Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study
Authors Ryg J, Engberg H, Mariadas P, Pedersen SGH, Jorgensen MG, Vinding KL, Andersen-Ranberg K
Received 1 June 2018
Accepted for publication 4 October 2018
Published 27 November 2018 Volume 2018:10 Pages 1789—1800
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Professor Vera Ehrenstein
Jesper Ryg,1,2 Henriette Engberg,3,4 Pavithra Mariadas,3,4 Solvejg Gram Henneberg Pedersen,5 Martin Gronbech Jorgensen,6 Kirsten Laila Vinding,7 Karen Andersen-Ranberg1,2
1Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark; 2Geriatric Research Unit, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; 3Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 4Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark; 5Medical Department, Holbæk Hospital, Holbæk, Denmark; 6Department of Geriatric Medicine, Aalborg University Hospital, Aalborg, Denmark; 7Medical Department, Kolding Hospital, Kolding, Denmark
Purpose: The Barthel Index (BI)-100 is used to measure geriatric patients’ activities of daily living (ADL). The aim of this study was to explore whether BI at hospital admission is associated with mortality.
Patients and methods: In a nationwide population-based cohort study, patients aged ≥65 years admitted during 2005–2014 to Danish geriatric departments were assessed with BI at admission. Data were entered into the Danish National Database of Geriatrics and linked at the individual level to the Danish health registers (Civil Registration System, National Patient Register, and National Database of Reimbursed Prescriptions). The BI was categorized into four predefined standard subcategories according to the national Danish version of the statistical classification of diseases (BI =80–100 [independent ADL], BI =50–79 [moderate reduced ADL], BI =25–49 [low ADL], and BI =0–24 [very low ADL]). Patients were followed until death, emigration, or end of the study (December 31, 2015). Associations with mortality adjusted for age, admission year, marital status, body mass index, Charlson comorbidity index, polypharmacy, and hospitalizations during the preceding year were analyzed by multivariable Cox regression analysis.
Results: Totally, 74,603 patients were included. Women (63%) were older than men (mean [SD] age; 83  vs 81  years) and had higher BI (median [IQR]; 55 [30–77] vs 52 [26–77]). Median survival (years [95% CI]) was lowest in the subcategory “BI =0–24” in both women (1.3 [1.2–1.4]) and men (0.9 [0.8–0.9]). Adjusted mortalities (HR [95% CI]; reference BI =80–100) in women were 2.41 (2.31–2.51) for BI =0–24, 1.66 (1.60–1.73) for BI =25–49, and 1.34 (1.29–1.39) for BI =50–79 and in men were 2.07 (1.97–2.18) for BI =0–24, 1.58 (1.51–1.66) for BI =25–49, and 1.29 (1.23–1.35) for BI =50–79.
Conclusion: BI at admission is strongly and independently associated with mortality in geriatric patients. BI has the potential to provide useful supplementary information for the planning of treatment and future care of older patients.
Keywords: ADL, prognostic, death, older, longitudinal
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