Tohoku J. Exp. Med., 2015 August, 236(4)
Lower Barthel Index Is Associated with Higher Risk of Hospitalization-Requiring Pneumonia in Long-Term Care Facilities
CHIH-CHUNG SHIAO,1,6 HSIU-CHUAN HSU,2 I-LING CHEN,2 CHING-YI WENG,2 JUI-CHU CHUANG,4 SU-CHIU LIN,3 FONG-FONG TSAI1 and ZEN-YONG CHEN1,5
1Department of Internal Medicine, Saint Mary's Hospital Luodong, Yilan, Taiwan
2Department of Nursing, Saint Mary's Hospital Luodong, Yilan, Taiwan
3Nursing Home, Saint Mary's Hospital Luodong, Yilan, Taiwan
4Catholic Marian Long-Term Care Center, Yilan, Taiwan
5Division of Neurology, Whei-Ming Hospital, Magon, Penghu, Taiwan
6Saint Mary's Medicine, Nursing and Management College, Yilan, Taiwan
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.
keywords —— Barthel index; hospitalization; long-term care facilities; nursing home-acquired pneumonia; percutaneous endoscopic gastrostomy
© 2015 Tohoku University Medical Press
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Tohoku J. Exp. Med., 2015, 236, 281-288
Correspondence: Chih-Chung Shiao, MD., Division of Nephrology, Department of Internal Medicine, Saint Mary's Hospital Luodong, 160 Chong-Cheng South Road, Loudong 265, Yilan, Taiwan.
e-mail: chungyy2001@yahoo.com.tw
Zen-Yong Chen, M.D., Ph.D., Division of Neurology, Whei-Ming Hospital, No. 14, Su-Dei Road, Magon City, Penghu, Taiwan.
e-mail: danjinyong@gmail.com