Elsevier

Clinical Nutrition

Volume 23, Issue 2, April 2004, Pages 213-221
Clinical Nutrition

ORIGINAL ARTICLE
An investigation into the relationships between quality of life, nutritional status and physical function

https://doi.org/10.1016/S0261-5614(03)00127-4Get rights and content

Abstract

Background & aims: The measurement of quality of life adds a holistic dimension to the assessment of a clinical state or the response to an intervention. The relationship between quality of life and nutritional status is not well studied. This study aimed to investigate this relationship in a group of sick elderly in-patients.

Methods: We used data from a RCT investigating the benefits of intensive feeding support on acute medicine for the elderly wards. The EuroQol EQ-5D questionnaire was administered to patients on admission and the results were then related to parameters of nutritional status, physical function, depression and serum albumin collected at the same time.

Results: Two hundred and thirty-three patients completed the EQ-5D questionnaire. Comparisons with UK norms for community living elderly showed significantly lower scores. No direct relationship was found between the EQ-5D scores and markers of nutritional status. However, clear differences were observed between patients with and without swallowing problems, those with good and poor appetite and those with good and poor physical function. Increasing risk of depression had a profound effect on quality of life scores.

Conclusions: Nutritional status does not appear to directly influence quality of life, as measured by the EQ-5D, but may affect it through the consequences of reduced physical function. Additionally, factors that directly affect a persons food intake seem to have a greater impact on quality of life, which underlines the importance of food and eating as an aspect of life quality.

Introduction

It is recognised that the personal burden of illness cannot be fully described by measures of disease status alone, such as the degree of weight loss or low serum albumin. Psychosocial and other factors also need to be considered, for example, mobility, pain and anxiety. This recognition has led to the development of tools to evaluate health-related quality of life (HRQoL).1 An assessment of HRQoL, which is in essence the patients’ subjective view of their own health state, adds another dimension to the evaluation of a treatment. By including this measure the treatment can be assessed more holistically, rather than by focusing solely on defined clinical outcomes.

This type of measure is particularly valuable in the older age group, as extension of life becomes less important than the ‘worth’ placed on life as experienced by the patient. Quality of life measures are being used with increasing frequency in research, to demonstrate how a person's overall evaluation of their life experience may be altered in response to an intervention.

Quality of life is not easy to define or measure, and there has been little work done to investigate the relationship between HRQoL and malnutrition. However, the available evidence suggests that a worse nutritional state corresponds to worsening quality of life.2., 3. Physical function is also an important variable that may play a part in any link between malnutrition and quality of life, and this has been shown to influence quality of life according to EuroQol4 and other measures.5

In this paper these relationships are studied in elderly hospitalised people using the EuroQol EQ-5D health-related quality of life instrument, which is a relatively simple and non-disease-specific instrument. The relationship between HRQoL, as measured by the EQ-5D HRQoL questionnaire, and nutrition has not previously been investigated.

Section snippets

Aim

To establish what, if any, relationships exist between indicators of nutritional state, physical function and health-related quality of life in sick elderly individuals (as measured by the EQ-5D).

Materials and methods

The data from this investigation was collected as part of a large intervention trial investigating the benefits of providing focused nutritional support to elderly in-patients to improve nutritional status.6 The Riverside Research Ethics Committee and the Hammersmith Hospital Ethics Committee approved this trial.

The EuroQol EQ-5D is a standardised non-disease-specific instrument for describing and valuing health-related quality of life. It was developed in various countries, used on many age

Results

Out of a possible 334 patients 233 completed the questionnaire. One hundred and one were excluded due to impaired cognition. Of the 233 questionnaires, 40 EQ-5Dindex scores could not be calculated as some or all of the individual dimensions were not completed and 59 EQ-5Dvas scores were missing or invalid. The missing values were due to patients refusing to answer parts of the questionnaire because they either did not feel they could give a valid answer within the constraints of the

Discussion

The relationship between altered nutritional status and quality of life remains unclear. The data presented here suggest that there is a connection between the two, but it occurs through functional difficulties in eating and a poor appetite rather than weight change. The difficulties in collecting quality of life data are also highlighted in this patient group.

Although the EQ-5D questionnaire is one of the shortest and simplest available, there were significant numbers of patients who did not

Conclusion

The relationships between quality of life, nutrition and function, which we set out to investigate, would appear to be complex. The data suggest that a link exists but it may not be direct, and is influenced by other factors, especially a high risk of depression. The argument also returns to the ill-defined concept of quality of life, the precision of the EQ-5D and the classification of nutritional state. The definition of quality of life and the dimensions selected to be included in any

Acknowledgements

Our thanks go to Ms Anna Kitt SRD for her help with the data management and initial analysis, and to the NHS Executive for financial support of the study.

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