (\u003cem\u003e0\u0026thinsp;=\u0026thinsp;sure it will not improve\u003c/em\u003e, \u003cem\u003e100\u0026thinsp;=\u0026thinsp;sure it will definitely improve\u003c/em\u003e). Substantial heterogeneity in the patients' responses was observed when utilizing a cutoff of 50 (50\u0026thinsp;=\u0026thinsp;undecided, \u0026lt; 50, \u0026gt;\u0026thinsp;50). For mobility problems as the most prevalent GS, 41.6% of inpatients but only 15% of outpatients expected the GS to improve. A similar pattern unfolds for the other GS, with outpatients reporting more pessimistic expectations regarding falls, pain, and sleep (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, Supplement Table\u0026nbsp;3). Both in- and outpatients are pessimistic regarding improvements in age-related GS such as loneliness, cognition and incontinence; however, due to small sample sizes, these results should be interpreted with caution.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eGeriatric Syndromes and Quality of Life\u003c/h2\u003e\u003cp\u003eFinally, we assessed the influence of the number of GS and in detail of each GS on physical and mental QoL.\u003c/p\u003e\u003cp\u003eAn increasing number of GS was correlated with worse physical (r = -0.53, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and mental QoL (r = -0.43, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Notably, this association was even stronger for outpatients (physical r = -0.74, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, mental r = -0.64, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) than for inpatients (physical r = -0.45, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, mental r = -0.40, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). According to Fisher\u0026rsquo;s Z test, the strength of the correlation is significantly higher in outpatients (p\u0026thinsp;\u0026lt;\u0026thinsp;.01).We performed regression analyses to understand the link between GS and QoL separately for inpatients and outpatients. For both patient groups, a higher number of GS was associated with lower physical QoL, even when controlling for covariates such as age, gender, GDS, cognition, and Lachs.\u003c/p\u003e\u003cp\u003eFor inpatients, a higher number of GS (\u0026szlig; = -5.37, 95% CI [-6.35; -4.40], p\u0026thinsp;\u0026lt;\u0026thinsp;.001) alone explained 19.5% of the QoL variance; neither gender (\u0026szlig; = 0.37, 95% CI [-3.30; 4.04], p\u0026thinsp;=\u0026thinsp;.844) nor age (\u0026szlig; = 0.25, 95% CI [-0.05; 0.55], p\u0026thinsp;=\u0026thinsp;.10) mitigated this effect (\u0026szlig; = -5.42, 95% CI [-6.40; -4.44], p\u0026thinsp;\u0026lt;\u0026thinsp;.001). With covariates, a higher number of GS remained significantly associated with worse physical QoL (\u0026szlig; = -4.15, 95% CI [-5.20, -3.10], p\u0026thinsp;\u0026lt;\u0026thinsp;.001) in addition to GDS, MMST and Lachs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). For outpatients, a similar picture emerged, with a higher number of GS (\u0026szlig; = -8.26, 95% CI [-9.72, -6.81], p\u0026thinsp;\u0026lt;\u0026thinsp;.001) explaining 49.3% of the variance of lower QoL; this association remained (\u0026szlig; = -8.11, 95% CI [-9.65; -6.57], p\u0026thinsp;\u0026lt;\u0026thinsp;.001) when adding gender (\u0026szlig; = 0.46, 95% CI [-4.84; 5.75], p\u0026thinsp;=\u0026thinsp;.864) and age (\u0026szlig; = -0.09, 95% CI [-0.50; 0.32], p\u0026thinsp;=\u0026thinsp;.667) to the model. With covariates, a higher number of GS remained a significant predictor of lower physical QoL (\u0026szlig; = -5.49, 95% CI [-7.36, -3.63], p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The same picture was found for mental QoL (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), with a higher number of GS alone explaining 16.7% of QoL variance for inpatients and 42.2% for outpatients. This association remained significant in the second model irrespective of age and gender, and in model 3 after including the other covariates.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis on association between Number of Syndromes and Quality of Life\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eInpatients \u0026ndash; Physical QOL\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u003cp\u003eOutpatients \u0026ndash; Physical QOL\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePredictors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eEst\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003ePredictors\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eEst\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026szlig;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e(Intercept)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e85.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.23\u0026ndash;114.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e(Intercept)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e75.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e44.77\u0026ndash;107.05\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSyndromNum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e-4.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-5.20 \u0026ndash; -3.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eSyndromNum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-5.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-7.36\u0026nbsp;\u0026ndash;\u0026nbsp;-3.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.05\u0026ndash;0.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.106\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.35\u0026ndash;0.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.862\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egender [male]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e0.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.27\u0026ndash;3.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.872\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003egender [male]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-3.44\u0026ndash;6.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.537\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e-1.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.84 \u0026ndash; -0.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eGDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-3.10\u0026nbsp;\u0026ndash;\u0026nbsp;-1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMMST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e-0.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.35 \u0026ndash; -0.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eMiniCog\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.41\u0026ndash;2.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLACHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e-1.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.47 \u0026ndash; -0.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;474, R2 / R2 adjusted0.269 / 0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;124, R2 / R2 adjusted0.567 / 0.549\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eInpatients \u0026ndash; Mental QOL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u003cp\u003e\u003cb\u003eOutpatients \u0026ndash; Mental QOL\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e(Intercept)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42.03\u0026ndash;87.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e(Intercept)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e75.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e54.62\u0026ndash;96.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eSyndromNum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-2.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.53\u0026nbsp;\u0026ndash;\u0026nbsp;-1.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSyndromNum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e-1.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-2.87\u0026nbsp;\u0026ndash;\u0026nbsp;-0.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.02\u0026ndash;0.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.15\u0026ndash;0.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.414\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003egender [male]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-3.00\u0026ndash;2.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.880\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003egender [male]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e1.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1.98\u0026ndash;4.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.427\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eGDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-1.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-2.28\u0026nbsp;\u0026ndash;\u0026nbsp;-1.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGDS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e-3.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-3.79\u0026nbsp;\u0026ndash;\u0026nbsp;-2.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMMST\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-0.31\u0026ndash;0.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMinicog\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u003cp\u003e0.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0.78\u0026ndash;1.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e0.581\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eLACHS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-0.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1.06\u0026ndash;0.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;472, R2 / R2 adjusted0.278 / 0.269\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"5\" nameend=\"c10\" namest=\"c6\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;139, R2 / R2 adjusted0.682 / 0.670\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"10\" nameend=\"c10\" namest=\"c1\"\u003e\u003cp\u003eGDS\u0026thinsp;=\u0026thinsp;Geriatric Depresson Scale, MMST\u0026thinsp;=\u0026thinsp;Mini Mental Status Test, Minicog\u0026thinsp;=\u0026thinsp;Mini Cognitive Assessment, Lachs\u0026thinsp;=\u0026thinsp;Geriaric Screening accoding to Lachs, SyndromNum\u0026thinsp;=\u0026thinsp;Number of geriatric syndromes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eLastly, we aimed to assess the influence of individual GS on QoL, repeating the regression analyses separately with each GS and the covariates as predictors for mental or physical QoL. Due to the small sample size of certain GS in outpatients, we report detailed analyses on the impact of specific GS on QoL primarily for inpatients (Supplement Table\u0026nbsp;4A). For the same reason, no results are reported for dysphagia. For inpatients, all GS except cognition were significantly associated with lower physical QoL, with mobility problems (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.44), pain (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.37), sleep problems (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.30), and falls (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.29) showing moderate effect sizes (Supplement Table\u0026nbsp;4). For mental QoL, the associations were weaker, with highest effect sizes found for loneliness (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.37), depressiveness (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.35), and cognition (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, r\u0026thinsp;=\u0026thinsp;.27). In outpatients, the association between mobility problems, falls, pain, and sleep as most prevalent GS was even higher (Supplement Table\u0026nbsp;4B).\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGS represent disease-overarching syndromes that frequently occur in older age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the present analysis from the SelfManGer project [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], we aimed to gather an insight into GS from the perspective of geriatric patients. For this purpose, we collected data on nine common GS, the amount of limitation patients perceive, the potential they see for improvement, and lastly their association with QoL. For both inpatients and outpatients, we found mobility-related problems to be perceived as most impactful on patients’ daily lives. Even after controlling for sociodemographic information, cognition, mental health and functional status, a higher number of GS remained linked to worse physical and mental QoL. The presence of each GS negatively impacts QoL, of which mobility problems and pain yielded the strongest impact on physical QoL while depressiveness, loneliness and cognitive decline strongly influence mental QoL. Notably, although they were on average younger and healthier than inpatients, the association between GS and QoL was even stronger in outpatients.\u003c/p\u003e\u003cp\u003eSeveral previous studies aimed to assess the prevalence of GS, however, due to a lack of consensus on their definition different studies assessed different GS. For example, Verstraeten et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] looked at polypharmacy and multimorbidity, cognitive deficits, depressive symptoms, nutrition, frailty and falls. In contrast, Sanford et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] solely looked at frailty, weight loss, sarcopenia, and dementia, and Möller et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] further included incontinence, insomnia, and vision impairments. Likewise, many studies combine different sources, combining interviews, standardized questionnaires, and routine data [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This heterogeneity in the included GS makes a comparison of studies difficult; however, across all studies, the high prevalence of GS has been confirmed: In line with Wang et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and Bell et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], 90% of our inpatients and 79% of outpatients reported more than one GS. In two cohorts with a comparable age profile to our study, Verstraeten et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] confirmed the high prevalence of GS, stating that most patients had 5 or more GS that rarely occurred in isolation. In our study, nearly half the patients reported four or more GS. Likewise, Alhalaseh et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] found almost all geriatric patients to have GS, ranging from 2.56 GS in younger patients to 3.55 in the oldest patients, matching the responses of our on average younger outpatients and older inpatients. The increasing prevalence of GS with age is confirmed in other studies [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], highlighting the need to understand and address GS in the light of the demographic shift.\u003c/p\u003e\u003cp\u003eIn addition to determining their presence, the key aim of the present study was to assess the impact GS have on patients. Thus, we asked patients to self-select the GS they experience and also asked about the restriction and the potential for improvement regarding the GS. To the best of our knowledge, this has not yet been done before.\u003c/p\u003e\u003cp\u003eFrom this patient perspective, considerable heterogeneity is present in the interpretation of GS. Some patients report to be strongly impacted by their GS to the point where normal daily activity was no longer possible, whereas other patients are less restricted by the respective GS. This heterogeneity again indicates that a patient-focused approach is needed to individually understand each patients’ experience and expectations. Notably, both in- and outpatients selected mobility-related problems as most frequent and most impactful. This influence of mobility has been confirmed in previous studies showing that falls were amongst the most prevalent GS [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and were related to increased mortality [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The influence of mobility may be rooted in its connection to daily activities: older adults often cite the ability to perform daily tasks independently as crucial for their well-being and QoL, which rises and falls with mobility [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Additionally, mobility is a pre-requisite for social participation as well as for physical activity [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], all of which are related to physical and mental QoL [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e–\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], underlining the importance of mobility interventions in clinical care.\u003c/p\u003e\u003cp\u003eWhile much variability exists in the restriction due to cognitive problems, depressiveness, incontinence and sleep, pain and falls were further described as relatively restrictive. In inpatients, improvement was expected mostly for pain, while patients were torn for mobility-related problems. In outpatients, both mobility problems and pain were assessed more pessimistically. For other GS, patients’ expectations vary. Again, these results indicate that each patient has their own set of GS accompanied by individual expectations and experiences. Notably, both in- and outpatients showed pessimistic expectations regarding cognitive deficits, loneliness and incontinence, all of which are typically perceived as age-related issues. As expectations regarding aging and health may influence health behaviour [\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e–\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e], it is crucial to uncover and target these perceptions in clinical care.\u003c/p\u003e\u003cp\u003eIn addition to mobility, other frequently reported GS in our study were pain, mentioned by about 60% of patients, sleep problems mentioned by 42–48%, and incontinence reported by about 35% of inpatients. Little data exists on pain as a GS in particular, with Bell et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] describing a prevalence of 22.3% for moderate to severe pain; notably, their patients were on average younger. While Liu et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] report a comparable prevalence of 56.4% for sleep problems, Möller et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] present a slightly higher rate of 60% for insomnia. Regarding urinary incontinence, similar rates between 24 and 40% have previously been reported [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Notably, Liu et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] show a significant relation between incontinence and QoL. Depressiveness as a GS was present in 40% of our inpatients but less so in outpatients, which matches the rate of 45% found by Verstraeten et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Other studies provide prevalence rates of 60% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], 30% [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], 28% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], or 11% when using a questionnaire with a strict cut-off score for severe depression[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to Möller et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], depressive symptoms as GS are linked to increased healthcare utilization.\u003c/p\u003e\u003cp\u003eCognitive restrictions were present in almost a third of both in- and outpatients, and again a third of outpatients perceived these as the most impactful GS. Wang et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] link cognitive deficits with hospitalization and nursing home admission, and Gómez-Ramos et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] even propose a link to increased mortality. Presence of cognitive deficits is often based upon cognitive tests [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], leading to higher prevalence rates compared to our study, although Bell et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] report similar rates of 25.5%. The differences in prevalence of cognitive deficits may be based on different tests and cut-off scores. Of note, due to the nature of the overall study, persons with severe cognitive deficits and insomnia were excluded from participation.\u003c/p\u003e\u003cp\u003eOverall, GS are an important cornerstone in geriatric care not only due to their increasing prevalence in advancing age, but also due to their relation with health outcomes and QoL [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e–\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Using regression analysis, we showed a higher number of GS to be associated with worse physical and mental QoL even when controlling for age, gender, cognition, mood, and functional health. In a similar fashion, Liu et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] found GS to be linked with QoL even when considering concrete illnesses. Likewise, in their review, Wang et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] link GS with hospital admission even when controlling for specific diseases. These results suggest that GS contribute to well-being above and beyond simple health status and carry information that is not covered in singular illnesses or specific assessments. The impact of GS further becomes evident in the comparably high variance explanation, ranging from 15 to 20% for mental and physical QoL in inpatients and even higher in outpatients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn addition to a higher number of GS overall contributing to lower QoL, we looked at the influence of individual GS. Similar to Liu et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], our patients reported lower physical and mental QoL for all GS in comparison to those patients without the respective GS. For physical QoL, effect sizes were moderate for mobility-related problems, pain, and sleep, whereas mental QoL was most closely related to depressiveness, cognition and loneliness. In previous studies, individual GS such as depressiveness, cognition, and insomnia have been linked to lower QoL [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. These results indicate a relation between the presence of overarching GS and worse well-being in older patients.\u003c/p\u003e\u003cp\u003ePsychological theories may aid in the interpretation of these results. Notably, in contrast to concrete illnesses which may be attributed to a specific cause and interpreted as out of control, overarching GS cannot be assigned to a singular cause, making them more diffuse in their control perception and attribution[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Likewise, their global impact on various areas of life may further reduce functionality and thus affect QoL more broadly than singular illnesses with a restricted set of symptoms. This approach of attribution and aging expectations should be explored in depth in future studies to understand the mechanisms with which GS impact health and well-being of geriatric patients. Notably, despite lower prevalence rates, the association between GS and QoL was even stronger in objectively younger and healthier outpatients. Both the Social Cognitive Theory [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e] and the Social Comparison Theory [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] propose an influence of the surrounding social network on well-being and attitudes, such as the interpretation of health and age-related changes. A comparison with the health and ability of peers may be influential in the sense that at a certain age, most peers also suffer from age-related decline and illness, thus normalizing this decline. In contrast, at a relatively younger age, peers may not yet show a decline in functional ability and health, leading to a more detrimental interpretation of one’s own worsening health [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. Self-perceptions of ageing may change over time, shifting towards a perspective of physical and social losses with advancing age [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. This is also evident in the fact that while our outpatients have improved physical health, less medications and diagnoses, and better physical QoL than our inpatients, their GDS and mental QoL are comparable. This suggests that the presence of GS may be related to a negative mood and interpretation of younger patients’ health status. These findings highlight the need to incorporate attitudes towards aging in clinical care, as these may shape well-being and behaviour in negative ways, but also provide potential for growth and protection [\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e–\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eThis study provides patient-centered information on prevalence, perception and influence of GSs on QoL and thus enriches previous research by providing a patient perspective on a highly prevalent but not yet understood cornerstone of geriatric healthcare. Still, the study is not free of limitations.\u003c/p\u003e\u003cp\u003eIts cross-sectional design does not allow for an interpretation of causality. Although the association between GS and QoL has been confirmed in previous studies, longitudinal data is required to fully understand their link. Likewise, the mechanisms by which GS influence QoL on top of objective health cannot be uncovered from the present data; instead, information on aging attitudes, coping and attribution should be included in future studies to provide an encompassing understanding of GS and their relation with psycho-social and health-related variables.\u003c/p\u003e\u003cp\u003eAdditionally, the data was collected in German clinical care, thus its generalizability to other regions and nations is limited. Cultural expectations as well as healthcare standards may influence the perception of GS for patients across the globe. As the data is based on patients’ experiences, some sample sizes – for example for dysphagia – are small, hindering robust analyses. Thus, some results should be interpreted with caution. Instead, this study aims to guide future research in the area of patient-centered approaches on GS and their impact by providing first insights into an under-explored topic.\u003c/p\u003e\u003cp\u003eLikewise, across studies a different interpretation of GS exists due to a lack of consensus on which GS should be included. Therefore, when interpreting the results and comparing them with other research, a potential variation in included GS must be kept in mind. Certain differences in prevalence and impact of GS may stem from differing types of included GS.\u003c/p\u003e\u003cp\u003eLastly, although the primary goal of our study was to provide a patient perspective on GS, self-reported information always carries a risk of bias. The presented GS are not based on medical expertise but rather on patients’ own perception of their health. While the patient perspective is essential in clinical research[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], the results may differ from previous studies where GS were assessed with standardized measures. Future studies should compare expert- and patient-given assessments to understand how they relate to each other and to QoL.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGS are disease-unspecific, overarching symptom clusters that may be useful in the treatment of older adults, where multimorbidity renders a disease-focused approach ineffective. From a patient\u0026rsquo;s perspective, GS are common, with mobility-related problems, sleep disturbances, pain and cognitive impairment being particularly prevalent in older patients. Although much variability exists regarding the amount of restriction patients experience and the potential they see for improvement, a higher number of GS is associated with worse physical and mental QoL even when controlling for sociodemographic and health-related information. A deeper understanding of the most impactful GS and their associations with well-being can guide geriatric care in a more effective and patient-centered manner.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eWe would like to thank Elisabeth Dobkowitz, Undine Germo, Julia Kemp, Sophie Kretschmar, Oscar Lieder, Pauline Otto, Nathalie Schaaf, Kirsten Scharr, Ulrich Spanaus, Ulrike Teschner, and Rebecca Wientzek for their help with study organization and data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe further acknowledge data sharing and support by the Data Integration Center of the Medical Faculty of the Martin-Luther-University Halle-Wittenberg and the University Hospital Halle (Saale). Study data were collected and managed using REDCap electronic data capture tools.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThis project was supported by a BMBF grant to TP (grant number 01GY2301).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAS\u003c/em\u003e\u003c/strong\u003e: Supervision, Study Conceptualization, Data Collection, Data Curation, Data Analysis, Writing: First Draft\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eKGH\u003c/em\u003e\u003c/strong\u003e: Supervision, Study Conceptualization, Data Collection, Data Curation, Data Analysis, Writing: Review and Editing\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eASt\u003c/em\u003e\u003c/strong\u003e: Data Collection, Data Curation, Writing: Review and Editing\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e\u003cem\u003ePL\u003c/em\u003e\u003c/strong\u003e: Data Collection, Data Curation, Writing: Review and Editing\u003cbr\u003e\u003cstrong\u003e\u003cem\u003eTP\u003c/em\u003e\u003c/strong\u003e: Funding Acquisition, Supervision, Study Conceptualization, Data Analysis, Writing: Review and Editing\u0026nbsp;\u003cbr\u003e\u0026nbsp;All authors read and approved of the present manuscript.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eCompeting Interests\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eNone\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eEthics Approval and Consent\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll patients gave written informed consent\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003e\u003cem\u003eData Availability\u003c/em\u003e\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll study materials are available from Sch\u0026ouml;nenberg, A., Heimrich, K. G., Prell, T., et al. (2025). Data on Self-Management of Geriatric Syndromes. osf.io/a68x5 [22]. Of note, due to the potential sensitive nature of the data, the datasets are only available after request [Link for review: https://osf.io/a68x5/?view_only=6d092e9330e046a49b043271d57cb0a4]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInouye SK, Studenski S, Tinetti ME, Kuchel GA (2007) Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. 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J Biomed Inform 95:103208. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jbi.2019.103208\u003c/span\u003e\u003cspan address=\"10.1016/j.jbi.2019.103208\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"geriatric syndromes, multimorbidity, patient-centered, older adults, geriatrics, geriatric assessment","lastPublishedDoi":"10.21203/rs.3.rs-7426749/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7426749/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eMany older patients suffer from multimorbidity, rendering disease-specific approaches moot. Instead, overarching geriatric syndromes (GS) can be used to describe patients\u0026rsquo; experiences above and beyond concrete diagnoses. However, little is known about how patients themselves perceive these GS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eWe collected self-reported data on N\u0026thinsp;=\u0026thinsp;511 geriatric in- and N\u0026thinsp;=\u0026thinsp;155 outpatients on the occurrence of nine GS: reduced mobility, falls, problems with cognition, depressiveness, loneliness, pain, incontinence, problems with sleep, and problems with swallowing. We additionally asked about the perceived restriction and expectations regarding improvement of the GS. Using descriptive statistics, group comparisons and linear regression, we describe patients\u0026rsquo; perception of the GS and their association with mental and physical quality of life (QoL) while controlling for cognition, functional status and health.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eOn average, patients report 3.4 (SD\u0026thinsp;=\u0026thinsp;1.8) different GS, while 47.2% reported\u0026thinsp;\u0026ge;\u0026thinsp;4. The most frequent GS were mobility problems, falls, and pain; these were also perceived as most restrictive in daily life. A higher number of GS significantly reduces mental and physical QoL, above and beyond physical health. For physical QoL, mobility problems, falls, and pain are most influential, while mental QoL is linked with depressiveness, loneliness and sleep problems. These associations were even stronger in out- than in inpatients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eGS are highly prevalent and lead to reduced mental and physical QoL. As they impact QoL above and beyond physical health and functionality, GS and their association with age-related expectations should be incorporated in clinical care to improve well-being.\u003c/p\u003e","manuscriptTitle":"Patients’ perspective on Geriatric Syndromes and their Relation with Quality of Life: a cross-sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 00:09:11","doi":"10.21203/rs.3.rs-7426749/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revisions","date":"2025-09-03T07:11:50+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-08-27T17:14:33+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-27T09:00:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-26T14:17:53+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Geriatric Medicine","date":"2025-08-21T09:36:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-geriatric-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"EGEM","sideBox":"Learn more about [European Geriatric Medicine](https://www.springer.com/journal/41999)","snPcode":"41999","submissionUrl":"https://www.editorialmanager.com/egem/default2.aspx","title":"European Geriatric Medicine","twitterHandle":"","acdcEnabled":false,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"801f64d3-ff7b-41af-b99f-0031b5b3085e","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-10T14:11:29+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-04 00:09:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7426749","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7426749","identity":"rs-7426749","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}