Psychological and functional factors associated with quality of life in comprehensive geriatric care: evidence from a multicenter observational cohort study

Background 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. Methods 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. Results Regression analyses based solely on clinical-functional assessment explained only a small proportion of variance in QoL (adjusted R 2 = 0.06). Adding sociodemographic and psychosocial factors substantially improved the model (adjusted R 2 = 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. Conclusion 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.