GeriQBank · Paper IV

Barthel Index of activities of daily living

Moderate YieldAsked ×17-mark noteNeeds clinical review

Topic: Comprehensive Geriatric Assessment
Chapter: Part I — Comprehensive Geriatric Assessment and Functional Evaluation
Years asked: Not recorded in the source
Frequency: Set 1× in Paper IV (2009–2025)

As set in the university paper

Barthel's Index of Activities of Daily Living.
Paper IV · Comprehensive Geriatric & Functional Assessment · asked ×1 · 7-mark note · see in paper list

Answer framework

What it is — origin; ten weighted items; 0–100 scale
The ten activities and their maximum points
How to score it — actual performance; what independence means; sources; time frame; middle categories and aids; time taken
Interpreting the score — dependency bands; the modified Barthel Index; nursing need
Strengths and limitations — strengths; the IADL gap; ceiling and floor effects
Use in geriatric practice — baseline and follow-up within CGA

An exam answer plan drawn from the detailed answer below. Use it to attempt the question first.

Detailed answer

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Short revision answer

The Barthel Index (Mahoney and Barthel, 1965, for stroke) is one of the oldest and best-researched measures of basic ADLs: ten weighted activities scored from 0 (fully dependent) to 100 (independent) in steps of 5.
Items and maximum points: feeding 10, bathing 5, grooming 5, dressing 10, bowels 10, bladder 10, toilet use 10, transfers 15, mobility on level surfaces 15, stairs 10.
Score what the person actually does, not what they could do. Any help, physical or verbal — even supervision — means not independent. Use the person, relatives, nurses and observation (no formal testing), covering the previous 24–48 hours.
A middle category means the person supplies more than half the effort; using an aid to be independent is allowed. It takes 20–30 minutes by observation, or 2–10 minutes by self-report or proxy.
Dependency bands (Shah): 0–20 total, 21–60 severe, 61–90 moderate, 91–99 slight, 100 independent. The modified Barthel Index (Shah, 1989) scores each item in five steps and is more sensitive; scores also reflect nursing-care needs.
Strengths: short, no equipment or training, can be done by proxy, reliable, correlates with the Katz Index. Limits: 100 does not mean full independence — IADLs such as cooking need the Lawton scale — and ceiling and floor effects hide change at the extremes.
Use it within comprehensive geriatric assessment as a functional baseline and to follow change, for example during rehabilitation.

Condensed by GeriClinics from the detailed answer below, with no new facts added.

A. What it is

The Barthel Index is one of the oldest measures of basic activities of daily living. Mahoney and Barthel developed it in 1965 to rate disability in personal care and mobility in people with stroke, and it is one of the best-researched ADL tools.

It scores ten activities, weighted by importance, for a total from 0 (fully dependent) to 100 (independent) in steps of 5.

B. The ten activities and their maximum points

•

Feeding — 10

•

Bathing — 5

•

Grooming — 5

•

Dressing — 10

•

Bowels — 10

•

Bladder — 10

•

Toilet use — 10

•

Transfers (bed to chair and back) — 15

•

Mobility on level surfaces — 15

•

Stairs — 10 C. How to score it

Record what the person actually does, not what they could do.

The aim is to establish independence from any help, physical or verbal, however small. Needing supervision means the person is not independent.

Use the best evidence available: the person, relatives and nurses, with direct observation and common sense. Formal testing is not needed.

Base the score on the previous 24–48 hours, occasionally longer.

A middle category means the person supplies more than half the effort. Using an aid to be independent is allowed.

It takes 20–30 minutes by direct observation, or 2–10 minutes by self-report or from a proxy.

D. Interpreting the score

Dependency bands (Shah et al., from stroke populations): 0–20 total dependence, 21–60 severe, 61–90 moderate, 91–99 slight, 100 independent.

10.

The modified Barthel Index (Shah, 1989) scores each item in five steps, which makes it more sensitive and reliable than the original.

11.

Scores also reflect how much nursing care the person needs.

E. Strengths and limitations

12.

Strengths: short, needs no equipment or formal training, can be completed by proxy, is reliable, and correlates well with the Katz Index.

13.

A score of 100 does not mean full independence: help may still be needed with instrumental activities such as cooking and cleaning, which need a separate measure such as the Lawton IADL scale.

14.

Ceiling and floor effects limit how well it shows change at the extremes of function.

F. Uses in geriatric practice

15.

Use it within a comprehensive geriatric assessment to record a functional baseline and to follow change over time, for example during rehabilitation.

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References

Spinal Cord Injury Research Evidence (SCIRE) Project. Barthel Index (BI) — outcome measure summary. — Items, administration, interpretation and measurement properties
SCIRE Project. Barthel Index worksheet (adapted from Mahoney and Barthel, 1965, with permission). — Scoring guidelines and points per activity
Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61–65. — Original description (not openly available); summarised here from the SCIRE worksheet

Written in GeriClinics' own words from the sources above, and checked against them. Not yet clinically reviewed.

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