Resources for the Comprehensive Geriatric Assessment based

Proactive and Personalised Primary Care of the Elderly

Barthel Index

Purpose : Assessment of functional independence in the domains of personal care and mobility

Admin time :  5-20 min.

User Friendly :  High

Administered by : GP or nurse

​

Content : The Barthel Indexl includes 10 personal activities: feeding, personal toileting, bathing, dressing and undressing, getting on and off a toilet, controlling bladder, controlling bowel, moving from wheelchair to bed and returning, walking on level surface (or propelling a wheelchair if unable to walk) and ascending and descending stairs.

Barthel Index - original

 

Content : in the Barthel Index - original, each item is rated in terms of whether the patient can perform the task independently, with some assistance, or is dependent on help based on observation : (0, 5), (0, 5, 10), (0, 5, 10, 15) dependent on the item.

 

Author :  Mahoney FI, Barthel  DW, 1965

​

Copyright : Public domain.

The Maryland State Medical Society holds the copyright for the Barthel Index.

It may be used freely for non-commercial purposes with the following citation:

Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61. Used with permission.

Barthel Index - modified

 

Content : In the Barthel Index - modified each item is rated in terms of whether the patient can perform the task independently, with some assistance, or is dependent on help based on observation (0=unable, 1=needs help, 2=independent).

 

Author :  Colin et al, 1988

​

Copyright : Public domain.

Barthel Index - Shah version

 

Content : In the Barthel Index - Shah version each item is rated in terms of whether the patient can perform the task independently, using a  5-level ordinal scale for each item to improve sensitivity to detecting change (1=unable to perform task, 2=attempts task but unsafe, 3=moderate help required, 4=minimal help required, 5=fully independent).

 

Author :  Shah S  et al, 1989

​

Copyright : Public domain.

BARTHEL INDEX - limitations and concerns

 

While the Barthel Index is widely and easy to use, there are some concerns regarding its interpretability in that sometimes improvements may not be apparent because the patient may still need supervision (if not physical assistance) to perform a task.

Thus, while a score of 100 indicates independence in all 10 areas, assistance may still be required with some IADLs, which are not included in the index.

​

The Barthel is also limited in that it does not evaluate other “life skills” and situational factors.

If the patient requires environmental modifications such as ramps, wider than standard doorways or grab bars in the tub or toilet, the Barthel should be administered in such an environment that simulates the one to which the patient would return. If this does not occur, the patients score will be lower.

​

Interestingly, geriatric patients tended to overestimate their own abilities. This suggests, potentially, that the Barthel be administered by clinical staff.

​

Given the variability in the scoring system of the Barthel, the results should not be used in isolation.

The interpretation of the scores and conclusions drawn should be carefully combined with findings from other parts of the clinical examination.

As always, a comprehensive evaluation is recommended for the assessment of safety and abilities in our elderly patients.

This Tool is used in the Assessment of Functioning

Back To : Assessment of Functioning

The Assessment of Functioning is one of 8 domains of the

 Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment