The Barthel activities of daily living index: Self-reporting versus actual performance in the old-old (≤ 75 years)

BACKGROUND AND PURPOSE: The Barthel Index for assessing activities of daily living (ADL) was developed particularly for young stroke patients, but it now has a wider application in the geriatric assessment profile. This study tests the validity of the Barthel Index by self-report in the old-old (≤ 75 years). If more than 10% of the studied population assessed themselves incorrectly (≤ 15-point discrepancy), the test may have limitations. We set out to try to quantify and explain this discrepancy. METHODS: During a 3- month period, we tested 126 old-old patients, both geriatric medical inpatients and subjects from the community, in a cross-sectional study. Using the Barthel Index, their functional status was assessed by self-report and by observation of performance. A measure of the magnitude of discrepancy between the two methods (discrepancy score) was calculated as the difference between the self report and performance total scores. RESULTS: Comparing the self- report with actual ADL performance scores, the mean score for self-report was higher (90 vs 88). There was a low Kappa score in all areas of the scale (range 0.103-0.398). Twenty of the 126 patients (15.9%) scored 15 or more points in the discrepancy score. By running a multiple linear regression, we were able to explain only 21% of the variance in the discrepancy score (R² = .21). Significant explanatory variables were the presence of cognitive impairment, source of patients from acute geriatric ward, and age (very old ≤ 85 years). CONCLUSION: For the purpose of this study, use of the Barthel Index by self-reporting was found to have its limitations in the old-old (≤ 75 years), particularly with regard to the very old (≤ 85 years) medical geriatric inpatients. Therefore we suggest that the older people may have to be assessed by the rehabilitation services using a performance-based measure or a different self-report test for documenting their activities of daily living, bearing in mind that self-reported and performance-based measures capture physical abilities differently.