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Activities of Daily Living of Home Healthcare Patients

Osakwe, Zainab Toteh, PhD, MSN, RN; Larson, Elaine, PhD, RN, FAAN; Andrews, Howard, PhD; Shang, Jingjing, PhD, RN

doi: 10.1097/NHH.0000000000000736

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.

Zainab Toteh Osakwe, PhD, MSN, RN, is an Assistant Professor, College of Nursing and Public Health, Adelphi University, Garden City, New York.

Elaine Larson, PhD, RN, FAAN, is an Associate Dean for Research, Anna C. Maxwell Professor of Nursing Research, School of Nursing, Professor of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.

Howard Andrews, PhD, is an Associate Professor Neuroscience, Biostatistics, Psychiatry, and Sergievsky Center, Columbia University Medical Center, New York, New York.

Jingjing Shang, PhD, RN, is an Assistant Professor, School of Nursing, Columbia University, New York, New York.

The authors declare no conflicts of interest.

Address for correspondence: Zainab Toteh Osakwe, MSN, PhD, WHNP, Adelphi University, 1 South Avenue, Garden City, New York, NY 11530 (

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