TY - JOUR

T1 - Activities of daily living at hospital admission associated with mortality in geriatric patients with dementia

T2 - a Danish nationwide population-based cohort study

AU - Veedfald, Thomas

AU - Andersen-Ranberg, Karen

AU - Waldorff, Frans

AU - Anru, Pavithra Laxsen

AU - Masud, Tahir

AU - Ryg, Jesper

PY - 2021

Y1 - 2021

N2 - Purpose: Determining life expectancy in patients with dementia are challenging. We aimed at studying the association between basic activities of daily living as measured by the Barthel Index at hospital admission and mortality among older patients with dementia. Methods: All patients aged ≥ 65 years with diagnosed dementia in the population-based National Danish Geriatric Database from 2005 to 2014 were included and followed until death, emigration, or study termination (31.12.2015). Data on Barthel Index (BI) were used to assess ADL. Patients were categorized into four predefined standard BI subcategories according to the national Danish version of the statistical classification of diseases [BI = 0–24 (very low ADL), BI = 25–49 (low ADL), BI = 50–79 (moderate reduced ADL), and BI = 80–100 (independent ADL)]. Association with mortality was assessed using multivariable Cox regression analysis adjusting for age, marital status, Charlson Comorbidity Index, BMI, prior hospitalizations, year of admission and polypharmacy. Results: In total, 6550 patients (women 62%) were included, median (IQR) age 84 (79–88) years and BI 37 (13–63). Mortality increased significantly with decreasing BI in both the crude and multivariable analysis. In subcategories BI = (80–100) and BI = (0–24), survival time (median (95%)) was 3.6 (3.4–3.9) years and 0.8 (0.7–0.9) years, respectively. Also, in patients with BI = (0–24), the overall mortality risk (HR (95% CI)) was 2.5 (2.2–2.8), 30-day risk 11.8 (5.8–23.9), and 1-year risk 4.4 (3.6–5.5) when using BI = (80–100) as reference. Conclusion: Barthel Index is independently associated with all-cause mortality among older patients with dementia admitted to hospital. BI may be a helpful tool for clinicians when discussing treatment and care strategies with patients and their families.

AB - Purpose: Determining life expectancy in patients with dementia are challenging. We aimed at studying the association between basic activities of daily living as measured by the Barthel Index at hospital admission and mortality among older patients with dementia. Methods: All patients aged ≥ 65 years with diagnosed dementia in the population-based National Danish Geriatric Database from 2005 to 2014 were included and followed until death, emigration, or study termination (31.12.2015). Data on Barthel Index (BI) were used to assess ADL. Patients were categorized into four predefined standard BI subcategories according to the national Danish version of the statistical classification of diseases [BI = 0–24 (very low ADL), BI = 25–49 (low ADL), BI = 50–79 (moderate reduced ADL), and BI = 80–100 (independent ADL)]. Association with mortality was assessed using multivariable Cox regression analysis adjusting for age, marital status, Charlson Comorbidity Index, BMI, prior hospitalizations, year of admission and polypharmacy. Results: In total, 6550 patients (women 62%) were included, median (IQR) age 84 (79–88) years and BI 37 (13–63). Mortality increased significantly with decreasing BI in both the crude and multivariable analysis. In subcategories BI = (80–100) and BI = (0–24), survival time (median (95%)) was 3.6 (3.4–3.9) years and 0.8 (0.7–0.9) years, respectively. Also, in patients with BI = (0–24), the overall mortality risk (HR (95% CI)) was 2.5 (2.2–2.8), 30-day risk 11.8 (5.8–23.9), and 1-year risk 4.4 (3.6–5.5) when using BI = (80–100) as reference. Conclusion: Barthel Index is independently associated with all-cause mortality among older patients with dementia admitted to hospital. BI may be a helpful tool for clinicians when discussing treatment and care strategies with patients and their families.

KW - ADL

KW - Barthel Index

KW - Dementia

KW - Mortality

KW - Population-based

U2 - 10.1007/s41999-020-00431-x

DO - 10.1007/s41999-020-00431-x

M3 - Journal article

C2 - 33393062

AN - SCOPUS:85098548228

VL - 12

SP - 627

EP - 636

JO - European Geriatric Medicine

JF - European Geriatric Medicine

SN - 1878-7649

ER -