Effects of a home visiting nurse intervention versus care as usual on individual activities of daily living: a secondary analysis of a randomized controlled trial

Abstract

BackgroundHome visiting nurses (HVNs) have long been part of home and community-based care interventions designed to meet the needs of functionally declining older adults. However, only one of the studies including HVNs that have demonstrated successful impacts on Activities of Daily Living (ADL) has reported how those interventions affected individual ADLs such as bathing, instead reporting the effect on means of various ADL indices and scales. Reporting impacts on means is insufficient since the same mean can consist of many different combinations of individual ADL impairments. The purpose of our study was to identify which individual ADLs were affected by a specific HVN intervention.MethodsThis is a secondary analysis comparing two arms of a randomized controlled study that enrolled Medicare patients (mean age = 76.8 years; 70% female) with considerable ADL impairment. At baseline difficulty with individual ADLs ranged from a low of 16.0% with eating to a high of 78.0% with walking. Through monthly home visits, the HVN focused on empowering patients and using behavior change approaches to facilitate chronic disease self-management. Three categories of analyses were used to compare difficulty with and dependence in 6 individual ADLs between the HVN (n = 237) and care as usual (n = 262) groups (total N = 499) at 22 months after study entry: (1) unadjusted analyses that strictly depend on random assignment, (2) multinomial logistic regression analyses adjusting for baseline risk factors, and (3) multinomial regression analyses that include variables reporting post-randomization healthcare use as well as the baseline risk factors.ResultsCompared to care as usual, patients receiving the HVN intervention had less difficulty performing bathing at 22 months. However, there were no effects for difficulty performing the other 5 ADLs. While no effects were found for lower levels of dependence for any ADLs, impacts were detected for the most dependent levels of 4 ADLs: patients experienced less dependence in walking and transferring, a substitution effect for toileting, and more dependence in eating.ConclusionsFuture research is needed to confirm these findings and determine how HVN interventions affect individual ADLs of older adults with multiple ADLs.

Effects of self-management support programmes on activities of daily living of older adults: A systematic review

“…The results of these studies may be biased due to a small sample size. On the other hand, the results were consistent with the results of studies that used a large sample size (Friedman et al, 2009, Friedman et al, 2014and Meng et al, 2009. It is important to highlight that the self-management support programmes in a lot of studies were provided in addition to usual care.…”

“…This may therefore result in an overestimation of the effect of self-management support programmes. However, studies were included in the present review that reported no significant effect of self-management support programmes on the activities of daily living of older adults (Elzen et al, 2007, Friedman et al, 2014, Meng et al, 2009, Sundsli et al, 2014and Wetzels et al, 2008. In some studies a small sample size was used (Alp et al, 2007, Ersek et al, 2003, Girdler et al, 2010and Sundsli et al, 2014.…”

“…The key domains in the summary assessment of the risk of bias for the outcome on the activities of daily living were 'allocation', 'incomplete outcome data' and 'selective reporting'. As for allocation, in the majority of the included studies (n = 7) the method used to conceal the allocation sequence remained 'unclear' ( Alp et al, 2007, Elzen et al, 2007, Ersek et al, 2003, Friedman et al, 2009, Friedman et al, 2014, Meng et al, 2007and Sundsli et al, 2014. In one study, this criterion was appraised as 'high risk of bias' because the control group had access to activities that were available to the intervention group (Leveille et al, 1998).…”

“…First, there were intensive programmes with a short duration (<six months) and weekly group sessions (Alp et al, 2007, Coleman et al, 2012, Elzen et al, 2007and Ersek et al, 2003. Second, there were less intensive programmes (≤one session a month), with a long duration (≥one year), using an individual approach (Friedman et al, 2009, Friedman et al, 2014, Leveille et al, 1998, Meng et al, 2007and Meng et al, 2009. Third, there were three programmes with an intermediate duration of 6-12 months, a less intensive programme (≤one session a month) and individual and/or group sessions (Girdler et al, 2010, Sundsli et al, 2014and Wetzels et al, 2008.…”

Nursing diagnoses focused on universal self‐care requisites

“…A nursing diagnosis determines nursing care interventions. Many of interventions implemented towards universal self‐care requisites needs' aim to improve or to prevent further impairment (Friedman et al 2014). In our findings, the nursing diagnoses point out to the individual’s resources and its potentiality to overcome the impairment.…”