Our study found that the mean EQ-5D index score among bedridden older adult patients was 0.853, much lower than that of the general population in China 24. With high morbidity and mortality rates owing to the aging of the population, people have become more concerned about their quality of life 25. A systematic review reported that the EQ-5D index in China for diabetes mellitus ranged from 0.79 to 0.94, hypertension from 0.78 to 0.93, coronary heart disease from 0.75 to 0.90, chronic obstructive pulmonary disease from 0.64 to 0.80, which was consistent with our study.
The current analysis revealed that a high proportion of patients tended to have problems with usual activities (31.4%), mobility (27.8%), and self-care (26.9%). This may be partly because the patients were older than 60 years and had bedridden experiences. As a result, they were more likely to have activity problems and impaired ability to meet their daily needs.
Although the patients reported fewer problems with anxiety/depression (11.9%) and pain/discomfort (19.8%), it also suggests to a certain extent that bedridden older adult patients may experience pain and psychological and physiological problems. Accumulating evidence suggests this conclusion. For example, a systematic review showed that older patients with pressure ulcers commonly reported negative emotions, such as frustration, anxiety, and depression 26.
Our results suggest that age is an important factor influencing the quality of life in bedridden patients, and older patients tend to have lower EQ-5D index values. According to a previous study, the values of the EQ-5D index in people aged 65 and over (0.84) were lower than those in people aged < 65 years (0.92) 27, which was the same as that in our study. Older patients are more likely to have underlying diseases, contributing to more medical complications and a lower quality of life 1. Overall, as the world population ages, more attention should be paid to older adults.
In most studies that reported sex-related EQ-5D index values, men had a better HRQoL than women 25. Our study showed that the EQ-5D index value of men was higher than that of women, but the difference was not statistically significant. This may be because our study focused on bedridden patients, and all patients were over 60 years of age.
One previous study found that HRQoL was significantly and negatively affected by the number of chronic conditions and the type of condition, particularly physical disability15. Another study found that patients with systemic sclerosis and reduced wrist and hand mobility had lower mental HRQoL 28. Our study confirmed that the quality of life in bedridden older adult patients was negatively correlated with the total bedridden time. Our patients may have had more severe physical dysfunction with longer bed stays. Physical functional impairments may impact patients’ psychological status, and psychological instability may lead to physical discomfort, potentially leading to a lower EQ-5D index value 29.
Nutritional status is also an associated factor for HRQoL, and we found that patients with a normal BMI had a higher EQ-5D index value than those who were underweight (BMI ≤ 18.4) or overweight (24–27.9). These results are consistent with those of previous studies 30. In addition, BMI is positively correlated with mobility; being underweight or overweight may cause poor exercise tolerance and slowness.
Patients with consciousness disorders had lower EQ-5D index values. This result is in line with that observed in the general population. The results of our study also showed the adverse effects of immobility-related complications in bedridden patients. Patients with any one type of complication had more problems in every dimension of the EQ-5D and had lower EQ-5D index values than those without complications. We found that the patients with pressure ulcers had lower EQ-5D index values. A systematic review showed that pain was the most significant consequence of a pressure ulcer and affected every aspect of the patients’ lives. Physical restrictions contribute to further problems associated with immobility 31. In addition, patients with pressure ulcers commonly report negative emotions, such as frustration, anxiety, and depression. Hence, pressure ulcers can seriously affect the quality of life of bedridden patients.
Bedridden patients exhibit several factors associated with the development of pneumonia, including limitations in activities of daily living, older age, and the presence of pre-existing lung and heart disease 32. Pulmonary infection was the most prevalent complication in this study population and was associated with a lower HRQOL in all five dimensions of the EQ-5D. Mangen et al. found that HRQOL was lower in patients with community-acquired pneumonia than those without it 33, which is similar to our results. One study reported that pneumonia has a poorly characterized long-term impact on HRQoL 34. Our data supplemented previous studies by demonstrating a significant link between pneumonia and HRQOL after a 3-month period.
In contrast, the urinary tract infection group showed significant associations with the EQ-5D. These results agree with those of previous investigations of urinary tract infections 35. Urinary tract infection caused by frequent urination, urgency, and pain seriously affects the quality of life of bedridden older adult patients.
However, we observed no significant association between deep venous thrombosis and decreased HRQOL in multiple linear regression analysis. Immobility during hospitalization has previously been found to increase the risk of venous thrombosis 36. Pain and body movement restrictions caused by deep venous thrombosis can reduce the quality of life. Utne et al. found that patients with deep venous thrombosis scored significantly lower on all dimensions of the EQ-5D than the control group 37. Our study also observed that patients with deep venous thrombosis had lower EQ-5D scores than those without deep venous thrombosis, but the difference was not statistically significant. This may be related to 66% of patients being bedridden for less than 7 days, and deep venous thrombosis is mostly a recessive symptom. In addition, most patients with venous thrombosis recovered after active treatment before discharge; thus, it had no impact on their quality of life. Therefore, further studies are needed to explore the effect of deep venous thrombosis on HRQOL among bedridden older adult patients.
This present study had some strengths and limitations. First, our study examined factors influencing the quality of life of bedridden older adult patients, which have not been explored for these special participants before. Second, the major strengths of this study are its multicenter design and large sample size. Therefore, it can be representative of a broader population. However, this study had several limitations. First, quality of life may be affected by other socioeconomic factors such as residency, marital status, employment, and income. Other health variables might also be present. Future studies should include larger-scale factors. Second, our study only focused on the HRQoL of patients after 3-months and lacked dynamic evaluation, which may have certain limitations for analyzing the influencing factors. Future studies should increase the number and duration of follow-ups to obtain richer data and further explore the relationship between complications and HRQoL. Third, the researchers were not directly involved in data collection, and there may be a risk of bias in the secondary data analysis.