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Who needs a nursing home? A simple and effective screening test
1Care of the Elderly Department, Charing Cross Hospital, London.
The British Journal of Clinical Practice
|November 1, 1993
Summary
The Barthel Index (BI) effectively identifies patients needing nursing home care, unlike the Mini-Mental State Examination (MMSE). A BI score of 15 or less accurately predicts the need for institutionalization, aiding discharge decisions.
Area of Science:
- Geriatrics
- Rehabilitation Medicine
- Health Services Research
Background:
- Distinguishing between home care and institutional long-term care is crucial for patient management.
- Accurate assessment tools are needed to guide discharge decisions for elderly patients.
Purpose of the Study:
- To evaluate the predictive value of the Barthel Index (BI) and Mini-Mental State Examination (MMSE) in determining patient discharge destinations.
- To compare the efficacy of BI and MMSE against expert multidisciplinary team decisions.
Main Methods:
- Retrospective comparison of BI and MMSE scores with expert team's discharge recommendations.
- Calculation of sensitivity, specificity, and predictive values for the BI.
Main Results:
- A Barthel Index score of 15 or less demonstrated high sensitivity (90%), specificity (83%), and predictive value (84%) for nursing home placement.
- The Mini-Mental State Examination showed no predictive value in differentiating discharge destinations.
Conclusions:
- The Barthel Index is a reliable and accurate tool for identifying patients requiring nursing home care.
- The BI aids in making informed decisions regarding long-term care placement.
- The MMSE is not suitable for predicting discharge destinations in this patient population.