Disability as a predictor of outcome for the elderly in a department of internal medicine. A comparison of predictions based on index of ADL and physician predictions.

The predictive validity of ratings based on Katz' Index of ADL (Activities of Daily Living) and of physician ratings of patient outcome was studied in a department of internal medicine, 129 patients, 65 years of age or older, were assessed independently and simultaneously by licensed practical nurses using Katz' Index of ADL and by a physician using clinical judgement. These assessments were related to observed outcome regarding survival or death in the ward, length of stay, and type of hospital discharge. Two alternative ADL-groupings were used, grade A-E versus grade F-G and grade A-F versus grade G. Sensitivity and specificity of ADL-ratings and of physician ratings were found to be rather similar regarding length of stay less than 10 days and discharge to own home. Predictions regarding patient deaths based on ADL-grades F-G and G had a higher sensitivity than predictions based on physician ratings. The specificity of the two types of predictions was about the same. There was only a fair correlation between age and ADL-grade. ADL-assessments may thus be useful for planning purposes for elderly patients also in acute medical wards.