Assessing the Quality of Life in Patients with Complex Chronic conditions Cronimad Study

Assessing the Quality of Life in Patients with Complex Chronic conditions Cronimad 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 Assessing the Quality of Life in Patients with Complex Chronic conditions Cronimad Study Pilar Cubo Romano, Pilar García de la Torre, Virginia Gracia Lorenzo, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5937106/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 08 Dec, 2025 Read the published version in BMC Geriatrics → Version 1 posted 8 You are reading this latest preprint version Abstract Background: People’s life expectancy has increased significantly in the past few decades, which has been associated with an increased prevalence of chronic diseases. Chronic-complex patients (CCP), including those characterized as polypathological patients (PPP), are now the majority among chronic patients and are considered a priority group in healthcare settings. This study aimed to determine the health-related quality of life (QoL) of Spanish CCP and its association with sociodemographic, clinical and functional variables and cognitive status. Methods: Patients identified as CCP or PPP from six hospitals in the Community of Madrid were included. The primary endpoint was to determine the QoL of CCP/PPP. To do so, patients were asked to complete the EuroQol questionnaire that included the visual analog scale (EQ-VAS), and the questionnaire with 5 dimensions and 5 levels (EQ-5D-5L). Several socio-demographic/health-related variables were further evaluated and correlated with QoL. Results: A total of 128 CCP/PPP were included. A median EQ-VAS score of 60.0 [45.0, 80.0, and 0.64 [0.40, 0.79] on the EQ-5D-5L Index were observed. The FRAIL Index showed a significant negative correlation with both the EQ-5D-5L (ρ = -0.50; p < 0.001) and EQ-VAS (ρ = -0.30; p = 0.020). Similarly, moderate to extreme pain was associated with lower QoL in both indexes (ρ = -0.55; p < 0.001 for EQ-5D-5L; ρ = -0.36; p < 0.001 for EQ-VAS), as were walking disturbances (ρ = -0.50; p < 0.001 for EQ-5D-5L; ρ = -0.28; p = 0.045 for EQ-VAS). Conversely, the MNA-SF Index showed a significant positive correlation with both the EQ-5D-5L (ρ = 0.36; p = 0.001) and EQ-VAS (ρ = 0.39; p < 0.001). Additionally, the Barthel Index was positively associated with QoL as measured by EQ-5D-5L (ρ = 0.47; p < 0.001). Conclusion: This study suggests that CCP/PPP experience a significantly lower QoL compared to those of the same age. This decline may be influenced by factors such as functional dependence and potentially reversible conditions, including frailty, malnutrition, and pain. All of this highlights the need for a comprehensive assessment that allows for early diagnosis of these conditions and the implementation of multidimensional interventions to prevent functional dependence and activities of daily living. Trial registration: Not applicable Multimorbidity Chronic complex patients polypathological patients Quality of life EQ-5D-5L Index healthcare management Figures Figure 1 INTRODUCTION People’s life expectancy has increased significantly in the past few decades. According to the World Health Organization (WHO), people lived 6 more years in 2019, compared to 2000 [ 2 ]. Specifically in Spain, the average life expectancy ranks among the world’s highest, with 20.1% of the population above 65 years old that is expected to increase to 30.4% in 2050 [ 3 ]. On the one hand, there has been a clear improvement in living conditions and significant advances in medical care since the 19th century [ 4 ]. However, associated with the progressive aging of the population, it is observed a marked increase in the prevalence of chronic diseases (e.g. diabetes, cancer, cardiovascular or chronic obstructive respiratory diseases). Indeed, chronic conditions are responsible for 60% of the total deaths worldwide, leading to a significant deterioration in patients' quality of life (QoL) and imposing a great challenge to physicians in providing cost-effective quality of care [ 5 ]. Presently, the most common scenario is the coexistence of multiple chronic pathologies (multimorbidity), rather than a single chronic disease [ 6 ]. Considering this, new concepts such as complex chronic patients (CCP), or polyphatologic patients (PPP) have been introduced. While a CCP characterizes a person with one or several long-term diseases of difficult management and related to cognitive or functional impairment [ 7 ], a PPP refers specifically to a CCP that suffers from chronic diseases included in two or more of 8 predefined categories [ 8 ]. Compared to other patient cohorts, CCP have a hospital prevalence range of 20–45% and share a specific clinical profile of increased age, social frailty, higher vulnerability, poor health-related QoL, prevalence of neurological deficits, functional deterioration, and higher 1-year mortality rate [ 7 , 8 ]. Importantly, this emergent group of patients is responsible for 20–40% of hospital admissions, 40% being admitted ≥ 3 times, and 13% ≥5 times a year [ 9 ], making them a priority group in healthcare management [ 7 , 8 ]. Attending to the significant change in the clinical profile of chronic patients, today’s chronic care requires a new reform. Strategies at global and local levels have been proposed since 2002 attempting to reduce the burden of chronic limitations [ 10 ] and, more recently, to combat the increased rate of multimorbid patients in the healthcare system [ 11 , 12 ]. Nonetheless, a deeper knowledge and characterization of these patients is still scarce and, therefore, urgent. One of the key aspects in this patient group is the assessment of QoL. To this end, various measurement scales have been employed, including the questionnaire EuroQol 5D (EQ- 5D) a widely used, standardized instrument developed in Europe to assess generic QoL. Agborsangaya et al. compared the measurement properties of the EQ-5D-3L and EQ-5D-5L in a general population sample, highlighting the advantages of the EQ-5D-5L and illustrating the negative impact of multimorbidity on QoL [ 13 ]. Similarly, N’Goran et al. analyzed QoL using the EQ-5D in a Swiss cohort of patients with multimorbidity, reporting significantly lower scores compared to the general population, particularly among individuals under 60 years old and women [ 14 ]. Van Wilder et al. also found reduced EQ-5D scores in patients with chronic diseases compared to the general population and developed a comprehensive international catalog of EQ-5D scores for various chronic diseases, providing a valuable reference for future comparisons [ 15 ]. The present study aims to assess the health-related QoL of CCP/PPP patients in the Community of Madrid using the EQ-5D-5L questionnaire. Additionally, it seeks to explore the relationship between QoL and key health indicators such as functional and cognitive status, nutritional condition, and hospital admissions. These findings are expected to contribute to the development of more comprehensive, multidimensional, and patient-centered healthcare management strategies. MATERIALS AND METHODS Study design Prospective multicenter descriptive study carried out in patients identified as PPP or as CCP that consecutively attended the CCP units of the Service of Internal Medicine of six hospitals in the Community of Madrid (Hospital Universitario Infanta Cristina, Hospital Universitario del Tajo, Hospital Universitario Infanta Leonor, Hospital Universitario de Fuenlabrada, Hospital Universitario Gregorio Marañón, and Hospital Universitario Rey Juan Carlos). At the consultation, patients were asked to answer the questionnaire developed by the EuroQol Research Foundation, including the visual analog scale (EQ-VAS) and the questionnaire with 5 dimensions and 5 levels (EQ-5D-5L). At the same appointment, all the patient’s sociodemographic data and multidimensional global assessment were collected. The inclusion period was from January 2021 to February 2022. Mortality was analyzed at one year of inclusion by reviewing electronic medical records or telephone calls. The only exclusion criteria were unwillingness to sign the informed consent form. The study was performed per the Belmont report “Ethical Principles and Guidelines for the Protection of Human Subjects of Research” and the up-to-date declaration of Helsinki. All participants received information, accepted, and signed informed consent forms. Data collection was anonymous and used exclusively for the present study. Data confidentiality was maintained under Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on Data Protection (GDPR) and the Spanish Organic Law 3/2018, of December 5, on the Protection of Personal Data and Guarantee of Digital Rights. The study was approved by the Clinical Research Ethics Committee of the Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid. Endpoints and variables The primary endpoint of this study was to determine the QoL of PPP or CCP attending Internal Medicine consultations. The secondary endpoint included examining the potential functional, psychological, and social factors affecting the QoL of these patients. To measure the QoL, the EQ-VAS and the EQ-5D-5L scales were used. For the EQ-VAS, the patient was asked to identify his QoL by choosing a number (from 0 to 100) out of a thermometer-like millimeter scale of 20 cm, with 0 being the worst possible QoL and 100 the best [ 16 ]. The EQ-5D-5L, on the other hand, consisted of a questionnaire with 5 dimensions (EQ-5D; mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each of these dimensions had 5 possible responses or severity levels (EQ-5D-5L; 1, no problems; 2, mild problems; 3, moderate problems; 4, severe problems; 5, very severe problems Each respondent indicated the level that best reflected his status for each of the 5 dimensions so that their state of health would be described by five digits taking values from 1 to 5 (11111, indicating no problems in all dimensions, to 55555 indicating very severe problems in all dimensions) [ 17 ]. The EQ-5D Index was then calculated by adjusting the perfect score of 1 (representing the highest QoL) based on negative coefficients derived from responses that differ from 1. The coefficients used are specific to the Spanish population and were calculated in a previous study [ 18 ]. The result is an Index that represents preferences for each of the 3,125 (5 5 ) possible health states resulting from the combinations of severity levels across the five dimensions, ranging from a maximum of 1 (indicating the best possible QoL, corresponding to 11111) to a minimum of -0.416 (representing the worst possible QoL, corresponding to 55555) [ 18 ]. From the EQ-5D Index, the Severity Index was obtained by summing the severity levels across five dimensions (e.g., 11111 = 5, 55555 = 25), subtracting 5, and then multiplying by 5 to create a range from 0 to 100, where 0 means the best QoL and 100 represents the worst QoL [ 17 ]. Finally, the Health Index was additionally obtained by subtracting the Severity Index from 100, with 0 being the total absence of QoL, and 100 representing the better perceived QoL [ 17 ]. A set of variables that may be associated to health related perceived QoL have been explored. Some may be causes of poor QoL perception, such as age, sex, functional deficits, frailty, cognitive impairments, malnutrition or pain. In this sense, to evaluate functional status, the simplified Barthel Index was used, grouping patients into those with severe dependence (Barthel less than 60), moderate dependence (Barthel 60–90), and independent (Barthel greater than 90) [ 19 ]. The FRAIL index was used to screen frailty, which evaluates fatigue, resistance, ambulation, presence of chronic diseases and weight loss, with a cut-off point for suspected frailty of ≥ 1 points [ 20 ]. The Global Deterioration Scale (GDS) of Reisberg was used for the diagnosis of dementia [ 21 ]. For those patients without dementia (GDS score lower than 4), the simplified Pfeiffer test was used as a screening for cognitive impairment [ 22 ]. Nutritional status was also assessed using the Mini-Nutritional Assessment-Short form (MNA-SF) [ 23 ]. A total score of MNA-SF 11 no malnutrition. Chronic pain was inquired, through clinical history or positive responses on the EQ-5D-5L scale. Additionally, patients were also asked about falls that occurred in the previous year using the questions proposed by the Ministry of Health in the "Consensus document on prevention of frailty and falls in the elderly" [ 24 ]. Also, polypharmacy (taking more than 10 drugs daily) was assessed. These factors could either be causes or consequences of poor health perception. Finally, we evaluated social determinants associated with poor prognosis, such as educational level, categorizing patients into those with no formal education, primary or secondary education, and university education. Additionally, we analyzed whether living alone or having a non-spousal caregiver was associated with a lower QoL Each of these variables was divided into several categories, and patients or their companions were asked directly to specify which one they belonged to. The number of hospital admissions and emergency room visits in the year prior to study inclusion in the study were reviewed to assess whether this could have an impact on QoL. The PROFUND index was used to estimate patient prognosis and to explore the relationship between life expectancy and QoL, independently of clinical outcomes. This validated tool predicts the one-year mortality risk in CPP/PPP, classifying them into four risk levels: low (0–2 points), medium (3–6 points), high (7–10 points), and very high (11–30 points) [ 7 ]. Furthermore, one-year mortality was analyzed to determine whether baseline QoL could serve as a predictor of mortality risk, providing potential insights into its prognostic value in this patient population. Statistical analysis A descriptive study was performed. Categorical variables were expressed as percentages while quantitative variables were expressed as median and interquartile range, except for the MNA-SF Index and the number of drugs, which had normal distribution and were expressed as mean and standard deviation (SD). To analyze possible factors influencing the QoL of these patients, the EQ-5D-5L and EQ-VAS indexes were correlated with 19 variables. The absence of normal distribution of both indexes was confirmed via the Shapiro test. Also, absence of linearity was detected in most of the comparisons. Some transformations of those variables where checked, but all of them failed to correct the violation of the assumptions of normality and linearity. So, Spearman's correlation Index and statistical significance between the EQ-5D-5L Index and quantitative, binary, and ordinal variables were estimated instead of regression coefficients and their confidence intervals. Nominal variables were not analyzed. The Heath Index showed a very good correlation with the weighted EQ-5D-5L Index (ρ 0.97, p < 0.001), and similar results were found on its association with the rest of the variables (data not shown). Only the correlations of patients’ socio-demographic/health conditioning variables with the EQ-5D-5L and EQ-VAS indexes are shown in the present manuscript. Correlations with p < 0.05 were considered statistically significant. Since the analysis was exploratory, significance was adjusted by Bonferroni correction, according to the following formula: p' = min (1; kp), where p' is the corrected significance, k is the number of correlations explored (19 for each index), and p is the significance of the individual test [ 25 , 26 ]. Statistical analysis was performed with the Stata software package version 18 (StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC). RESULTS Study population Between January 2021 and January 2022, data were collected from 128 patients across six public hospitals in the Autonomous Community of Madrid, of whom 56% were women, with a median age of 83.3 years old [77.3–89.0]. All demographic data are presented in Table 1 . Table 1 Association of the EQ5D5L Index and the EQ-VAS Index with the different variables. No. (%)/Median [Q1-Q3] EQ-5D-5L Index: Median [Q1-Q3] Spearman coefficient (ρ); P value EQ-VAS Index: Median [Q1-Q3] Spearman coefficient (ρ); P value Age (years) (N = 126) 83.3 [77.3–88.90] 0.6 [0.4–0.8] -0.12; 1.0000 60.0 [45.0–80.0] -0.05; 1.0000 Women (N = 126) -0.23; 0.1734 -0.18; 0.9943 No 55 (43.7%) 0.74 [0.47–0.84] 70.00 [50.00–80.00] Yes 71 (56.3%) 0.59 [0.28–0.76] 50.00 [40.00–75.00] Death in the following year (N = 128) -0.02; 1.0000 0.07; 1.0000 No 119 (93.0%) 0.64 [0.42–0.79] 60.00 [40.00–80.00] Yes 9 (7.0%) 0.62 [0.28–0.81] 67.50 [50.00–77.50] Level of education (N = 125) 0.17; 1.0000 0.08; 1.0000 No studies 55 (44.0%) 0.56 [0.30–0.76] 60.00 [45.00–75.00] Primary education 58 (46.4%) 0.70 [0.47–0.79] 50.00 [35.00–70.00] Secondary education 8 (6.4%) 0.58 [0.36–0.90] 80.00 [75.00–80.00] University degree 4 (3.2%) 0.86 [0.65–0.96] 77.50 [75.00–80.00] Caregiver (N = 121) 0.17; 1.0000 0.19; 0.7456 No caregiver or non-spouse 88 (72.7%) 0.60 [0.35–0.78] 50.00 [40.00–70.00] Caregiver spouse 33 (27.3%) 0.71 [0.48–0.87] 72.50 [50.00–80.00] Lives alone (N = 123) 0.00; 1.0000 -0.15; 1.0000 No 102 (82.9%) 0.61 [0.42–0.79] 60.00 [45.00–80.00] Yes 21 (17.1%) 0.70 [0.43–0.77] 50.00 [30.00–60.00] Number of hospital admissions in the previous year (N = 128) 1.0 [0.5-3.0] 0.6 [0.4–0.8] -0.14; 1.0000 60.0 [45.0–80.0] -0.01; 1.0000 Number of visits to the emergency department in the previous year (N = 128) 1.0 [0.0–2.0] 0.6 [0.4–0.8] -0.05; 1.0000 60.0 [45.0–80.0] 0.05; 1.0000 FRAIL Index (N = 114) 2.0 [1.0–3.0] 0.6 [0.4–0.8] -0.50; 0.0000 60.0 [50.0–80.0] -0.30; 0.0199 MNA-SF Index (N = 123) 10.0 [8.0–13.0] 0.6 [0.4–0.8] 0.36; 0.0009 60.0 [42.5–80.0] 0.39; 0.0002 PROFUND Index (N = 122) 6.0 [3.0–9.0] 0.6 [0.4–0.8] -0.34; 0.0027 60.0 [42.5–80.0] -0.16; 1.0000 Falls in the last year (N = 124) 0.01; 1.0000 0.04; 1.0000 No 95 (76.6%) 0.64 [0.43–0.79] 50.00 [45.00–80.00] Yes 29 (23.4%) 0.64 [0.33–0.84] 67.50 [40.00–77.50] More than two falls per year (N = 124) 0.03; 1.0000 -0.12; 1.0000 No 105 (84.7%) 0.64 [0.36–0.79] 60.00 [50.00–80.00] Yes 19 (15.3%) 0.60 [0.47–0.84] 50.00 [10.00–75.00] Gait disturbance (N = 122) -0.50; 0.0000 -0.28; 0.0453 No 59 (48.4%) 0.79 [0.59–0.87] 70.00 [50.00–80.00] Yes 63 (51.6%) 0.48 [0.28–0.69] 50.00 [30.00–70.00] Cognitive impairment (GDS) (n = 127) -0.05; 1.0000 -0.07; 1.0000 Absent-mild 117 (92.1%) 0.64 [0.36–0.80] 60.00 [45.00–80.00] Moderate-severe 5 (3.9%) 0.62 [0.54–0.79] 60.00 [50.00–80.00] Severe-very severe 5 (3.9%) 0.53 [0.46–0.54] 50.00 [40.00–50.00] Suspected dementia (GDS < 4) (N = 97) -0.27; 0.1574 -0.21; 0.5772 No 81 (83,6%) 0.71 [0.46–0.81] 67.50 [50.00–80.00] Yes 16 (16.5%) 0.45 [0.18–0.68] 40.00 [30.00–70.00] Barthel Index (N = 108) 0.47; 0.0000 0.13; 1.0000 Barthel 90 38 (35.2%) 0.79 [0.64–0.88] 70.00 [50.00–80.00] Polypharmacy (> 10 drugs) (N = 84) 0.04; 1.0000 -0.04; 1.0000 No 20 (23.3%) 0.66 [0.46–0.79] 50.00 [40.00–80.00] Yes 66 (76.7%) 0.69 [0.47–0.80] 60.00 [50.00–80.00] Moderate to extreme pain (N = 128) -0.55; 0.0000 -0.36; 0.0009 No 65 (50.8%) 0.79 [0.60–0.85] 70.00 [50.00–80.00] Yes 63 (49.2%) 0.46 [0.21–0.64] 50.00 [30.00–70.00] Note: MNA-SF, Mini-Nutritional Assessment-Short form; GDS, Global deterioration scale; EQ-VAS, EuroQol questionnaire-Visual analog scale; EQ-5D-5L, EuroQol questionnaire with 5 dimensions and 5 levels Data collected demonstrated that patients frequently used the hospital services, with a median of 1 hospitalizations [0.5–3.0] and 1 emergency department visits [0.0–2.0] per year. While 55% of patients were widowed, divorced, or single, only 17.1% lived alone. Concerning the presence of a caregiver, 72.7% either had no caregiver or indicated their caregiver was not a spouse. Looking at the health-associating factors, the prevalence of moderate to very severe cognitive impairment within this population was low, at 7.9%. However, among those without a cognitive impairment diagnosis (GDS Index < 4), 16.5% had a positive Peiffer screening test (Table 1 ). Moreover, severe dependence (Barthel < 60) was present in 16.7% of patients, yet among those who were independent in daily activities, defined by a Barthel greater than 90 (35.2%), 75.8% had a FRAIL Index ≥ 1. Falls were common, with 23.4% of patients reporting at least one fall in the previous year, 15.3% experiencing two or more (Table 1 ), and 6.5% requiring medical assistance as a consequence of a fall. Additionally, malnutrition was a concern with an average MNA SF score of 10.34 (SD = 2.56), 16.3% of patients malnourished (MNA SF score 0–7) and 43.9% at risk of malnutrition (MNA SF score 8–11). Regarding drug prescription and administration, this analysis demonstrated that patients were taking an average of 12.6 (SD 3.81) drugs, with 76.7% being prescribed 10 or more medications (extreme polypharmacy). Despite this, the majority (92.7%) showed to have good treatment adherence. Importantly, 49.2% of patients experienced moderate to extreme pain. Concerning the patient’s prognosis, the median PROFUND index was 6 [3.0–9.0], corresponding to a 21.5% probability of death within one year, increasing to 21–31% one-year post-hospital discharge in case of admission [ 7 , 27 ]. Finally, based on the assessment of patient information and medical records, it was concluded that the mortality one year after inclusion in the study was 7%, lower than the one estimated by the PROFUND index (Table 1 ). Quality of life Self-reported QoL was evaluated using the EQ-VAS and EQ-5D-5L questionnaires. Patients presented a median QoL score of 60.0 [45.0, 80.0] (mean 56.0, SD = 25.2) on the EQ-VAS scale and 0.64 [0.40, 0.79] (mean 0.57, DS = 0.29) on the EQ-5D-5L Index. According to the EQ-5D-5L questionnaire, patients reported moderate to severe problems with mobility, usual activities, pain or discomfort, self-care, and anxiety/depression in 58.1, 51.6, 49.2, 41.4, and 32.0% of cases, respectively (Fig. 1 ). Factors influencing the QoL of PPP and CCP Attempting to identify significant variables influencing the QoL in these patients, the EQ-5D-5L and the EQ-VAS indexes were correlated with 19 variables (Table 1 ). No significant association was found between aging and poorer QoL (ρ = -0.12; p = 1.000 for EQ-5D-5L and ρ = -0.05; p = 1.000 for EQ-VAS). Although not reaching statistical significance, female sex showed a negative correlation with the EQ-5D-5L Index (ρ = -0.23), indicating a potential trend toward lower QoL among female patients.To further elaborate on this point, an analysis of a possible association between patient gender and different health variables was conducted. Indeed, it was observed that women in this study were less likely to have a spousal caregiver (OR 0.38, 95% CI 0.17–0.86; p = 0.021), more likely to have walking difficulties (OR 2.24, 95% CI 1.07–4.68; p = 0.032), or to have a higher risk of malnutrition (OR 2.78, 95% CI 1.32–5.88; p = 0.007). It was observed that the FRAIL Index showed a significant negative association with both the EQ-5D-5L (ρ -0.50; p < 0.001), and the EQ-VAS indexes (ρ -0.30; p = 0.020). Similarly, the presence of moderate to extreme pain also associated with worse QoL in both indexes (ρ -0.55; p < 0.001vs ρ -0.36; p < 0.001 for EQ-5D-5L and EQ-VAS respectively), and the same was also observed for walking disturbances (ρ -0.50; p < 0.001 vs ρ -0.28; p = 0.045, for EQ-5D-5L and EQ-VAS respectively). The MNA-SF Index, on the other hand, resulted in a significant positive correlation with both the EQ-5D-5L Index (ρ 0.36; p = 0.001) and the EQ-VAS Index (ρ 0.39; p < 0.001). Another positive correlation was found significant between the Barthel Index and the QoL measured by the EQ-5D-5L Index (ρ 0.47; p < 0.001), revealing that a higher functional dependence and a higher level of malnutrition are linked to a poorer QoL in the surveyed patients. Patients with a higher PROFUND Index, and therefore worse prognostic estimation, showed to be associated with poorer QoL (ρ -0.34; p = 0.003), when evaluated using the EQ-5D-5L Index. Nevertheless, QoL was not shown to be a predictor of poor prognosis (Table 1 ). DISCUSSION The present study found that the QoL on CCP/PPP, as measured by the EQ-5D-5L, is lower than that reported by individuals of the same age in Spain. [ 17 ]. More than half of the patients experienced moderate or severe impairments in mobility and performance of daily activities. Greater functional dependence, higher levels of malnutrition, and moderate or severe chronic pain could be associated with poorer QoL in this population. Additionally, among patients without functional dependence, those meeting frailty criteria also exhibited lower QoL. The prevalence of patients with multimorbidity in the hospital setting and primary care is high and is expected to increase even more in the upcoming years [ 7 ]. Particularly, CCP are already the majority of patients in certain health departments in Switzerland [ 28 ], Scotland [ 29 ], Portugal [ 6 ], and Spain [ 8 ]. These are patients characterized by a higher frailty, risk of malnutrition, and extreme polypharmacy, with a significant proportion of them suffering from moderate or severe pain. For this reason, considering their complexity, greater vulnerability, and weight on caregivers, families, and medical areas, healthcare models are now subjected to important reforms aiming to implement and offer more friendly and patient-centered daily care strategies [ 11 ]. The better we know the state of health of these patients, the easier it will be to adjust their needs and implement/execute the aforementioned strategies. When evaluating the QoL of our population aged 65 years and older, who constitute the majority of the sample, it is evident that the average QoL index values are consistently lower than the national average for a population of a similar age (Table 2 ). However, an exception is observed in the EQ-VAS scores for individuals over 85 years old, where our population reports slightly higher values (58.31 vs. 54.55, respectively). The differences in QoL scores are even more pronounced when comparing our data with those published for the Community of Madrid, highlighting a significant disparity (Table 2 ) [ 17 ]. Table 2 EQ-VAS and EQ-5D-5L Outcomes Between the Study Population and the Spanish National Health Survey Study Population NHS (Spain) NHS Community of Madrid Age (years) EQ-VAS (mean) EQ-5D-5L(mean)* EQ-VAS (mean) EQ-5D-5L (mean)* EQ-VAS (mean) EQ-5D-5L(mean)* 65–74 59.44 59.38 69.82 86.49 76.42 90.3 75–84 53.78 53.54 62.57 78.12 68.66 80.7 + 85 58.31 58.44 54.55 62.51 67.70 70.0 Total 64.82 79.84 Note: EQ-VAS, EuroQol questionnaire-Visual analog scale; EQ-5D-5L, EuroQol questionnaire with 5 dimensions and 5 levels; NHS, National Health Survey 2011–2012 [ 14 ]. *Valor de EQ-5D-5L x 100 Focusing on the responses to the EQ-5D-5L questionnaire, national data showed that most of the very severe problems described by the age-matched population were associated with the performance of their usual activities (8.8% of a total of 3,165 people ≥ 75 years old). The most common moderate to very severe problems were associated with mobility (36.1% of a total of 3,165 people ≥ 75 years old), usual activities (29.4%), and pain/discomfort (35.1%). Interestingly, although these results align with our data, at a percentage level, one may acknowledge the higher percentages of very severe and moderate to very severe problems in all three dimensions (mobility, 58.1%; usual activities, 51.6%; pain/discomfort, 49.2%) observed for our CCP/PPP group. Moderate to severe problems in self-care and anxiety/depression were also more reported in our series than in national data (41.4% and 32.0% versus 21.2% and 12.8%, respectively) [ 17 ]. Looking at the socio-demographic characteristics, these results could be partly justified by the high presence of respondents with no education/only primary education (90.4%), without caregivers (72.7%), or by the presence of 56.3% female participants. In fact, studies carried out at national and global levels have not only shown that there is a relationship between the level of education and the health status in the elderly population but have also described a lower QoL associated with women vs. men [ 17 , 30 , 31 ]. More interestingly, related to the presence/absence of caregivers, Molina-Mula et al ., revealed a significant association between the number of nurse home visits and the level of dependence on the CCP, leading to a worse perception of the QoL [ 9 ]. On the other hand, judging by the average age of the respondents, the aging-associated processes could also justify the relatively low QoL value observed [ 10 ]. Nonetheless, our correlation analysis suggests that neither aging, the level of education, nor the presence of a caregiver interfered in the QoL of CCP/PPP, but rather a set of health conditioning factors. Relevantly, it was seen that a worse QoL was associated with patients with gait disorder, poor nutrition, higher frailty and higher levels of pain. All these variables have long been associated with the QoL of either older people or chronic patients [ 32 – 36 ]. However, there is a large gap in studies that corroborate its use for the characterization of QoL in CCP. Focusing on the EQ-5D-5L Index, our data further demonstrates that CCP/PPP have a poorer QoL when suffering functional dependence, which is in accordance with previous data showing a positive correlation between the Barthel Index and the EuroQoL-5D-5L scales in patients with multiple chronic conditions [ 9 ]. Regarding frailty it is relevant to highlight that this is a previous stage before dependency. The FRAIL Index is considered the best predictor of adverse events such as falls, hospitalization, disability, and death, independently of other parameters (e.g., multimorbidity) but, more importantly, frailty can be reversible [ 37 ]. Indeed, multiple interventions have been shown to reduce frailty y, namely targeting physical exercise training, loneliness, and fall prevention [ 38 , 39 ]. Apart from frailty, strategies improving malnutrition [ 40 , 41 ], and ameliorating gait disturbance (e.g., multicomponent exercise) [ 34 ] have also shown to benefit patients’ QoL, opening a window of opportunity for CCP. In our study, QoL was not found to be a prognostic marker, as has been demonstrated in other studies, probably related to the low one-year mortality rate [ 42 , 43 ]. However, it was observed that patients with CCP/PPP with a higher PROFUND score, and therefore a worse prognostic estimate, have a lower QoL. The PROFUND score is an accurate and reliable method for estimating the one-year risk of death in patients with PPP. Therefore, these results could encourage the use of this tool to effectively stratify patients with PPP into groups with different risks of death, as well as to group them according to their QoL levels. Finally, it is worth mentioning that a slight tendency for a worse QoL in women CCP was observed, as described in other studies [ 14 ]. Based on the above data, this could result from the significant association observed between women with both gait disturbance and nutritional problems. However, other factors associated with this gender difference have been described. For example, in a Spanish study of people aged 60 and over, the QoL was worse in women compared to men, suggesting that sociodemographic factors, such as lower educational levels, and lifestyle factors, such as a more sedentary lifestyle, may explain a substantial part of the differences in QoL [ 44 ]. We acknowledge the several limitations of this study. The sample size is insufficient for multivariate analysis, so we consider the present findings valid only for hypothesis generation. Therefore, more studies are needed to corroborate these preliminary results. Another limitation of our study is that the general population data used for comparison with CCP were collected more than a decade ago, and it is known that the perception of QoL evolves over time, albeit slowly, and can be influenced by economic or health crises [ 45 , 46 ]. Even so, our data strongly imply that accurate access to QoL in these patients can only be done by a complex and complete assessment of all the variables, rather than using only the most validated ones. We, therefore, believe that conducting a multidimensional assessment of a vulnerable population, such as the PCC, is of great value for tailoring the healthcare system into a more patient-driven one with increased functionality and decreased unnecessary and spiraling visits to hospital settings, this way ameliorating patients’ well-being and increasing the number of years CCP/PPP will spend with good QoL [ 1 ]. In conclusion, the study identifies that patients with CCP/PPP have a poorer quality of life than patients of the same age. This could be influenced by functional dependence potentially but reversible factors such as frailty, malnutrition, and pain. All of this highlights the need for a comprehensive assessment that allows for early diagnosis of these conditions and the implementation of multidimensional interventions to prevent functional dependence and activities of daily living. We hope this study results will help improve chronic disease management and identify those most in need of healthcare support. List Of Abbreviations CCP Chronic-complex patients EQ-5D-5L EuroQol questionnaire with 5 dimensions and 5 levels MNA-SF Mini-Nutritional Assessment-Short form QoL Quality of Life SD Standard deviation WHO World Health Organization EQ EuroQol questionnaire GDS Global Deterioration Scale NHS National Health Survey PPP Polypathological patients VAS Visual analog scale Declarations Ethics approval and consent to participate The study was performed per the Belmont report “Ethical Principles and Guidelines for the Protection of Human Subjects of Research” and the up-to-date declaration of Helsinki. All participants received information, accepted, and signed informed consent forms. The study was approved by the Clinical Research Ethics Committee of the Instituto de Investigación Puerta de Hierro-Segovia de Arana, Madrid. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This study was supported by a grant from Menarini Laboratories. Authors' contributions All authors have contributed equally to the conceptualization, writing, and revision of this manuscript. Acknowledgements The authors wish to express their sincere gratitude to the members of the CRONIMAD group for their valuable contributions to this work. Special thanks are extended to Dr. Pilar Arcos Pereda from Hospital del Tajo, Dr. Manuel Méndez Bailón from Hospital Universitario Clínico San Carlos, Dr. Sonia Gonzalo Pascua from Hospital Universitario de Fuenlabrada, Dr. Desiree Vélez from Hospital Universitario del Sureste, Dr. Luis Cabeza Osorio from Hospital Universitario del Henares, and Dr. Ester Moreno Hernández from Hospital Universitario Puerta de Hierro. Their expertise and dedication have been pivotal in the development and completion of this research. References Vallejo Maroto I, Cubo Romano P, Mafé Nogueroles MC, Matesanz-Fernández M, Pérez-Belmonte LM, Said Criado I, et al. Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. Revista Clínica Española (English Edition). 2021 Jun;221(6):347–58. World Health Organization. GHE: Life expectancy and healthy life expectancy [Internet]. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ ghe-life-expectancy-and-healthy-life-expectancy Instituto Nacional de Estadística. Proyecciones de Población 2022-2072 [Internet]. Available from: https://www.ine.es/prensa/pp_2022_2072.pdf. Braveman P, Gottlieb L. The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Rep. 2014 Jan;129(1_suppl2):19–31. European Union. EU Reflection on Chronic Disease [Internet]. Available from: https://health.ec.europa.eu/document/download/4fdb23ef-d0b4-4078-b09b-a84e9c3d48df_en Prazeres F, Santiago L. Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study. BMJ Open. 2015 Sep;5(9):e009287. Bernabeu-Wittel M, Ollero-Baturone M, Moreno-Gaviño L, Barón-Franco B, Fuertes A, Murcia-Zaragoza J, et al. Development of a new predictive model for polypathological patients. The PROFUND index. European Journal of Internal Medicine. 2011 Jun;22(3):311–7. Wittel M B, Romero L G, Zaragoza J M, Mancera R G, Santos R A, Manglano J D, et al. Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population. J Biomed Res Environ Sci. 2022 Nov;3(12):1321–36. Molina-Mula J, Miguélez-Chamorro A, Taltavull-Aparicio JM, Miralles-Xamena J, Ortego-Mate MDC. Quality of Life and Dependence Degree of Chronic Patients in a Chronicity Care Model. Healthcare. 2020 Aug 24;8(3):293. Ministerio de Sanidad. Strategy for Addressing Chronicity in the National Health System [Internet]. Available from: https://www.sanidad.gob.es/areas/calidadAsistencial/estrategias/abordajeCronicidad/docs/ Resumen_Ejecutivo_Estrategia_Abordaje_Cronicidad_ENGLISH_02.pdf Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expectations. 2021 Aug;24(4):1300–11. Comunidad de Madrid. Estrategia de atención a las personas con enfermedades crónicas de la Comunidad de Madrid [Internet]. Available from: https://www.comunidad.madrid/transparencia/sites/default/files/plan/document/432_474_ libro_estratpac_enfcroniccommadrid_ip_0.pdf Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes. 2014 May 16;12:74. N’Goran AA, Déruaz-Luyet A, Haller DM, Zeller A, Rosemann T, Streit S, et al. Comparing the self-perceived quality of life of multimorbid patients and the general population using the EQ-5D-3L. PLoS One. 2017;12(12):e0188499. Van Wilder L, Rammant E, Clays E, Devleesschauwer B, Pauwels N, De Smedt D. A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review. Qual Life Res. 2019 Dec;28(12):3153–61. Rabin R, Charro FD. EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine. 2001 Jan;33(5):337–43. Ministerio de Sanidad. Encuesta nacional de salud España 2011/12. Ramos-Goñi JM, Craig BM, Oppe M, Ramallo-Fariña Y, Pinto-Prades JL, Luo N, et al. Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value in Health. 2018 May;21(5):596–604. Bernabeu-Wittel M, Díez-Manglano J, Nieto-Martín D, Ramírez-Duque N, Ollero-Baturone M, Abella-Vázquez L, et al. Simplificación de la escala de Barthel para el cribado de fragilidad y dependencia severa en pacientes pluripatológicos. Revista Clínica Española. 2019 Nov;219(8):433–9. Ministerio de Sanidad. Actualización del documento de consenso sobre prevención de la fragilidad en la persona mayor (2022) [Internet]. Available from: https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSaludable/fragilidadCaidas/docs/ ActualizacionDoc_FragilidadyCaidas_personamayor.pdf Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. AJP. 1982 Sep 1;139(9):1136–9. Bernabeu-Wittel M, Nieto Martín D, Moreno-Gaviño L, Ollero-Baturone M. Valor diagnóstico de un cuestionario de Pfeiffer simplificado en pacientes pluripatológicos. Revista Clínica Española. 2017 Aug;217(6):320–4. Sysal P, Veronese N, Arik F, Kalan U, Smith L, Isik AT. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. CIA. 2019 Apr;Volume 14:693–9. Documento de consenso sobre prevención de fragilidad y caídas en la persona mayor. Estrategia de promoción de la salud y prevención en el SNS (2024) [Internet]. Available from: https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSaludable/ fragilidadCaidas/estrategiaSNS/docs/FragilidadyCaidas_personamayor.pdf Stata. Spearman’s and Kendall’s correlations [Internet]. Available from: https://www.stata.com/manuals/rspearman.pdf Armstrong RA. When to use the B onferroni correction. Ophthalmic Physiologic Optic. 2014 Sep;34(5):502–8. Martín-Escalante MD, Quirós-López R, Martos-Pérez F, Olalla-Sierra J, Rivas-Ruiz F, Aguilar-García JA, et al. Validation of the PROFUND index to predict early post-hospital discharge mortality. QJM: An International Journal of Medicine. 2019 Nov 1;112(11):854–60. Excoffier S, Herzig L, N’Goran AA, Déruaz-Luyet A, Haller DM. Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella). BMJ Open. 2018 Mar;8(3):e019616. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012 Jul;380(9836):37–43. Medhi G, Sarma J, Bhattacharyya H, Pala S, Visi V, Bora P. Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India. J Family Med Prim Care. 2019;8(7):2473. Lee KH, Xu H, Wu B. Gender differences in quality of life among community-dwelling older adults in low- and middle-income countries: results from the Study on global AGEing and adult health (SAGE). BMC Public Health. 2020 Dec;20(1):114. Mhesin D, Nazzal H, Amerah J, Azamtta M, Ismail Y, Daralammouri Y, et al. Prevalence of pain and its association with quality of life of patients with heart failure in a developing country: findings from a multicenter cross-sectional study. BMC Cardiovasc Disord. 2022 Sep 28;22(1):426. Jørstad EC, Hauer K, Becker C, Lamb SE, on behalf of the ProFaNE Group. Measuring the Psychological Outcomes of Falling: A Systematic Review. J American Geriatrics Society. 2005 Mar;53(3):501–10. Herman T, Giladi N, Gruendlinger L, Hausdorff JM. Six Weeks of Intensive Treadmill Training Improves Gait and Quality of Life in Patients With Parkinson’s Disease: A Pilot Study. Archives of Physical Medicine and Rehabilitation. 2007 Sep;88(9):1154–8. Rasheed S, Woods RT. Malnutrition and quality of life in older people: A systematic review and meta-analysis. Ageing Research Reviews. 2013 Mar;12(2):561–6. Chang YW, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, et al. Frailty and Its Impact on Health-Related Quality of Life: A Cross-Sectional Study on Elder Community-Dwelling Preventive Health Service Users. Vina J, editor. PLoS ONE. 2012 May 25;7(5):e38079. Abizanda P, Romero L, Sanchez-Jurado PM, Martinez-Reig M, Alfonso-Silguero SA, Rodriguez-Manas L. Age, frailty, disability, institutionalization, multimorbidity or comorbidity. which are the main targets in older adults? The Journal of nutrition, health and aging. 2014 Jun;18(6):622–7. Ožić S, Vasiljev V, Ivković V, Bilajac L, Rukavina T. Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population. Medicine. 2020 Feb;99(8):e19145. Gwyther H, Bobrowicz-Campos E, Luis Alves Apóstolo J, Marcucci M, Cano A, Holland C. A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty. Health Psychology Review. 2018 Oct 2;12(4):382–404. Bharaniidharan J, Reshmi SK. Review on Malnutrition: Impact and Prevention. IJARI. 2019;7(3):49–55. Vivanti A. Improving the quality of life of aged care residents through the joy of food. Australas J Ageing. 2018 Dec;37(4):252–3. Gobbens RJJ, van der Ploeg T. The prediction of mortality by quality of life assessed with the WHOQOL-BREF: a longitudinal analysis at the domain and item levels using a seven-year follow-up period. Qual Life Res. 2021 Jul;30(7):1951–62. Otero-Rodríguez A, León-Muñoz LM, Balboa-Castillo T, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. Change in health-related quality of life as a predictor of mortality in the older adults. Qual Life Res. 2010 Feb;19(1):15–23. Guallar-Castillón P, Sendino AR, Banegas JR, López-García E, Rodríguez-Artalejo F. Differences in quality of life between women and men in the older population of Spain. Soc Sci Med. 2005 Mar;60(6):1229–40. Fernandez A, Garcia-Alonso J, Royo-Pastor C, Garrell-Corbera I, Rengel-Chica J, Agudo-Ugena J, et al. Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain. Br J Gen Pract. 2015 Mar;65(632):e198-203. Davalos ME, French MT. This recession is wearing me out! Health-related quality of life and economic downturns. J Ment Health Policy Econ. 2011 Jun;14(2):61–72. Additional Declarations No competing interests reported. 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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-5937106","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443768708,"identity":"eae4ada3-4f68-4e43-8a09-1aeb6c12115a","order_by":0,"name":"Pilar Cubo 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16:14:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1605695,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5937106/v1/4dfc4d01-e06f-4e5f-bd97-a0ba3f76742d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssessing the Quality of Life in Patients with Complex Chronic conditions Cronimad Study\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePeople\u0026rsquo;s life expectancy has increased significantly in the past few decades. According to the World Health Organization (WHO), people lived 6 more years in 2019, compared to 2000 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Specifically in Spain, the average life expectancy ranks among the world\u0026rsquo;s highest, with 20.1% of the population above 65 years old that is expected to increase to 30.4% in 2050 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the one hand, there has been a clear improvement in living conditions and significant advances in medical care since the 19th century [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, associated with the progressive aging of the population, it is observed a marked increase in the prevalence of chronic diseases (e.g. diabetes, cancer, cardiovascular or chronic obstructive respiratory diseases). Indeed, chronic conditions are responsible for 60% of the total deaths worldwide, leading to a significant deterioration in patients' quality of life (QoL) and imposing a great challenge to physicians in providing cost-effective quality of care [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePresently, the most common scenario is the coexistence of multiple chronic pathologies (multimorbidity), rather than a single chronic disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Considering this, new concepts such as complex chronic patients (CCP), or polyphatologic patients (PPP) have been introduced. While a CCP characterizes a person with one or several long-term diseases of difficult management and related to cognitive or functional impairment [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], a PPP refers specifically to a CCP that suffers from chronic diseases included in two or more of 8 predefined categories [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCompared to other patient cohorts, CCP have a hospital prevalence range of 20\u0026ndash;45% and share a specific clinical profile of increased age, social frailty, higher vulnerability, poor health-related QoL, prevalence of neurological deficits, functional deterioration, and higher 1-year mortality rate [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Importantly, this emergent group of patients is responsible for 20\u0026ndash;40% of hospital admissions, 40% being admitted\u0026thinsp;\u0026ge;\u0026thinsp;3 times, and 13% \u0026ge;5 times a year [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], making them a priority group in healthcare management [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAttending to the significant change in the clinical profile of chronic patients, today\u0026rsquo;s chronic care requires a new reform. Strategies at global and local levels have been proposed since 2002 attempting to reduce the burden of chronic limitations [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and, more recently, to combat the increased rate of multimorbid patients in the healthcare system [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Nonetheless, a deeper knowledge and characterization of these patients is still scarce and, therefore, urgent.\u003c/p\u003e \u003cp\u003eOne of the key aspects in this patient group is the assessment of QoL. To this end, various measurement scales have been employed, including the questionnaire EuroQol 5D (EQ- 5D) a widely used, standardized instrument developed in Europe to assess generic QoL.\u003c/p\u003e \u003cp\u003eAgborsangaya et al. compared the measurement properties of the EQ-5D-3L and EQ-5D-5L in a general population sample, highlighting the advantages of the EQ-5D-5L and illustrating the negative impact of multimorbidity on QoL [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Similarly, N\u0026rsquo;Goran et al. analyzed QoL using the EQ-5D in a Swiss cohort of patients with multimorbidity, reporting significantly lower scores compared to the general population, particularly among individuals under 60 years old and women [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Van Wilder et al. also found reduced EQ-5D scores in patients with chronic diseases compared to the general population and developed a comprehensive international catalog of EQ-5D scores for various chronic diseases, providing a valuable reference for future comparisons [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study aims to assess the health-related QoL of CCP/PPP patients in the Community of Madrid using the EQ-5D-5L questionnaire. Additionally, it seeks to explore the relationship between QoL and key health indicators such as functional and cognitive status, nutritional condition, and hospital admissions.\u003c/p\u003e \u003cp\u003eThese findings are expected to contribute to the development of more comprehensive, multidimensional, and patient-centered healthcare management strategies.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eProspective multicenter descriptive study carried out in patients identified as PPP or as CCP that consecutively attended the CCP units of the Service of Internal Medicine of six hospitals in the Community of Madrid (Hospital Universitario Infanta Cristina, Hospital Universitario del Tajo, Hospital Universitario Infanta Leonor, Hospital Universitario de Fuenlabrada, Hospital Universitario Gregorio Mara\u0026ntilde;\u0026oacute;n, and Hospital Universitario Rey Juan Carlos). At the consultation, patients were asked to answer the questionnaire developed by the EuroQol Research Foundation, including the visual analog scale (EQ-VAS) and the questionnaire with 5 dimensions and 5 levels (EQ-5D-5L). At the same appointment, all the patient\u0026rsquo;s sociodemographic data and multidimensional global assessment were collected. The inclusion period was from January 2021 to February 2022. Mortality was analyzed at one year of inclusion by reviewing electronic medical records or telephone calls. The only exclusion criteria were unwillingness to sign the informed consent form.\u003c/p\u003e \u003cp\u003eThe study was performed per the Belmont report \u003cem\u003e\u0026ldquo;Ethical Principles and Guidelines for the Protection of Human Subjects of Research\u0026rdquo;\u003c/em\u003e and the up-to-date declaration of Helsinki. All participants received information, accepted, and signed informed consent forms. Data collection was anonymous and used exclusively for the present study. Data confidentiality was maintained under Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on Data Protection (GDPR) and the Spanish Organic Law 3/2018, of December 5, on the Protection of Personal Data and Guarantee of Digital Rights. The study was approved by the Clinical Research Ethics Committee of the Instituto de Investigaci\u0026oacute;n Puerta de Hierro-Segovia de Arana, Madrid.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEndpoints and variables\u003c/h3\u003e\n\u003cp\u003eThe primary endpoint of this study was to determine the QoL of PPP or CCP attending Internal Medicine consultations. The secondary endpoint included examining the potential functional, psychological, and social factors affecting the QoL of these patients.\u003c/p\u003e \u003cp\u003eTo measure the QoL, the EQ-VAS and the EQ-5D-5L scales were used. For the EQ-VAS, the patient was asked to identify his QoL by choosing a number (from 0 to 100) out of a thermometer-like millimeter scale of 20 cm, with 0 being the worst possible QoL and 100 the best [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The EQ-5D-5L, on the other hand, consisted of a questionnaire with 5 dimensions (EQ-5D; mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each of these dimensions had 5 possible responses or severity levels (EQ-5D-5L; 1, no problems; 2, mild problems; 3, moderate problems; 4, severe problems; 5, very severe problems Each respondent indicated the level that best reflected his status for each of the 5 dimensions so that their state of health would be described by five digits taking values from 1 to 5 (11111, indicating no problems in all dimensions, to 55555 indicating very severe problems in all dimensions) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The EQ-5D Index was then calculated by adjusting the perfect score of 1 (representing the highest QoL) based on negative coefficients derived from responses that differ from 1. The coefficients used are specific to the Spanish population and were calculated in a previous study [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The result is an Index that represents preferences for each of the 3,125 (5\u003csup\u003e5\u003c/sup\u003e) possible health states resulting from the combinations of severity levels across the five dimensions, ranging from a maximum of 1 (indicating the best possible QoL, corresponding to 11111) to a minimum of -0.416 (representing the worst possible QoL, corresponding to 55555) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrom the EQ-5D Index, the Severity Index was obtained by summing the severity levels across five dimensions (e.g., 11111\u0026thinsp;=\u0026thinsp;5, 55555\u0026thinsp;=\u0026thinsp;25), subtracting 5, and then multiplying by 5 to create a range from 0 to 100, where 0 means the best QoL and 100 represents the worst QoL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Finally, the Health Index was additionally obtained by subtracting the Severity Index from 100, with 0 being the total absence of QoL, and 100 representing the better perceived QoL [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA set of variables that may be associated to health related perceived QoL have been explored. Some may be causes of poor QoL perception, such as age, sex, functional deficits, frailty, cognitive impairments, malnutrition or pain. In this sense, to evaluate functional status, the simplified Barthel Index was used, grouping patients into those with severe dependence (Barthel less than 60), moderate dependence (Barthel 60\u0026ndash;90), and independent (Barthel greater than 90) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The FRAIL index was used to screen frailty, which evaluates fatigue, resistance, ambulation, presence of chronic diseases and weight loss, with a cut-off point for suspected frailty of \u0026ge;\u0026thinsp;1 points [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The Global Deterioration Scale (GDS) of Reisberg was used for the diagnosis of dementia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For those patients without dementia (GDS score lower than 4), the simplified Pfeiffer test was used as a screening for cognitive impairment [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNutritional status was also assessed using the Mini-Nutritional Assessment-Short form (MNA-SF) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. A total score of MNA-SF\u0026thinsp;\u0026lt;\u0026thinsp;8 indicates malnutrition, 8\u0026ndash;11 risk of malnutrition, and \u0026gt;\u0026thinsp;11 no malnutrition.\u003c/p\u003e \u003cp\u003eChronic pain was inquired, through clinical history or positive responses on the EQ-5D-5L scale.\u003c/p\u003e \u003cp\u003eAdditionally, patients were also asked about falls that occurred in the previous year using the questions proposed by the Ministry of Health in the \"Consensus document on prevention of frailty and falls in the elderly\" [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Also, polypharmacy (taking more than 10 drugs daily) was assessed. These factors could either be causes or consequences of poor health perception.\u003c/p\u003e \u003cp\u003eFinally, we evaluated social determinants associated with poor prognosis, such as educational level, categorizing patients into those with no formal education, primary or secondary education, and university education. Additionally, we analyzed whether living alone or having a non-spousal caregiver was associated with a lower QoL\u003c/p\u003e \u003cp\u003eEach of these variables was divided into several categories, and patients or their companions were asked directly to specify which one they belonged to.\u003c/p\u003e \u003cp\u003eThe number of hospital admissions and emergency room visits in the year prior to study inclusion in the study were reviewed to assess whether this could have an impact on QoL.\u003c/p\u003e \u003cp\u003eThe PROFUND index was used to estimate patient prognosis and to explore the relationship between life expectancy and QoL, independently of clinical outcomes. This validated tool predicts the one-year mortality risk in CPP/PPP, classifying them into four risk levels: low (0\u0026ndash;2 points), medium (3\u0026ndash;6 points), high (7\u0026ndash;10 points), and very high (11\u0026ndash;30 points) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Furthermore, one-year mortality was analyzed to determine whether baseline QoL could serve as a predictor of mortality risk, providing potential insights into its prognostic value in this patient population.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eA descriptive study was performed. Categorical variables were expressed as percentages while quantitative variables were expressed as median and interquartile range, except for the MNA-SF Index and the number of drugs, which had normal distribution and were expressed as mean and standard deviation (SD).\u003c/p\u003e \u003cp\u003eTo analyze possible factors influencing the QoL of these patients, the EQ-5D-5L and EQ-VAS indexes were correlated with 19 variables. The absence of normal distribution of both indexes was confirmed via the Shapiro test. Also, absence of linearity was detected in most of the comparisons. Some transformations of those variables where checked, but all of them failed to correct the violation of the assumptions of normality and linearity. So, Spearman's correlation Index and statistical significance between the EQ-5D-5L Index and quantitative, binary, and ordinal variables were estimated instead of regression coefficients and their confidence intervals. Nominal variables were not analyzed. The Heath Index showed a very good correlation with the weighted EQ-5D-5L Index (ρ 0.97, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and similar results were found on its association with the rest of the variables (data not shown). Only the correlations of patients\u0026rsquo; socio-demographic/health conditioning variables with the EQ-5D-5L and EQ-VAS indexes are shown in the present manuscript.\u003c/p\u003e \u003cp\u003eCorrelations with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were considered statistically significant. Since the analysis was exploratory, significance was adjusted by Bonferroni correction, according to the following formula: p' = min (1; kp), where p' is the corrected significance, k is the number of correlations explored (19 for each index), and p is the significance of the individual test [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Statistical analysis was performed with the Stata software package version 18 (StataCorp. 2023. Stata Statistical Software: Release 18. College Station, TX: StataCorp LLC).\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eBetween January 2021 and January 2022, data were collected from 128 patients across six public hospitals in the Autonomous Community of Madrid, of whom 56% were women, with a median age of 83.3 years old [77.3\u0026ndash;89.0]. All demographic data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\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\u003eAssociation of the EQ5D5L Index and the EQ-VAS Index with the different variables.\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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\" colname=\"c2\"\u003e \u003cp\u003eNo. (%)/Median [Q1-Q3]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEQ-5D-5L Index: Median [Q1-Q3]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSpearman coefficient (ρ); P value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEQ-VAS Index: Median [Q1-Q3]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSpearman coefficient (ρ); P value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years) (N\u0026thinsp;=\u0026thinsp;126)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e83.3 [77.3\u0026ndash;88.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.12; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [45.0\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.05; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWomen (N\u0026thinsp;=\u0026thinsp;126)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.23; 0.1734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.18; 0.9943\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (43.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.74 [0.47\u0026ndash;0.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59 [0.28\u0026ndash;0.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [40.00\u0026ndash;75.00]\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\u003e\u003cb\u003eDeath in the following year (N\u0026thinsp;=\u0026thinsp;128)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.02; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.07; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119 (93.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64 [0.42\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [40.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (7.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.62 [0.28\u0026ndash;0.81]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67.50 [50.00\u0026ndash;77.50]\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\u003e\u003cb\u003eLevel of education (N\u0026thinsp;=\u0026thinsp;125)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.08; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo studies\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55 (44.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.56 [0.30\u0026ndash;0.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [45.00\u0026ndash;75.00]\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\u003e\u003cb\u003ePrimary education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70 [0.47\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [35.00\u0026ndash;70.00]\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\u003e\u003cb\u003eSecondary education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (6.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.58 [0.36\u0026ndash;0.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.00 [75.00\u0026ndash;80.00]\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\u003e\u003cb\u003eUniversity degree\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (3.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86 [0.65\u0026ndash;0.96]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77.50 [75.00\u0026ndash;80.00]\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\u003e\u003cb\u003eCaregiver (N\u0026thinsp;=\u0026thinsp;121)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.17; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.19; 0.7456\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo caregiver or non-spouse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60 [0.35\u0026ndash;0.78]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [40.00\u0026ndash;70.00]\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\u003e\u003cb\u003eCaregiver spouse\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (27.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.71 [0.48\u0026ndash;0.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72.50 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eLives alone (N\u0026thinsp;=\u0026thinsp;123)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.00; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.15; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (82.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.61 [0.42\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [45.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.70 [0.43\u0026ndash;0.77]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [30.00\u0026ndash;60.00]\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\u003e\u003cb\u003eNumber of hospital admissions in the previous year (N\u0026thinsp;=\u0026thinsp;128)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 [0.5-3.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.14; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [45.0\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.01; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of visits to the emergency department in the previous year (N\u0026thinsp;=\u0026thinsp;128)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 [0.0\u0026ndash;2.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.05; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [45.0\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFRAIL Index (N\u0026thinsp;=\u0026thinsp;114)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.0 [1.0\u0026ndash;3.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.50; 0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [50.0\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.30; 0.0199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMNA-SF Index (N\u0026thinsp;=\u0026thinsp;123)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0 [8.0\u0026ndash;13.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.36; 0.0009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [42.5\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.39; 0.0002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePROFUND Index (N\u0026thinsp;=\u0026thinsp;122)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 [3.0\u0026ndash;9.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.6 [0.4\u0026ndash;0.8]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.34; 0.0027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.0 [42.5\u0026ndash;80.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.16; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFalls in the last year (N\u0026thinsp;=\u0026thinsp;124)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.01; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.04; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (76.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64 [0.43\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [45.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (23.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64 [0.33\u0026ndash;0.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67.50 [40.00\u0026ndash;77.50]\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\u003e\u003cb\u003eMore than two falls per year (N\u0026thinsp;=\u0026thinsp;124)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.12; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64 [0.36\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60 [0.47\u0026ndash;0.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [10.00\u0026ndash;75.00]\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\u003e\u003cb\u003eGait disturbance (N\u0026thinsp;=\u0026thinsp;122)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.50; 0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.28; 0.0453\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79 [0.59\u0026ndash;0.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.48 [0.28\u0026ndash;0.69]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [30.00\u0026ndash;70.00]\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\u003e\u003cb\u003eCognitive impairment (GDS) (n\u0026thinsp;=\u0026thinsp;127)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.05; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.07; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbsent-mild\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (92.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.64 [0.36\u0026ndash;0.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [45.00\u0026ndash;80.00]\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\u003e\u003cb\u003eModerate-severe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.62 [0.54\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eSevere-very severe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (3.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53 [0.46\u0026ndash;0.54]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [40.00\u0026ndash;50.00]\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\u003e\u003cb\u003eSuspected dementia (GDS\u0026thinsp;\u0026lt;\u0026thinsp;4) (N\u0026thinsp;=\u0026thinsp;97)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.27; 0.1574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.21; 0.5772\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (83,6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.71 [0.46\u0026ndash;0.81]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e67.50 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (16.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.45 [0.18\u0026ndash;0.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.00 [30.00\u0026ndash;70.00]\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\u003e\u003cb\u003eBarthel Index (N\u0026thinsp;=\u0026thinsp;108)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47; 0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.13; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBarthel\u0026thinsp;\u0026lt;\u0026thinsp;60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.47 [0.26\u0026ndash;0.59]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [50.00\u0026ndash;75.00]\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\u003e\u003cb\u003eBarthel 60\u0026ndash;90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (48.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.59 [0.33\u0026ndash;0.77]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [30.00\u0026ndash;75.00]\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\u003e\u003cb\u003eBarthel\u0026thinsp;\u0026gt;\u0026thinsp;90\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79 [0.64\u0026ndash;0.88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003ePolypharmacy (\u0026gt;\u0026thinsp;10 drugs) (N\u0026thinsp;=\u0026thinsp;84)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04; 1.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.04; 1.0000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (23.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66 [0.46\u0026ndash;0.79]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [40.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (76.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69 [0.47\u0026ndash;0.80]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eModerate to extreme pain (N\u0026thinsp;=\u0026thinsp;128)\u003c/b\u003e\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=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.55; 0.0000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e-0.36; 0.0009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65 (50.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.79 [0.60\u0026ndash;0.85]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.00 [50.00\u0026ndash;80.00]\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\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (49.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.46 [0.21\u0026ndash;0.64]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00 [30.00\u0026ndash;70.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: MNA-SF, Mini-Nutritional Assessment-Short form; GDS, Global deterioration scale; EQ-VAS, EuroQol questionnaire-Visual analog scale; EQ-5D-5L, EuroQol questionnaire with 5 dimensions and 5 levels\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eData collected demonstrated that patients frequently used the hospital services, with a median of 1 hospitalizations [0.5\u0026ndash;3.0] and 1 emergency department visits [0.0\u0026ndash;2.0] per year. While 55% of patients were widowed, divorced, or single, only 17.1% lived alone. Concerning the presence of a caregiver, 72.7% either had no caregiver or indicated their caregiver was not a spouse.\u003c/p\u003e \u003cp\u003eLooking at the health-associating factors, the prevalence of moderate to very severe cognitive impairment within this population was low, at 7.9%. However, among those without a cognitive impairment diagnosis (GDS Index\u0026thinsp;\u0026lt;\u0026thinsp;4), 16.5% had a positive Peiffer screening test (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Moreover, severe dependence (Barthel\u0026thinsp;\u0026lt;\u0026thinsp;60) was present in 16.7% of patients, yet among those who were independent in daily activities, defined by a Barthel greater than 90 (35.2%), 75.8% had a FRAIL Index\u0026thinsp;\u0026ge;\u0026thinsp;1.\u003c/p\u003e \u003cp\u003eFalls were common, with 23.4% of patients reporting at least one fall in the previous year, 15.3% experiencing two or more (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), and 6.5% requiring medical assistance as a consequence of a fall. Additionally, malnutrition was a concern with an average MNA SF score of 10.34 (SD\u0026thinsp;=\u0026thinsp;2.56), 16.3% of patients malnourished (MNA SF score 0\u0026ndash;7) and 43.9% at risk of malnutrition (MNA SF score 8\u0026ndash;11).\u003c/p\u003e \u003cp\u003eRegarding drug prescription and administration, this analysis demonstrated that patients were taking an average of 12.6 (SD 3.81) drugs, with 76.7% being prescribed 10 or more medications (extreme polypharmacy). Despite this, the majority (92.7%) showed to have good treatment adherence. Importantly, 49.2% of patients experienced moderate to extreme pain.\u003c/p\u003e \u003cp\u003eConcerning the patient\u0026rsquo;s prognosis, the median PROFUND index was 6 [3.0\u0026ndash;9.0], corresponding to a 21.5% probability of death within one year, increasing to 21\u0026ndash;31% one-year post-hospital discharge in case of admission [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Finally, based on the assessment of patient information and medical records, it was concluded that the mortality one year after inclusion in the study was 7%, lower than the one estimated by the PROFUND index (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuality of life\u003c/h2\u003e \u003cp\u003eSelf-reported QoL was evaluated using the EQ-VAS and EQ-5D-5L questionnaires. Patients presented a median QoL score of 60.0 [45.0, 80.0] (mean 56.0, SD\u0026thinsp;=\u0026thinsp;25.2) on the EQ-VAS scale and 0.64 [0.40, 0.79] (mean 0.57, DS\u0026thinsp;=\u0026thinsp;0.29) on the EQ-5D-5L Index. According to the EQ-5D-5L questionnaire, patients reported moderate to severe problems with mobility, usual activities, pain or discomfort, self-care, and anxiety/depression in 58.1, 51.6, 49.2, 41.4, and 32.0% of cases, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFactors influencing the QoL of PPP and CCP\u003c/h3\u003e\n\u003cp\u003eAttempting to identify significant variables influencing the QoL in these patients, the EQ-5D-5L and the EQ-VAS indexes were correlated with 19 variables (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo significant association was found between aging and poorer QoL (ρ = -0.12; p\u0026thinsp;=\u0026thinsp;1.000 for EQ-5D-5L and ρ = -0.05; p\u0026thinsp;=\u0026thinsp;1.000 for EQ-VAS).\u003c/p\u003e \u003cp\u003eAlthough not reaching statistical significance, female sex showed a negative correlation with the EQ-5D-5L Index (ρ = -0.23), indicating a potential trend toward lower QoL among female patients.To further elaborate on this point, an analysis of a possible association between patient gender and different health variables was conducted. Indeed, it was observed that women in this study were less likely to have a spousal caregiver (OR 0.38, 95% CI 0.17\u0026ndash;0.86; p\u0026thinsp;=\u0026thinsp;0.021), more likely to have walking difficulties (OR 2.24, 95% CI 1.07\u0026ndash;4.68; p\u0026thinsp;=\u0026thinsp;0.032), or to have a higher risk of malnutrition (OR 2.78, 95% CI 1.32\u0026ndash;5.88; p\u0026thinsp;=\u0026thinsp;0.007).\u003c/p\u003e \u003cp\u003eIt was observed that the FRAIL Index showed a significant negative association with both the EQ-5D-5L (ρ -0.50; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the EQ-VAS indexes (ρ -0.30; p\u0026thinsp;=\u0026thinsp;0.020). Similarly, the presence of moderate to extreme pain also associated with worse QoL in both indexes (ρ -0.55; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001vs ρ -0.36; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 for EQ-5D-5L and EQ-VAS respectively), and the same was also observed for walking disturbances (ρ -0.50; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 vs ρ -0.28; p\u0026thinsp;=\u0026thinsp;0.045, for EQ-5D-5L and EQ-VAS respectively). The MNA-SF Index, on the other hand, resulted in a significant positive correlation with both the EQ-5D-5L Index (ρ 0.36; p\u0026thinsp;=\u0026thinsp;0.001) and the EQ-VAS Index (ρ 0.39; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Another positive correlation was found significant between the Barthel Index and the QoL measured by the EQ-5D-5L Index (ρ 0.47; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), revealing that a higher functional dependence and a higher level of malnutrition are linked to a poorer QoL in the surveyed patients.\u003c/p\u003e \u003cp\u003ePatients with a higher PROFUND Index, and therefore worse prognostic estimation, showed to be associated with poorer QoL (ρ -0.34; p\u0026thinsp;=\u0026thinsp;0.003), when evaluated using the EQ-5D-5L Index. Nevertheless, QoL was not shown to be a predictor of poor prognosis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study found that the QoL on CCP/PPP, as measured by the EQ-5D-5L, is lower than that reported by individuals of the same age in Spain. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. More than half of the patients experienced moderate or severe impairments in mobility and performance of daily activities.\u003c/p\u003e \u003cp\u003eGreater functional dependence, higher levels of malnutrition, and moderate or severe chronic pain could be associated with poorer QoL in this population. Additionally, among patients without functional dependence, those meeting frailty criteria also exhibited lower QoL.\u003c/p\u003e \u003cp\u003eThe prevalence of patients with multimorbidity in the hospital setting and primary care is high and is expected to increase even more in the upcoming years [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Particularly, CCP are already the majority of patients in certain health departments in Switzerland [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], Scotland [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Portugal [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and Spain [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These are patients characterized by a higher frailty, risk of malnutrition, and extreme polypharmacy, with a significant proportion of them suffering from moderate or severe pain. For this reason, considering their complexity, greater vulnerability, and weight on caregivers, families, and medical areas, healthcare models are now subjected to important reforms aiming to implement and offer more friendly and patient-centered daily care strategies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The better we know the state of health of these patients, the easier it will be to adjust their needs and implement/execute the aforementioned strategies.\u003c/p\u003e \u003cp\u003eWhen evaluating the QoL of our population aged 65 years and older, who constitute the majority of the sample, it is evident that the average QoL index values are consistently lower than the national average for a population of a similar age (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). However, an exception is observed in the EQ-VAS scores for individuals over 85 years old, where our population reports slightly higher values (58.31 vs. 54.55, respectively). The differences in QoL scores are even more pronounced when comparing our data with those published for the Community of Madrid, highlighting a significant disparity (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\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\u003e\u003cb\u003eEQ-VAS and EQ-5D-5L Outcomes Between the Study Population and the Spanish National Health Survey\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\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 \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\u003eStudy Population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNHS (Spain)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eNHS Community of Madrid\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEQ-VAS (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEQ-5D-5L(mean)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEQ-VAS (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eEQ-5D-5L (mean)*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEQ-VAS (mean)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eEQ-5D-5L(mean)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e65\u0026ndash;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e86.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e90.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e75\u0026ndash;84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e68.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+\u0026thinsp;85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\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 \u003cp\u003e64.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: EQ-VAS, EuroQol questionnaire-Visual analog scale; EQ-5D-5L, EuroQol questionnaire with 5 dimensions and 5 levels; NHS, National Health Survey 2011\u0026ndash;2012 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*Valor de EQ-5D-5L x 100\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFocusing on the responses to the EQ-5D-5L questionnaire, national data showed that most of the \u003cem\u003every severe\u003c/em\u003e problems described by the age-matched population were associated with the performance of their usual activities (8.8% of a total of 3,165 people\u0026thinsp;\u0026ge;\u0026thinsp;75 years old). The most common \u003cem\u003emoderate to very severe\u003c/em\u003e problems were associated with mobility (36.1% of a total of 3,165 people\u0026thinsp;\u0026ge;\u0026thinsp;75 years old), usual activities (29.4%), and pain/discomfort (35.1%). Interestingly, although these results align with our data, at a percentage level, one may acknowledge the higher percentages of \u003cem\u003every severe\u003c/em\u003e and \u003cem\u003emoderate to very severe\u003c/em\u003e problems in all three dimensions (mobility, 58.1%; usual activities, 51.6%; pain/discomfort, 49.2%) observed for our CCP/PPP group. Moderate to severe problems in self-care and anxiety/depression were also more reported in our series than in national data (41.4% and 32.0% versus 21.2% and 12.8%, respectively) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLooking at the socio-demographic characteristics, these results could be partly justified by the high presence of respondents with no education/only primary education (90.4%), without caregivers (72.7%), or by the presence of 56.3% female participants. In fact, studies carried out at national and global levels have not only shown that there is a relationship between the level of education and the health status in the elderly population but have also described a lower QoL associated with women vs. men [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. More interestingly, related to the presence/absence of caregivers, Molina-Mula \u003cem\u003eet al\u003c/em\u003e., revealed a significant association between the number of nurse home visits and the level of dependence on the CCP, leading to a worse perception of the QoL [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. On the other hand, judging by the average age of the respondents, the aging-associated processes could also justify the relatively low QoL value observed [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Nonetheless, our correlation analysis suggests that neither aging, the level of education, nor the presence of a caregiver interfered in the QoL of CCP/PPP, but rather a set of health conditioning factors.\u003c/p\u003e \u003cp\u003eRelevantly, it was seen that a worse QoL was associated with patients with gait disorder, poor nutrition, higher frailty and higher levels of pain. All these variables have long been associated with the QoL of either older people or chronic patients [\u003cspan additionalcitationids=\"CR33 CR34 CR35\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. However, there is a large gap in studies that corroborate its use for the characterization of QoL in CCP. Focusing on the EQ-5D-5L Index, our data further demonstrates that CCP/PPP have a poorer QoL when suffering functional dependence, which is in accordance with previous data showing a positive correlation between the Barthel Index and the EuroQoL-5D-5L scales in patients with multiple chronic conditions [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding frailty it is relevant to highlight that this is a previous stage before dependency. The FRAIL Index is considered the best predictor of adverse events such as falls, hospitalization, disability, and death, independently of other parameters (e.g., multimorbidity) but, more importantly, frailty can be reversible [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Indeed, multiple interventions have been shown to reduce frailty y, namely targeting physical exercise training, loneliness, and fall prevention [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Apart from frailty, strategies improving malnutrition [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], and ameliorating gait disturbance (e.g., multicomponent exercise) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] have also shown to benefit patients\u0026rsquo; QoL, opening a window of opportunity for CCP.\u003c/p\u003e \u003cp\u003eIn our study, QoL was not found to be a prognostic marker, as has been demonstrated in other studies, probably related to the low one-year mortality rate [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, it was observed that patients with CCP/PPP with a higher PROFUND score, and therefore a worse prognostic estimate, have a lower QoL. The PROFUND score is an accurate and reliable method for estimating the one-year risk of death in patients with PPP.\u003c/p\u003e \u003cp\u003eTherefore, these results could encourage the use of this tool to effectively stratify patients with PPP into groups with different risks of death, as well as to group them according to their QoL levels.\u003c/p\u003e \u003cp\u003eFinally, it is worth mentioning that a slight tendency for a worse QoL in women CCP was observed, as described in other studies [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Based on the above data, this could result from the significant association observed between women with both gait disturbance and nutritional problems. However, other factors associated with this gender difference have been described. For example, in a Spanish study of people aged 60 and over, the QoL was worse in women compared to men, suggesting that sociodemographic factors, such as lower educational levels, and lifestyle factors, such as a more sedentary lifestyle, may explain a substantial part of the differences in QoL [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWe acknowledge the several limitations of this study. The sample size is insufficient for multivariate analysis, so we consider the present findings valid only for hypothesis generation. Therefore, more studies are needed to corroborate these preliminary results.\u003c/p\u003e \u003cp\u003eAnother limitation of our study is that the general population data used for comparison with CCP were collected more than a decade ago, and it is known that the perception of QoL evolves over time, albeit slowly, and can be influenced by economic or health crises [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEven so, our data strongly imply that accurate access to QoL in these patients can only be done by a complex and complete assessment of all the variables, rather than using only the most validated ones. We, therefore, believe that conducting a multidimensional assessment of a vulnerable population, such as the PCC, is of great value for tailoring the healthcare system into a more patient-driven one with increased functionality and decreased unnecessary and spiraling visits to hospital settings, this way ameliorating patients\u0026rsquo; well-being and increasing the number of years CCP/PPP will spend with good QoL [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn conclusion, the study identifies that patients with CCP/PPP have a poorer quality of life than patients of the same age. This could be influenced by functional dependence potentially but reversible factors such as frailty, malnutrition, and pain.\u003c/p\u003e \u003cp\u003eAll of this highlights the need for a comprehensive assessment that allows for early diagnosis of these conditions and the implementation of multidimensional interventions to prevent functional dependence and activities of daily living.\u003c/p\u003e \u003cp\u003eWe hope this study results will help improve chronic disease management and identify those most in need of healthcare support.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"2\"\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 \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCCP\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eChronic-complex patients\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEQ-5D-5L\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eEuroQol questionnaire with 5 dimensions and 5 levels\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eMNA-SF\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eMini-Nutritional Assessment-Short form\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eQoL\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eQuality of Life\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSD\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eStandard deviation\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eWHO\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eWorld Health Organization\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEQ\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eEuroQol questionnaire\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGDS\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eGlobal Deterioration Scale\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNHS\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNational Health Survey\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePPP\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003ePolypathological patients\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eVAS\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eVisual analog scale\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was performed per the Belmont report \u003cem\u003e\u0026ldquo;Ethical Principles and Guidelines for the Protection of Human Subjects of Research\u0026rdquo;\u0026nbsp;\u003c/em\u003eand the up-to-date declaration of Helsinki. All participants received information, accepted, and signed informed consent forms. \u0026nbsp;The study was approved by the Clinical Research Ethics Committee of the Instituto de Investigaci\u0026oacute;n Puerta de Hierro-Segovia de Arana, Madrid.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by a grant from Menarini Laboratories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have contributed equally to the conceptualization, writing, and revision of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to express their sincere gratitude to the members of the CRONIMAD group for their valuable contributions to this work. Special thanks are extended to Dr. Pilar Arcos Pereda from Hospital del Tajo, Dr. Manuel M\u0026eacute;ndez Bail\u0026oacute;n from Hospital Universitario Cl\u0026iacute;nico San Carlos, Dr. Sonia Gonzalo Pascua from Hospital Universitario de Fuenlabrada, Dr. Desiree V\u0026eacute;lez from Hospital Universitario del Sureste, Dr. Luis Cabeza Osorio from Hospital Universitario del Henares, and Dr. Ester Moreno Hern\u0026aacute;ndez from Hospital Universitario Puerta de Hierro. Their expertise and dedication have been pivotal in the development and completion of this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eVallejo Maroto I, Cubo Romano P, Maf\u0026eacute; Nogueroles MC, Matesanz-Fern\u0026aacute;ndez M, P\u0026eacute;rez-Belmonte LM, Said Criado I, et al. Recommendations on the comprehensive, multidimensional assessment of hospitalized elderly people. Position of the Spanish Society of Internal Medicine. Revista Cl\u0026iacute;nica Espa\u0026ntilde;ola (English Edition). 2021 Jun;221(6):347\u0026ndash;58.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. GHE: Life expectancy and healthy life expectancy [Internet]. Available from: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/\u003cbr\u003eghe-life-expectancy-and-healthy-life-expectancy\u003c/li\u003e\n \u003cli\u003eInstituto Nacional de Estad\u0026iacute;stica. Proyecciones de Poblaci\u0026oacute;n 2022-2072 [Internet]. Available from: https://www.ine.es/prensa/pp_2022_2072.pdf.\u003c/li\u003e\n \u003cli\u003eBraveman P, Gottlieb L. The Social Determinants of Health: It\u0026rsquo;s Time to Consider the Causes of the Causes. Public Health Rep. 2014 Jan;129(1_suppl2):19\u0026ndash;31.\u003c/li\u003e\n \u003cli\u003eEuropean Union. EU Reflection on Chronic Disease [Internet]. Available from: https://health.ec.europa.eu/document/download/4fdb23ef-d0b4-4078-b09b-a84e9c3d48df_en\u003c/li\u003e\n \u003cli\u003ePrazeres F, Santiago L. Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study. BMJ Open. 2015 Sep;5(9):e009287.\u003c/li\u003e\n \u003cli\u003eBernabeu-Wittel M, Ollero-Baturone M, Moreno-Gavi\u0026ntilde;o L, Bar\u0026oacute;n-Franco B, Fuertes A, Murcia-Zaragoza J, et al. Development of a new predictive model for polypathological patients. The PROFUND index. European Journal of Internal Medicine. 2011 Jun;22(3):311\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eWittel M B, Romero L G, Zaragoza J M, Mancera R G, Santos R A, Manglano J D, et al. Characterization of Patients with Chronic Diseases and Complex Care Needs: A New High-Risk Emergent Population. J Biomed Res Environ Sci. 2022 Nov;3(12):1321\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003eMolina-Mula J, Migu\u0026eacute;lez-Chamorro A, Taltavull-Aparicio JM, Miralles-Xamena J, Ortego-Mate MDC. Quality of Life and Dependence Degree of Chronic Patients in a Chronicity Care Model. Healthcare. 2020 Aug 24;8(3):293.\u003c/li\u003e\n \u003cli\u003eMinisterio de Sanidad. Strategy for Addressing Chronicity in the National Health System [Internet]. Available from: https://www.sanidad.gob.es/areas/calidadAsistencial/estrategias/abordajeCronicidad/docs/\u003cbr\u003eResumen_Ejecutivo_Estrategia_Abordaje_Cronicidad_ENGLISH_02.pdf\u003c/li\u003e\n \u003cli\u003eRijken M, St\u0026uuml;ssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expectations. 2021 Aug;24(4):1300\u0026ndash;11.\u003c/li\u003e\n \u003cli\u003eComunidad de Madrid. Estrategia de atenci\u0026oacute;n a las personas con enfermedades cr\u0026oacute;nicas de la Comunidad de Madrid [Internet]. Available from: https://www.comunidad.madrid/transparencia/sites/default/files/plan/document/432_474_\u003cbr\u003elibro_estratpac_enfcroniccommadrid_ip_0.pdf\u003c/li\u003e\n \u003cli\u003eAgborsangaya CB, Lahtinen M, Cooke T, Johnson JA. Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes. 2014 May 16;12:74.\u003c/li\u003e\n \u003cli\u003eN\u0026rsquo;Goran AA, D\u0026eacute;ruaz-Luyet A, Haller DM, Zeller A, Rosemann T, Streit S, et al. Comparing the self-perceived quality of life of multimorbid patients and the general population using the EQ-5D-3L. PLoS One. 2017;12(12):e0188499.\u003c/li\u003e\n \u003cli\u003eVan Wilder L, Rammant E, Clays E, Devleesschauwer B, Pauwels N, De Smedt D. A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review. Qual Life Res. 2019 Dec;28(12):3153\u0026ndash;61.\u003c/li\u003e\n \u003cli\u003eRabin R, Charro FD. EQ-SD: a measure of health status from the EuroQol Group. Annals of Medicine. 2001 Jan;33(5):337\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eMinisterio de Sanidad. Encuesta nacional de salud Espa\u0026ntilde;a 2011/12.\u003c/li\u003e\n \u003cli\u003eRamos-Go\u0026ntilde;i JM, Craig BM, Oppe M, Ramallo-Fari\u0026ntilde;a Y, Pinto-Prades JL, Luo N, et al. Handling Data Quality Issues to Estimate the Spanish EQ-5D-5L Value Set Using a Hybrid Interval Regression Approach. Value in Health. 2018 May;21(5):596\u0026ndash;604.\u003c/li\u003e\n \u003cli\u003eBernabeu-Wittel M, D\u0026iacute;ez-Manglano J, Nieto-Mart\u0026iacute;n D, Ram\u0026iacute;rez-Duque N, Ollero-Baturone M, Abella-V\u0026aacute;zquez L, et al. Simplificaci\u0026oacute;n de la escala de Barthel para el cribado de fragilidad y dependencia severa en pacientes pluripatol\u0026oacute;gicos. Revista Cl\u0026iacute;nica Espa\u0026ntilde;ola. 2019 Nov;219(8):433\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eMinisterio de Sanidad. Actualizaci\u0026oacute;n del documento de consenso sobre prevenci\u0026oacute;n de la fragilidad en la persona mayor (2022) [Internet]. Available from: https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSaludable/fragilidadCaidas/docs/\u003cbr\u003eActualizacionDoc_FragilidadyCaidas_personamayor.pdf\u003c/li\u003e\n \u003cli\u003eReisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. AJP. 1982 Sep 1;139(9):1136\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eBernabeu-Wittel M, Nieto Mart\u0026iacute;n D, Moreno-Gavi\u0026ntilde;o L, Ollero-Baturone M. Valor diagn\u0026oacute;stico de un cuestionario de Pfeiffer simplificado en pacientes pluripatol\u0026oacute;gicos. Revista Cl\u0026iacute;nica Espa\u0026ntilde;ola. 2017 Aug;217(6):320\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eSysal P, Veronese N, Arik F, Kalan U, Smith L, Isik AT. Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults. CIA. 2019 Apr;Volume 14:693\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eDocumento de consenso sobre prevenci\u0026oacute;n de fragilidad y ca\u0026iacute;das en la persona mayor. Estrategia de promoci\u0026oacute;n de la salud y prevenci\u0026oacute;n en el SNS (2024) [Internet]. Available from: https://www.sanidad.gob.es/areas/promocionPrevencion/envejecimientoSaludable/\u003cbr\u003efragilidadCaidas/estrategiaSNS/docs/FragilidadyCaidas_personamayor.pdf\u003c/li\u003e\n \u003cli\u003eStata. Spearman\u0026rsquo;s and Kendall\u0026rsquo;s correlations [Internet]. Available from: https://www.stata.com/manuals/rspearman.pdf\u003c/li\u003e\n \u003cli\u003eArmstrong RA. When to use the B onferroni correction. Ophthalmic Physiologic Optic. 2014 Sep;34(5):502\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eMart\u0026iacute;n-Escalante MD, Quir\u0026oacute;s-L\u0026oacute;pez R, Martos-P\u0026eacute;rez F, Olalla-Sierra J, Rivas-Ruiz F, Aguilar-Garc\u0026iacute;a JA, et al. Validation of the PROFUND index to predict early post-hospital discharge mortality. QJM: An International Journal of Medicine. 2019 Nov 1;112(11):854\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eExcoffier S, Herzig L, N\u0026rsquo;Goran AA, D\u0026eacute;ruaz-Luyet A, Haller DM. Prevalence of multimorbidity in general practice: a cross-sectional study within the Swiss Sentinel Surveillance System (Sentinella). BMJ Open. 2018 Mar;8(3):e019616.\u003c/li\u003e\n \u003cli\u003eBarnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012 Jul;380(9836):37\u0026ndash;43.\u003c/li\u003e\n \u003cli\u003eMedhi G, Sarma J, Bhattacharyya H, Pala S, Visi V, Bora P. Sociodemographic variations in health-related quality of life (HRQOL) among elderly individuals in an urban locality in India. J Family Med Prim Care. 2019;8(7):2473.\u003c/li\u003e\n \u003cli\u003eLee KH, Xu H, Wu B. Gender differences in quality of life among community-dwelling older adults in low- and middle-income countries: results from the Study on global AGEing and adult health (SAGE). BMC Public Health. 2020 Dec;20(1):114.\u003c/li\u003e\n \u003cli\u003eMhesin D, Nazzal H, Amerah J, Azamtta M, Ismail Y, Daralammouri Y, et al. Prevalence of pain and its association with quality of life of patients with heart failure in a developing country: findings from a multicenter cross-sectional study. BMC Cardiovasc Disord. 2022 Sep 28;22(1):426.\u003c/li\u003e\n \u003cli\u003eJ\u0026oslash;rstad EC, Hauer K, Becker C, Lamb SE, on behalf of the ProFaNE Group. Measuring the Psychological Outcomes of Falling: A Systematic Review. J American Geriatrics Society. 2005 Mar;53(3):501\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eHerman T, Giladi N, Gruendlinger L, Hausdorff JM. Six Weeks of Intensive Treadmill Training Improves Gait and Quality of Life in Patients With Parkinson\u0026rsquo;s Disease: A Pilot Study. Archives of Physical Medicine and Rehabilitation. 2007 Sep;88(9):1154\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eRasheed S, Woods RT. Malnutrition and quality of life in older people: A systematic review and meta-analysis. Ageing Research Reviews. 2013 Mar;12(2):561\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eChang YW, Chen WL, Lin FG, Fang WH, Yen MY, Hsieh CC, et al. Frailty and Its Impact on Health-Related Quality of Life: A Cross-Sectional Study on Elder Community-Dwelling Preventive Health Service Users. Vina J, editor. PLoS ONE. 2012 May 25;7(5):e38079.\u003c/li\u003e\n \u003cli\u003eAbizanda P, Romero L, Sanchez-Jurado PM, Martinez-Reig M, Alfonso-Silguero SA, Rodriguez-Manas L. Age, frailty, disability, institutionalization, multimorbidity or comorbidity. which are the main targets in older adults? The Journal of nutrition, health and aging. 2014 Jun;18(6):622\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eOžić S, Vasiljev V, Ivković V, Bilajac L, Rukavina T. Interventions aimed at loneliness and fall prevention reduce frailty in elderly urban population. Medicine. 2020 Feb;99(8):e19145.\u003c/li\u003e\n \u003cli\u003eGwyther H, Bobrowicz-Campos E, Luis Alves Ap\u0026oacute;stolo J, Marcucci M, Cano A, Holland C. A realist review to understand the efficacy and outcomes of interventions designed to minimise, reverse or prevent the progression of frailty. Health Psychology Review. 2018 Oct 2;12(4):382\u0026ndash;404.\u003c/li\u003e\n \u003cli\u003eBharaniidharan J, Reshmi SK. Review on Malnutrition: Impact and Prevention. IJARI. 2019;7(3):49\u0026ndash;55.\u003c/li\u003e\n \u003cli\u003eVivanti A. Improving the quality of life of aged care residents through the joy of food. Australas J Ageing. 2018 Dec;37(4):252\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eGobbens RJJ, van der Ploeg T. The prediction of mortality by quality of life assessed with the WHOQOL-BREF: a longitudinal analysis at the domain and item levels using a seven-year follow-up period. Qual Life Res. 2021 Jul;30(7):1951\u0026ndash;62.\u003c/li\u003e\n \u003cli\u003eOtero-Rodr\u0026iacute;guez A, Le\u0026oacute;n-Mu\u0026ntilde;oz LM, Balboa-Castillo T, Banegas JR, Rodr\u0026iacute;guez-Artalejo F, Guallar-Castill\u0026oacute;n P. Change in health-related quality of life as a predictor of mortality in the older adults. Qual Life Res. 2010 Feb;19(1):15\u0026ndash;23.\u003c/li\u003e\n \u003cli\u003eGuallar-Castill\u0026oacute;n P, Sendino AR, Banegas JR, L\u0026oacute;pez-Garc\u0026iacute;a E, Rodr\u0026iacute;guez-Artalejo F. Differences in quality of life between women and men in the older population of Spain. Soc Sci Med. 2005 Mar;60(6):1229\u0026ndash;40.\u003c/li\u003e\n \u003cli\u003eFernandez A, Garcia-Alonso J, Royo-Pastor C, Garrell-Corbera I, Rengel-Chica J, Agudo-Ugena J, et al. Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain. Br J Gen Pract. 2015 Mar;65(632):e198-203.\u003c/li\u003e\n \u003cli\u003eDavalos ME, French MT. This recession is wearing me out! Health-related quality of life and economic downturns. J Ment Health Policy Econ. 2011 Jun;14(2):61\u0026ndash;72.\u003c/li\u003e\n\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":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Multimorbidity, Chronic complex patients, polypathological patients, Quality of life, EQ-5D-5L Index, healthcare management","lastPublishedDoi":"10.21203/rs.3.rs-5937106/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5937106/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e People’s life expectancy has increased significantly in the past few decades, which has been associated with an increased prevalence of chronic diseases. Chronic-complex patients (CCP), including those characterized as polypathological patients (PPP), are now the majority among chronic patients and are considered a priority group in healthcare settings. This study aimed to determine the health-related quality of life (QoL) of Spanish CCP and its association with sociodemographic, clinical and functional variables and cognitive status.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Patients identified as CCP or PPP from six hospitals in the Community of Madrid were included. The primary endpoint was to determine the QoL of CCP/PPP. To do so, patients were asked to complete the EuroQol questionnaire that included the visual analog scale (EQ-VAS), and the questionnaire with 5 dimensions and 5 levels (EQ-5D-5L). Several socio-demographic/health-related variables were further evaluated and correlated with QoL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 128 CCP/PPP were included. A median EQ-VAS score of 60.0 [45.0, 80.0, and 0.64 [0.40, 0.79] on the EQ-5D-5L Index were observed. \u0026nbsp;The FRAIL Index showed a significant negative correlation with both the EQ-5D-5L (ρ = -0.50; p \u0026lt; 0.001) and EQ-VAS (ρ = -0.30; p = 0.020). Similarly, moderate to extreme pain was associated with lower QoL in both indexes (ρ = -0.55; p \u0026lt; 0.001 for EQ-5D-5L; ρ = -0.36; p \u0026lt; 0.001 for EQ-VAS), as were walking disturbances (ρ = -0.50; p \u0026lt; 0.001 for EQ-5D-5L; ρ = -0.28; p = 0.045 for EQ-VAS). Conversely, the MNA-SF Index showed a significant positive correlation with both the EQ-5D-5L (ρ = 0.36; p = 0.001) and EQ-VAS (ρ = 0.39; p \u0026lt; 0.001). Additionally, the Barthel Index was positively associated with QoL as measured by EQ-5D-5L (ρ = 0.47; p \u0026lt; 0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study suggests that CCP/PPP experience a significantly lower QoL compared to those of the same age. This decline may be influenced by factors such as functional dependence and potentially reversible conditions, including frailty, malnutrition, and pain.\u003c/p\u003e\n\u003cp\u003eAll of this highlights the need for a comprehensive assessment that allows for early diagnosis of these conditions and the implementation of multidimensional interventions to prevent functional dependence and activities of daily living.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTrial registration: \u003c/strong\u003eNot applicable\u003c/p\u003e","manuscriptTitle":"Assessing the Quality of Life in Patients with Complex Chronic conditions Cronimad Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 06:33:35","doi":"10.21203/rs.3.rs-5937106/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-05T09:22:46+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-27T19:36:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60647503250649853122708045218765121617","date":"2025-04-18T08:46:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-16T10:18:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214145864302395925895196152775199982570","date":"2025-04-16T06:31:09+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-16T01:18:48+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-08T12:14:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-04-04T08:08:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bb4197d1-1c26-4ad4-aec1-486ab6bab21b","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:09:00+00:00","versionOfRecord":{"articleIdentity":"rs-5937106","link":"https://doi.org/10.1186/s12877-025-06359-w","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2025-12-08 15:59:05","publishedOnDateReadable":"December 8th, 2025"},"versionCreatedAt":"2025-04-21 06:33:35","video":"","vorDoi":"10.1186/s12877-025-06359-w","vorDoiUrl":"https://doi.org/10.1186/s12877-025-06359-w","workflowStages":[]},"version":"v1","identity":"rs-5937106","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5937106","identity":"rs-5937106","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}