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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
[Application of a short version of the Barthel Index for functional stratification in inpatients with multiple
Dino Moretti1, Guido Novello1, Carina Cadavay1
1Servicio de Clínica Médica, Sanatorio Delta, Rosario, Santa Fe, Argentina.
Introduction:
Functional impairment is prevalent in patients with multiple pathologies (PP) and implies the need for caregivers, impaired quality of life, and increased mortality. The objective was to evaluate the functional stratification and prognostic performance of the MiniBarthel (MB), a short, simplified, three-dimensional version of the Barthel Index (BI), in hospitalized PP.
Materials And Methods:
A prospective, observational study was conducted. The PROFUND prognostic score was administered upon admission, and patients were classified as MB0 (cannot do anything alone), MB1 (can feed themselves), MB2 (can feed and ambulate alone), and MB3 (can feed, ambulate, and climb stairs alone) by the attending physician. The BI was determined by the physical therapist to maintain the blinding. A 12-month follow-up was conducted to assess survival.
Results:
Ninety-nine patients were enrolled in the study, of whom 50 (50.5%) died during follow-up. They classified 21%, 17%, 17%, and 44% of patients as MB0, MB1, MB2, and MB3, with a median (IQR) BI of 10 (5- 20), 50 (40-60), 85 (75-90), and 95 (80-100) p < 0.001 and mortality of 66%, 64%, 52%, and 34% p 0.014, respectively. The area under the curve (AUC) (95% CI) of PROFUND, IB, and MB to discriminate 12-month mortality was 0.661 (0.553-0.769), 0.655 (0.547-0.762), and 0.654 (0.546-0.749), respectively.
Conclusion:
The Mini-Barthel's high performance, simplicity, and ease of use for functional stratification would enable a proactive approach to frailty and dependency care, focusing on functional decline and prognosis in hospitalized patients with multiple pathologies.
Insights
The Mini-Barthel (MB) effectively stratifies functional status in patients with multiple pathologies, aiding in prognosis and care. This simple tool helps identify patients needing proactive frailty and dependency support.
Area of Science:
- Gerontology
- Internal Medicine
- Rehabilitation Medicine
Background:
- Functional impairment is common in patients with multiple pathologies (PP), leading to increased care needs, reduced quality of life, and higher mortality.
- Assessing functional status is crucial for managing PP patients and predicting outcomes.
Purpose of the Study:
- To evaluate the functional stratification and prognostic performance of the Mini-Barthel (MB) score.
- To assess the MB score's utility in hospitalized patients with multiple pathologies.
Main Methods:
- A prospective, observational study involving 99 hospitalized patients with multiple pathologies.
- Patients were stratified using the Mini-Barthel (MB) score (MB0-MB3) upon admission.
- A 12-month follow-up was conducted to assess survival and compare MB performance with the PROFUND score and Barthel Index (BI).
Main Results:
- The Mini-Barthel (MB) score effectively stratified patients into four functional groups (MB0-MB3).
- Mortality rates varied significantly across MB strata, with higher mortality in lower functional groups (MB0: 66%, MB1: 64%, MB2: 52%, MB3: 34%).
- The area under the curve (AUC) for predicting 12-month mortality was comparable across MB, BI, and PROFUND scores (approx. 0.65-0.66).
Conclusions:
- The Mini-Barthel (MB) demonstrates high performance, simplicity, and ease of use for functional stratification in hospitalized patients with multiple pathologies.
- The MB score enables a proactive approach to managing frailty and dependency by focusing on functional decline and prognosis.
- This tool can aid clinicians in identifying at-risk patients and tailoring care interventions.
