Psychological and functional factors associated with quality of life in comprehensive geriatric care: evidence from a...

Quality of life (QoL) serves as a central patient-reported outcome but is insufficiently integrated into Comprehensive Geriatric Care (CGC). Although CGC includes a standardized Comprehensive Geriatric Assessment (CGA) to evaluate patient's initial mobility, cognition, depression, and functional impairment, it remains unclear whether it adequately addresses the factors most relevant to QoL.

We conducted a multicenter observational cohort study including 487 inpatients receiving standardized CGC at three hospitals in Germany. QoL was assessed using the WHOQOL-BREF global items (overall QoL and self-rated health). We examined (1) correlations between the global items and the four WHOQOL domains, (2) interrelations among variables using a regularized partial correlation network with bootstrap stability analysis, and (3) determinants of QoL using multiple linear regression with demographic, clinical, functional and psychosocial factors.

Regression analyses based solely on clinical-functional assessment explained only a small proportion of variance in QoL (adjusted R² = 0.06). Adding sociodemographic and psychosocial factors substantially improved the model (adjusted R² = 0.26), with depressive symptoms (β = -0.22), anxiety (β = -0.20), and self-efficacy (β = 0.17) emerging as the strongest predictors of QoL, while functional variables lost significance. Domain-specific regressions confirmed that psychosocial factors consistently predicted all WHOQOL subdomains. Network analysis revealed a cohesive QoL cluster with strong positive connections between QoL domains and negative connections from depressive symptoms, anxiety and loneliness. Self-efficacy emerged as a key positive node.

Psychological distress (particularly depressive symptoms, anxiety, loneliness and reduced self-efficacy) was more strongly associated with QoL than traditional clinical-functional variables assessed in the CGA variables among older adults receiving CGC. Routine assessment of psychosocial burden and resources should be integrated into CGC to enable more individualized, patient-centered rehabilitation strategies.