Predicting quality of life among older patients: validation of the HAT in Swedish primary care

Background

As populations age, primary care requires tools capturing multidimensional health and patient-centered outcomes. Health-related quality of life (HRQoL) is a key indicator of well-being in older adults but is rarely used to evaluate predictive performance of geriatric tools. We aimed to externally validate the Health Assessment Tool (HAT) in Swedish primary care by assessing its ability to predict HRQoL levels and clinically meaningful changes over time.

Methods

This multicenter prospective cohort study included 1,005 adults aged ≥60 years across six Swedish primary care centers (November 2022–December 2024). HAT scores were derived from five indicators: personal and instrumental activities of daily living, gait speed, cognition, and chronic disease burden. HRQoL was measured using EQ-5D-5L and EQ-VAS at baseline and 6–12 months. Predictive performance was assessed using receiver operating characteristic curves and area under the curve (AUC) values for cross-sectional HRQoL levels and predefined clinically meaningful changes over time. Models accounted for key demographic and clinical characteristics.

Results

HAT showed good to high predictive performance for HRQoL. Cross-sectional AUCs ranged from 0.80–0.81 for EQ-5D-5L (10th and 15th percentiles) and 0.71–0.74 for EQ-VAS (25th and 40th percentiles). For longitudinal improvements, AUCs ranged from 0.69–0.74 for EQ-5D-5L (10% and 15% increases) and 0.71–0.80 for EQ-VAS (25% and 40% increases). HAT consistently outperformed its individual components, supporting the added value of multidimensional assessment over single-domain measures.

Conclusions

HAT demonstrates predictive validity for HRQoL in older primary care patients. Its integration into routine assessments may support early identification of individuals at risk of decline, inform personalized care planning, and facilitate monitoring of patient-centered outcomes in clinical practice.

Key messages

• HAT predicts both HRQoL levels and changes over time in primary care, supporting its use for identifying older adults at risk of decline using a multidimensional, patient-centered approach.

• Multidimensional assessment outperforms single components in predicting HRQoL, highlighting the value of integrated tools for guiding personalized care and monitoring outcomes in older patients.