Assessment of Activity of Daily Living Among Older Adult Patients in Home Healthcare and Skilled Nursing Facilities: An Integrative Review.
Zainab Toteh Osakwe, Elaine Larson, Mansi Agrawal and 1 others
PMID 28471793WHAT IT FOUND
Older adult ADL assessments in home health and skilled nursing use different tools, definitions, scoring and reporters, so scores may not be comparable.
Check the method before using it to guide care.
Key findings
01Eight primary studies were reviewed, four in home healthcare and four in skilled nursing, with sample sizes from 131 to 1,023,036.
02The reviewed ADL instruments differed in items, time frames, scoring rules and who completed them, and the review noted that these differences make comparisons difficult.
03Five included studies reported poor ADL ability associated with poor health outcomes; one home health study reported a restorative model associated with approximately one-third fewer admissions than usual care.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The review searched only peer-reviewed English articles and excluded grey literature, dissertations and non-English papers, so it may have missed relevant studies. Only eight studies were included, and none of the home healthcare studies used the current OASIS C1, so the findings may not fit current practice. The included studies used different instruments, populations, time frames and reporters, so scores cannot be compared directly. The review did not test whether a different ADL assessment improves patient outcomes. The authors noted that the fragmented system limited their ability to describe patient characteristics and compare outcomes across settings.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as evidence that a particular ADL tool is better or that changing the tool improves outcomes. The review compared assessment methods and found variation; it did not test a new assessment as a patient-care intervention.