# Health-related quality of life trajectories and loss of independence among community-dwelling older adults

## TL;DR

This study shows that changes in mental and physical health quality over time strongly predict loss of independence in older adults.

## Contribution

The study identifies distinct HRQOL trajectory patterns and their association with LOI risk in older adults.

## Key findings

- MCS decline is associated with higher LOI or death risk (HR 1.51).
- MCS increase is associated with lower LOI or death risk (HR 0.26).
- PCS decline is linked to higher LOI risk (HR 1.66).

## Abstract

Health-related quality of life (HRQOL) is a key determinant of loss of independence (LOI) among older adults. However, the relationship between late-life HRQOL trajectory patterns and the risk of LOI remains unclear. This study utilized 5-year longitudinal data from the Sukagawa Study, and group-based trajectory modeling. HRQOL trajectories were analyzed using the mental component scale (MCS) and physical component scale (PCS) from the SF-8. Hazard ratios (HRs) and 95% confidence intervals (CIs) for LOI or death were calculated using Cox proportional hazards regression. Among 4043 participants (median age 78.8 years, interquartile range [IQR] 75.8–82.5; 56% women), HRQOL change score trajectories were categorized as decline, stable, and increase for MCS (11.7%, 81.0%, 7.2%) and PCS (10.9%, 81.4%, 7.6%). Over a mean follow-up of 66.4 months (IQR 48.0–73.0), LOI or death incidence was 42.5 per 1000 person-years (95% CI 39.8–45.2). Compared to the stable group, MCS decline was associated with higher LOI or death risk (HR 1.51, 95% CI 1.04–2.18), and an increase was associated with lower risk (HR 0.26, 95% CI 0.11–0.57). PCS decline was linked to higher LOI risk (HR 1.66, 95% CI 1.17–2.37), while an increase showed no significant association (HR 1.07, 95% CI 0.61–1.89). Longitudinal HRQOL trajectory is closely related to LOI risk among community-dwelling older adults. A declining trajectory in physical and mental components is strongly associated with higher LOI risk, while an increasing trajectory in the mental component is possibly associated with lower risk.

The online version contains supplementary material available at 10.1007/s11357-025-01804-5.