Activities of daily living at hospital admission and estimated survival time of older patients.

BACKGROUND: Predicting expected survival time in acutely hospitalised older patients is a clinical challenge. OBJECTIVE: To examine if activities of daily living (ADL) assessed by Barthel-Index-100 (Barthel-Index) at hospital admission adds useful information to clinicians on expected survival time in older patients. METHODS: A nationwide population-based cohort study was used. All patients aged ≥65 years in the National Danish Geriatric Database from 2005 to 2014 were followed up until death, emigration or study termination (31 December 2015). Individual data were linked to national health registers. Barthel-Index was categorised into five-point subcategories with a separate category of Barthel-Index = 0. Kaplan-Meier analysis was used to assess crude survival proportions (95% CI) and Cox regression to examine association of Barthel-Index and mortality adjusting for age, Charlson comorbidity index, medication use, BMI, marital status, prior hospitalisations and admission year. RESULTS: In total, 74,589 patients (63% women) aged (mean (SD)) 82.5(7.5) years with Barthel-Index (median (IQR)) 54(29-77) were included. In patients with Barthel-Index = 100-96 crude survival was 0.96(0.95-0.97) after 90-days, 0.88(0.87-0.89) after 1-year, and 0.79(0.78-0.80) after 2-years. Corresponding survival in patients with Barthel-Index = 0 was 0.49(0.47-0.51), 0.35(0.34-0.37) and 0.26(0.24-0.27). Decreasing Barthel-Index was associated with increasing mortality in the multivariable analysis. In women with Barthel-Index = 0, the mortality risk (HR (95% CI)) was 14.74(11.33-19.18) after 90-days, 8.40(7.13-9.90) after 1-year and 6.22(5.47-7.07) after 2-years using Barthel-Index = 100-96 as reference. In men, the corresponding risks were 11.36(8.81-14.66), 6.22(5.29-7.31) and 5.22(4.56-5.98). CONCLUSIONS: ADL measured by Barthel-Index provides useful, easily accessible and independent information to clinicians on expected survival time in patients admitted to a geriatric department.

Barthel Index at hospital admission is associated with mortality in geriatric patients: a Danish nationwide population-based cohort study.

PURPOSE: The Barthel Index (BI)-100 is used to measure geriatric patients' activities of daily living (ADL). The aim of this study was to explore whether BI at hospital admission is associated with mortality. PATIENTS AND METHODS: In a nationwide population-based cohort study, patients aged ≥65 years admitted during 2005-2014 to Danish geriatric departments were assessed with BI at admission. Data were entered into the Danish National Database of Geriatrics and linked at the individual level to the Danish health registers (Civil Registration System, National Patient Register, and National Database of Reimbursed Prescriptions). The BI was categorized into four predefined standard subcategories according to the national Danish version of the statistical classification of diseases (BI =80-100 [independent ADL], BI =50-79 [moderate reduced ADL], BI =25-49 [low ADL], and BI =0-24 [very low ADL]). Patients were followed until death, emigration, or end of the study (December 31, 2015). Associations with mortality adjusted for age, admission year, marital status, body mass index, Charlson comorbidity index, polypharmacy, and hospitalizations during the preceding year were analyzed by multivariable Cox regression analysis. RESULTS: Totally, 74,603 patients were included. Women (63%) were older than men (mean [SD] age; 83 [7] vs 81 [7] years) and had higher BI (median [IQR]; 55 [30-77] vs 52 [26-77]). Median survival (years [95% CI]) was lowest in the subcategory "BI =0-24" in both women (1.3 [1.2-1.4]) and men (0.9 [0.8-0.9]). Adjusted mortalities (HR [95% CI]; reference BI =80-100) in women were 2.41 (2.31-2.51) for BI =0-24, 1.66 (1.60-1.73) for BI =25-49, and 1.34 (1.29-1.39) for BI =50-79 and in men were 2.07 (1.97-2.18) for BI =0-24, 1.58 (1.51-1.66) for BI =25-49, and 1.29 (1.23-1.35) for BI =50-79. CONCLUSION: BI at admission is strongly and independently associated with mortality in geriatric patients. BI has the potential to provide useful supplementary information for the planning of treatment and future care of older patients.

[Implementation of the shared medication record is difficult]. / Implementering af fælles medicinkort er vanskeligt.

The aim of the study was to examine the implementation of the shared medication record (SMR) and the barriers to lack of implementation. The research was done in three hospitals in Denmark. Data showed that SMR was not used systematically in the period 5-19 March 2012 at a hospital in the Capital Region of Denmark. We found that motivation, technical problems, time, and competencies were barriers to using SMR. Although all the doctors liked the idea of SMR, they did not find the present version of SMR to be fully developed for use in practice.