Does the degree of limitation in activities of daily living in geriatric patients influence the amount of care and case management required? An analysis from the RubiN project.

Abstract

Background: The number of people in Germany over the age of 70 will increase significantly over the next 10 years. This will be accompanied by an increase in geriatric diseases and disabilities. An important goal for many geriatric patients is to remain in their own homes for as long as possible, while making use of support services. To achieve this, patients with limitations in their daily activities and in need of geriatric care should be identified as early as possible. The RubiN project implemented assessment-based care and case management for geriatric patients in physician networks in Germany. To support future planning, the present analysis investigated whether the intensity of case management increases with increasing limitations in patients' activities of daily living.

Methods: Using the Barthel Index, an assessment tool to record patients' ability to perform activities of daily living, patients' current limitations were assessed for ten activities (eating; sitting up and moving; washing; toileting; bathing/showering; getting up and walking; climbing stairs; dressing/undressing; bowel incontinence; urinary incontinence). For each item, the score (0 to max. 15 points) is determined and added to the Barthel Index score (max. 100 points). Counselling and coordination services provided by case managers were documented according to medical, nursing, therapeutic and social counselling content. Linear multivariate analysis was performed to determine whether the Barthel Index score was a determinant of the intensity of care and case management.

Results: Two thousand three hundred six patients in the RubiN intervention group (65% female; mean age 81.5 years (SD 5.6)) were included in the analysis. 74% of these patients achieved a Barthel Index score between 100 and 85 points at baseline, and correspondingly, 26% of the patients had a Barthel Index score of 80 points or less. Problems with 'bathing/showering', 'getting up and walking', 'climbing stairs', 'dressing/undressing' and 'controlling urination' were the most common reasons for not achieving the maximum Barthel Index score of 100 points. A total of 26,833 patient contacts were documented by the care and case manager. On average, patients received 11.6 contacts (SD = 9.1). Social (31.8%) and medical (26.3%) counselling and coordination services were provided in the majority of contacts. "Therapeutic counselling content" and "nursing counselling content" were provided in 21.7% and 20.1% of contacts, respectively. Multivariate analysis showed a significant correlation between an decreasing Barthel Index and a higher number of contacts with the care and case manager.

Conclusions: The Barthel Index score can be used to predict the intensity of care and assistance needed by geriatric patients. The scores provide a good basis for planning and implementing care and case management.

Trial registration: German Clinical Trials Register, ID: DRKS00016642. Registered on 29.10.2019-retrospectively registered.