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 (greater than or equal to 75 years). If more than 10% of the studied population assessed themselves incorrectly (greater than or equal to 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 (R-2 =.21). Significant explanatory variables were the presence of cognitive impairment, source of patients from acute geriatric ward, and age (very old greater than or equal to 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 (greater than or equal to 75 years), particularly with regard to the very old (not greater than or equal to 85 years) medical geriatric inpatients. Therefore, we suggest that the older people may have to be assessed by the rehabilatation 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.