Association between the different basic activities of daily living on the Barthel index and community living, use of mobility aids, and the survival at 5 years

Introduction The Barthel index has designed to assess functional capacity to perform basic activities of daily living. This study analyzes the association between each of these activities and community living, the use of mobility aids, and various socioeconomic factors, as well as survival associated with each activity at 5 years. Methods Study conducted between 2020 and 2025 in the functionally dependent population (Barthel ≤60) of the Orcasitas neighborhood in Madrid (Spain). A total of 127 people participated, with a mean age of 86 ± 6.3 years. Barthel index activities were classified into three groups, and the relationship between community living and the use of mobility aids with the level of dependency and survival was analyzed. Results One in four people in this cohort was dependent for activities included in group 2 (dressing-undressing, grooming, bathing), but only one in ten was dependent for activities in group 1 (walking independently, chair-to-bed transfers, going up-down stairs, and toilet use) and group 3 (feeding or maintaining bladder and bowel control). Dependence on others on feeding, toilet use, chair-to-bed transfers, and bathing, as well as fecal incontinence, were associated with the need to live with other people. Chair-to-bed transfers, up-down stairs, and urinary incontinence were associated with living homebound. Feeding, toileting, bathing, dressing-undressing, and urinary or fecal incontinence were associated with the need for a hired caregiver. Only bathing was not associated with the use of mobility aids. The activities that showed the strongest association with mortality risk were using the toilet, dressing-undressing, and chair-to-bed transfers. Conclusion Dependence on others to perform each of the activities on the Barthel index follows a different pattern with respect to the interrelationships established with dependence on other activities and the personal and social adaptations that this dependence imposes. These characteristics must take account when designing population studies and planning social and health care services.