Lower Barthel Index Is Associated with Higher Risk of Hospitalization-Requiring Pneumonia in Long-Term Care Facilities

Abstract

Pneumonia is an important infectious entity that affects residents in long-term care facilities (LTCFs), whereas hospitalization-requiring pneumonia (HRP) represents a more critical patient condition with worse outcomes. The evidence addressing the association between Barthel index and risk of HRP among LTCF residents is lacking. A multicenter, retrospective cohort study was conducted in three LTCFs enrolling adult patients who resided for 3 months or more and ever underwent Barthel index evaluation within a study period of January 1 to December 31, 2010. The endpoint was HRP after enrollment. A total of 299 patients (169 women; age, 79.0 ± 12.2 years) were enrolled and categorized into HRP Group (n = 68; 36 women; age, 79.1 ± 11.3 years) and Non-HRP Group (n = 231; 133 women; age, 79.0 ± 12.4 years) by the endpoint. The patients in HRP Group had significantly lower Barthel index (8.6 versus 25.8 points, p < 0.001) but higher proportion of chronic obstructive pulmonary disease (13.2% versus 3.9%, p = 0.004). By the multivariate analysis of logistic regression, we found that lower Barthel index (odds ratio (OR), 0.967; p < 0.001), existence of chronic obstructive pulmonary disease (OR, 4.192; p = 0.015), and feeding route (percutaneous endoscopic gastrostomy comparing with oral feeding; OR, 0.177; p = 0.012) were independently associated with HRP. In conclusion, a lower Barthel index is significantly associated with the occurrence of pneumonia that requires hospitalization in long-term care residents. Barthel index is a useful and reliable tool for risk evaluation in this population.

A Composite of Functional Status and Pneumonia Severity Index Improves the Prediction of Pneumonia Mortality in Older Patients

“…24 Studies of primarily institutionalized patients have reported that a low BI is associated not only with increased risk of nursing homeacquired pneumonia, but also with increased mortality. 25 A prospective observational study of factors other than the PSI associated with pneumonia mortality found a BI < 80 was more important than other factors, such as age or comorbidities, and as important as the PSI in predicting the prognosis of elderly patients with pneumonia. 19 This is particularly relevant in the case of institutionalized patients, in whom a low BI is a major determinant of the need for hospitalization.…”

Potential associated factors of functional disability in Chinese older inpatients: a multicenter cross-sectional study

“…Maryland State Med Journal 1965; 14:56-61. Used with permission [15,16]. BI consists of 10 ADL, each of which is graded as 0, 5, or 10 with a maximum total score of 100 [17].…”

Activities of Daily Living (ADL) Predicts in-hospital Mortality in Geriatric Patients with Community-acquired Pneumonia (CAP)

“…In CAP, a worse ADL is directly related to increased immediate and long-term mortality [32] . It was reported that a BI level 80 was associated with 30-day mortality in pneumonia patients [33] and a low BI with increased mortality in institutionalized patients [34] . On the other hand, a high BI level has been reported was related to reduced 30-day and 18 months mortalities in elderly CAP patients [35] .…”