Matzen, Lars E3; Jepsen, Ditte B2; Ryg, Jesper3; Masud, Tahir3
1 Geriatrics, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU2 Geriatri3 Geriatrics, Department of Clinical Research, Det Sundhedsvidenskabelige Fakultet, SDU
ABSTRACT: BACKGROUND: Functional decline is associated with increased risk of mortality in geriatric patients.Assessment of activities of daily living (ADL) with the Barthel Index (BI) at admission wasstudied as a predictor of survival in older patients admitted to an acute geriatric unit. METHODS: All first admissions of patients with age >65 years between January 1st 2005 and December31st 2009 were included. Data on BI, sex, age, and discharge diagnoses were retrieved fromthe hospital patient administrative system, and data on survival until September 6th 2010 wereretrieved from the Civil Personal Registry. Co-morbidity was measured with Charlson ComorbidityIndex (CCI). Patients were followed until death or end of study. RESULTS: 5,087 patients were included, 1,852 (36.4%) men and 3,235 (63.6%) women with mean age(SD) 82.0 (6.8) and 84.0 (7.0) years respectively. The median [IQR] length of stay was 8 days, the median follow up [IQR] 1.4 [0.3; 2.8] years and in hospital mortality 8.2%.Mortality was greater in men than in women with median survival (95%-CI) 1.3 (1.2 -1.5)years and 2.2 (2.1-2.4) years respectively (p <0.001). The median survivals (95%-CI)stratified on BI groups in men (n = 1,653) and women (n = 2,874) respectively were: BI 80-100: 2.6 (1.9-3.1) years and 4.5 (3.9-5.4) years; BI 50-79: 1.7 (1.5-2.1) years and 3.1 (2.7-3.5) years; BI 25-49: 1.5 (1.3-1.9) years and 1.9 (1.5-2.2) years and BI 0-24: 0.5 (0.3-0.7)years and 0.8 (0.6-0.9) years. In multivariate logistic regression analysis with BI 80-100 asbaseline and controlling for significant covariates (sex, age, CCI, and diseases of cancer,haematology, cardiovascular, respiratory, infectious and bone and connective tissues) theodds ratios for 3 and 12 months survival (95%-CI) decreased with declining BI: BI 50-79:0.74 (0.55-0.99) (p <0.05) and 0,80 (0.65-0.97)(p <0.05); BI 25-49: 0.44 (0.33-0.59)(p <0.001) and 0.55 (0.45-0.68)(p <0.001); and BI 0-24: 0.18 (0.14-0.24)(p <0.001) and0.29 (0.24-0.35)(p <0.001) respectively. CONCLUSION: BI is a strong independent predictor of survival in older patients admitted to an acute geriatricunit. These data suggest that assessment of ADL may have a potential role in decisionmaking for the clinical management of frail geriatric inpatients.