Functional level at admission is a predictor of survival in older patients admitted to an acute geriatric unit

Abstract

Background: Functional decline is associated with increased risk of mortality in geriatric patients. Assessment ofactivities of daily living (ADL) with the Barthel Index (BI) at admission was studied as a predictor of survival in olderpatients admitted to an acute geriatric unit.Methods: All first admissions of patients with age >65 years between January 1st 2005 and December 31st 2009were included. Data on BI, sex, age, and discharge diagnoses were retrieved from the hospital patient administrativesystem, and data on survival until September 6th 2010 were retrieved from the Civil Personal Registry. Co-morbiditywas measured with Charlson Co-morbidity Index (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 81.8 (6.8) and83.9 (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 inmen (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 as baseline and controlling forsignificant covariates (sex, age, CCI, and diseases of cancer, haematology, cardiovascular, respiratory, infectious andbone and connective tissues) the odds ratios for 3 and 12 months survival (95%-CI) decreased with declining BI: BI50-79: 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) and 0.29 (0.24-0.35)(p<0.001) respectively.Conclusion: BI is a strong independent predictor of survival in older patients admitted to an acute geriatric unit.These data suggest that assessment of ADL may have a potential role in decision making for the clinicalmanagement of frail geriatric inpatients. © 2012 Matzen et al.; licensee BioMed Central Ltd.