title: 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.
authors.affiliation: Department of Internal Medicine, Saint Mary's Hospital Luodong.
authors.forename: Chih-Chung
authors.initials: CC
authors.lastname: Shiao
authors.forename: Hsiu-Chuan
authors.initials: HC
authors.lastname: Hsu
authors.forename: I-Ling
authors.initials: IL
authors.lastname: Chen
authors.forename: Ching-Yi
authors.initials: CY
authors.lastname: Weng
authors.forename: Jui-Chu
authors.initials: JC
authors.lastname: Chuang
authors.forename: Su-Chiu
authors.initials: SC
authors.lastname: Lin
authors.forename: Fong-Fong
authors.initials: FF
authors.lastname: Tsai
authors.forename: Zen-Yong
authors.initials: ZY
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005248:Feeding Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D011014:Pneumonia / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology