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Updated: Feb 9, 2026
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Specific item patterns in comparison to generalized sum score-the Care Dependency Scale (CDS) as a screening tool for
Simone Kuntz1, Theo Dassen2, Nils A Lahmann1
1Department of Geriatrics, Geriatrics Research Group, Working Group-Nursing Research, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Aims:
The aim of this study is to identify items of the Care Dependency Scale (CDS) with overriding importance for the specific nursing care problems of pressure ulcers, falls, and malnutrition.
Method:
Secondary data analysis of 5 multicentre consecutive annual cross-sectional surveys from 2008 to 2012. For the study, data were analysed from 19 787 individuals in 262 long-term care facilities throughout Germany. Based on a standardized study protocol and international definitions, data regarding care dependency and care problems were gathered by direct examination. To identify the most relevant items of the CDS regarding pressure ulcers, falls, and malnutrition, classification trees (Classification and Regression Trees) were calculated. The validity of the identified items was then confirmed by applying "area under the receiver operating characteristic curve (AUC)" statistics.
Results:
The Classification and Regression Tree analysis showed a total of 6 nodes for pressure ulcer prevalence on 2 levels. Both levels provided the CDS item mobility as the most important predictor for the prevalence of pressure ulcers with a prevalence of 9.0% for these being completely dependent. The most important CDS item to determine malnutrition is completely dependent on eat and drink with a malnutrition prevalence of 25.2%. Of all CDS items that have been entered into the model, the item mobility showed the strongest association with falls. For pressure ulcers, the CDS items mobility (0.72) and body posture (0.71) provided a higher AUC than the total CDS sum score. Furthermore, for malnutrition, we measured an AUC of 0.63 for item eat and drink while the total CDS provided an AUC of 0.62.
Conclusions:
The results of our study suggest that the CDS may be a useful tool for screening patients regarding the risk of pressure ulcers and/or malnutrition. According to our study, the CDS can be used as an assessment for many different care problems.
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