Abstract
BACKGROUND: Quality of life (QOL) has been reported to be associated with sociodemographic characteristics and geriatric syndromes in older adults, but the impact of interactions among multiple geriatric syndromes on QOL remains unexplored. We aimed to apply a machine learning method to evaluate the effects of interactions among multiple geriatric syndromes on QOL in older adults. METHODS: We recruited adults aged ≥ 65 years admitted to a tertiary medical center from June 2018 to September 2018. The main outcome was the three-level five-dimensional Euro-Quality of Life tool (EQ-5D-3 L) utility value. The random forest algorithm was used to identify and rank the strongest predictors of geriatric syndromes. The relation between predictors and outcomes was visualized with accumulated local effects plots and interaction effects. Model performance was evaluated by 5-fold cross-validation with metrics of R-square, the mean square error of estimation and the mean absolute error of estimation. RESULTS: The study included 160 older adults with a mean age of 79 years. The top ten features that significantly influenced the utility prediction were activities of daily living (ADL), frailty, pain, the number of medications used, age, depression, the Charlson Comorbidity Index (CCI), body mass index (BMI), peptic ulcer, and emotional loneliness. The two-way interactions between ADL, frailty, and pain significantly interacted with other predictors. CONCLUSION: ADL, frailty, and pain are important factors to be considered when assessing QOL in older adults. It is important for clinicians to consider them together in clinical decision-making.