Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study

Ryg, Jesper; Engberg, Henriette; Mariadas, Pavithra; Pedersen, Solvejg Gram Henneberg; Jørgensen, Martin Grønbech; Vinding, Kirsten; Andersen‐Ranberg, Karen

doi:10.2147/clep.s176035

Cited by 53 publications

(52 citation statements)

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“…Subjects with severe dependence have a very high probability of dying during hospitalization, especially if admitted to a medical area and with a diagnosis of cancer. A recent nationwide register‐based longitudinal cohort study on elderly patients admitted in geriatrics departments had reported that mortality, as in our study, increased with lower levels of BI, but also increased for both genders with higher age and multi‐comorbidities and multi‐drugs prescription as reported in our descriptive results (Ryg et al., 2018).…”

Section: Discussionsupporting

confidence: 87%

“…For in‐hospital mortality, the evaluation of functional dependence at admission is a major determinant of mortality during hospitalization (De Buyser, Petrovic, Taes, Vetrano, Corsonello, et al., 2014; Gullón et al., 2018; Ryg et al., 2018). Usually, a patient with a low functional status has a greater number of comorbidities and a worse level of health.…”

Section: Discussionmentioning

confidence: 99%

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The Barthel index as an indicator of hospital outcomes: A retrospective cross‐sectional study with healthcare data from older people

Ocagli

Cella

Stivanello

et al. 2020

Journal of Advanced Nursing

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Aims The assessment of functional status is a more appropriate measure in the older people than traditional healthcare outcomes. The present study aimed to analyse the association between functional status assessed using the Barthel Index and length of stay, in‐hospital mortality, discharge destination, and Diagnosis‐Related Groups‐based cost. Design This study was a retrospective study that used administrative data from patients older than 65 discharged from the University Hospital of Padua (Italy) in 2016. Methods A logistic regression model for categorical variables (length of stay, in‐hospital mortality, and discharge destination) and a generalized linear model with gamma distributions and log links for continuous variables (cost of hospitalization) were used to evaluate associations with the Barthel Index. Results A total of 13,484 admissions were included in the analysis. In‐hospital mortality, safe discharge, and length of stay were higher in patients with severe dependence than in patients with mild/no dependence with a 12‐fold increased risk of death (OR = 12.81; 95% CI 9.22–18.14), a 4 times greater likelihood of safe discharge (OR = 4.64; 95% CI 3.96–5.45), and a 2‐fold increase in length of stay (OR = 2.56; 95% CI 2.34–2.81). On the other hand, no significant association was found between the cost of hospitalization and the Barthel Index. Conclusions Barthel Index was strongly associated with in‐hospital mortality, discharge destination, and length of stay. The costs of hospitalization, however, were not related to patients’ functional impairment. Impact The study considers functional status as an indicator of hospital outcomes. Better comprehension of the relationship between functional status and healthcare outcomes may help with early and adequate healthcare planning and resource management.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

The Barthel index as an indicator of hospital outcomes: A retrospective cross‐sectional study with healthcare data from older people

Ocagli

Cella

Stivanello

et al. 2020

Journal of Advanced Nursing

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“…The results showed that BI was negatively correlated with the mortality of patients, and the higher the BI score, the lower the mortality of patients. 48 However, our study did not further follow up with the patients. Follow-up information should be further increased in later studies.…”

Section: Discussionmentioning

confidence: 88%

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Chang¹,

Hou²,

Wang³

et al. 2020

CIA

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Introduction: Elderly people are at increased risk of falls, disability and death due to reduced functional reserve, decline in multiple systems functions, which affects their activities of daily living (ADL) and eventually develop into frailty. The ADL assessment is conducive to early detection to avoid further serious situations. Previous studies on patients' activities of daily living with chronic kidney disease (CKD) are mainly focused on dialysis patients. Little information is available on non-dialysis patients. Patients and Methods: A total of 303 elderly patients with CKD stage 3-5 who were admitted to our hospital were selected. ADL evaluation was performed on patients at admission, with Barthel index (BI) as the evaluation tool. They were divided into two groups based on BI (≥60 and <60). Demographic information, lifestyle and clinical profile were collected. The risk factors related to ADL were analyzed by univariate and multivariate models. Results: The data of 303 patients enrolled in this study were analyzed. The average age of patients was 84.48± 7.14 years and 62.05% were male. There were 88 patients (29.04%) in BI <60 group and 215 patients (70.96%) in the BI ≥60 group. The average age of subjects in the two groups was 87.47 ± 5.85 years and 83.26± 7.28 years, respectively. On univariate analysis, ADL impairment was associated with many factors, such as age, body mass index, blood lipid, heart rate, smoking history, Charlson comorbidity index (CCI), hemoglobin, serum albumin, BNP, eGFR, etc. Multivariate logistic regression showed that age (OR 1.08, 95% CI 1.00-1.17, P=0.0390), Charlson comorbidity index (OR 4.75, 95% CI 1.17-19.30, P=0.0295), and serum albumin (OR 0.80, 95% CI 0.70-0.92, P=0.0012) were the independent risk factors of ADL impairment. Conclusion: Decline of ADL in CKD patients was independently correlated with age, Charlson comorbidity index and serum albumin. ADL and its influential factors in the elderly CKD patients deserve further attention.

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“…Several prognostic scores for mortality in hospitalized older patients have been proposed, such as the Multidimensional Prognostic Index (MPI) ( 36 ), the Hospital-patient One-year Mortality Risk (HOMR) score ( 41 , 42 ), and the Identification of Seniors At Risk-Hospitalized Patients (ISAR-HP) score ( 43 ). However, a simpler way to predict in-hospital mortality in the older adults is to assess functional status using the Barthel Index, which evaluates the ability to perform activities of daily living and has been demonstrated to be a good predictor of mortality in geriatric patients hospitalized for any reason ( 44 ). Our study is the first report that has found that preadmission functional status is related to mortality in older adults aged more than 80 years old patients with COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain

Ramos-Rincón

Buonaiuto

Ricci

et al. 2020

The Journals of Gerontology: Series A

114

102

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Background Advanced age is a well-known risk factor for poor prognosis in COVID-19. However, few studies have specifically focused on very old inpatients with COVID-19. This study aims to describe the clinical characteristics of very old inpatients with COVID-19 and identify risk factors for in-hospital mortality at admission. Methods We conducted a nationwide, multicenter, retrospective, observational study in patients ≥80 years hospitalized with COVID-19 in 150 Spanish hospitals (SEMI-COVID-19) Registry (March 1–May 29, 2020). The primary outcome was in-hospital mortality. A uni- and multivariate logistic regression was performed to assess predictors of mortality at admission. Results 2,772 consecutive patients (49.4% men, median age 86.3 years) were analyzed. Rates of atherosclerotic cardiovascular disease, diabetes mellitus, dementia, and Barthel Index <60 were 30.8%, 25.6%, 30.5%, and 21.0%, respectively. The overall case-fatality rate was 46.9% (n:1,301) and increased with age (80-84 years:41.6%; 85-90 years:47.3%; 90-94 years:52.7%; ≥95 years:54.2%). After analysis, male sex and moderate-to-severe dependence were independently associated with in-hospital mortality; comorbidities were not predictive. At admission, independent risk factors for death were: SatO2 <90%; temperature ≥37.8ºC; qSOFA score ≥2; and unilateral-bilateral infiltrates on chest X-rays. Some analytical findings were independent risk factors for death, including eGFR <45 ml/min/1.73m 2; lactate dehydrogenase ≥500 U/L; CRP ≥80 mg/L; neutrophils ≥7.5x10 3/μL; lymphocytes <0.8x10 3/μL; and monocytes <0.5 x 10 3/μL. Conclusions This first large, multicenter cohort of very old inpatients with COVID-19 shows that age, male sex, and poor pre-admission functional status—not comorbidities—are independently associated with in-hospital mortality. Severe COVID-19 at admission is related to poor prognosis.

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Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study

Cited by 53 publications

References 50 publications

The Barthel index as an indicator of hospital outcomes: A retrospective cross‐sectional study with healthcare data from older people

The Barthel index as an indicator of hospital outcomes: A retrospective cross‐sectional study with healthcare data from older people

<p>Main Risk Factors Related to Activities of Daily Living in Non-Dialysis Patients with Chronic Kidney Disease Stage 3–5: A Case–Control Study</p>

Clinical Characteristics and Risk Factors for Mortality in Very Old Patients Hospitalized With COVID-19 in Spain

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