Activities of Daily Living of Home Healthcare Patients.
Zainab Toteh Osakwe, Elaine Larson, Howard Andrews and 1 others
PMID 31058736WHAT IT FOUND
Most home health patients needed help with daily activities at admission, and 58.1% improved by discharge.
Bathing was the most common problem, and impaired decision-making was linked to severe dependence.
Key findings
01At admission, 88.4% of home health patients needed help in at least one activity of daily living, and bathing was the most common dependency at 96.8%.
02From admission to discharge, 58.1% of patients improved in activities of daily living, 35.6% declined, and 6.3% had no change.
03Patients with impaired decision-making at admission had 3.51 times higher odds of severe ADL dependency.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
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What it does not show
The paper reports a final sample of 105,654 but also describes a sample of 154,801 patients in Supplemental Digital Content 1. The difference is not explained. It did not include service utilization during the home health episode, so it cannot show which nursing or therapy visits, or how many, were linked to ADL improvement. It only used one year of data and could not follow patients who were hospitalized or died, because ADLs were not measured at transfer. ADL dependency was dichotomized and summed, which can obscure differences in difficulty among activities. The ADL change score used a corrected Likert approach whose measurement properties were not established, and reliability and validity studies cited were for OASIS-B, not OASIS-C.
Declared interests
The authors declared no conflicts of interest. The paper does not report funding.
The easy way to misread this
Do not read the 58.1% ADL improvement as proof that home health services caused improvement. The study did not measure therapy or nursing visits during the episode, and it only compared patients at admission and discharge.