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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Geriatrics 1/2014

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

BMC Geriatrics > Ausgabe 1/2014
Bruce Friedman, Yanen Li, Dianne V Liebel, Bethel A Powers
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2318-14-24) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

BF planned the study, supervised the data analysis, and wrote the Introduction, much of the Methods and Results, and most of the Discussion. YL performed all statistical analyses and wrote portions of the Methods and Results. DVL wrote sections of the Methods and Discussion. BAP read the entire manuscript and contributed to its revision. All authors read and approved the final manuscript.



Home 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.


This 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.


Compared 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.


Future research is needed to confirm these findings and determine how HVN interventions affect individual ADLs of older adults with multiple ADLs.
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