Assessment of Activity of Daily Living Among Older Adult Patients in Home Healthcare and Skilled Nursing Facilities

Abstract

Older adult’s ability to self-manage illness is dependent on their ability to perform activities of daily living (ADL). Forty-five percent of those older than 65 years will have ongoing clinical needs after hospital discharge and require post-acute care (PAC) services in settings such as home health care (HHC) and skilled nursing facilities (SNF). The Improving Medicare Post-Acute Care Transformation Act (IMPACT) of 2014 requires PAC providers to begin collecting and reporting ADL data to build a coordinated approach to payment and standardize patient assessments and quality measurement. The aim of this integrative review was to compare the methods of assessing ADLs in HHC to SNF. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used to ensure results were reported systematically. A scientific literature search without date restriction within the PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases was conducted. Two independent investigators assessed study quality using the quality appraisal instrument developed by Kmet and colleagues. Study quality ranged from 94.5% to 100%. Of the 18749 articles identified by the search, eight met inclusion criteria and four tools were identified that are used to assess ADLs in SNF and HHC. Although SNF and HHC collect similar ADL information, the range of content covered, item definitions, scoring, and psychometrics are not comparable across settings.

Use of Standardized and Non-Standardized Tools for Measuring the Risk of Falls and Independence in Clinical Practice

“…Pashmdarfard and Azad also supports the results of our study, which demonstrates the usability of these standardized tools in clinical practice [ 15 ]. On the other hand, Osakwe et al disagrees with these observations and regard the original versions of the ADL and IADL to be antiquated and recommend a more modern tool that focuses more on domains and factors enabling a better assessment of independence for each patient [ 30 ]. Liebzeit et al also supports this opinion.…”

The Time is Now: Informatics Research Opportunities in Home Health Care

“…A portion of HHC referral and admission data are unstructured and free text (including for example care and follow/up recommendations section of hospital discharge summaries) which presents data analytic challenges. 13 An exception is the standardized Outcome and Assessment Information Data Set (OASIS) 24 used by CMS and others for quality measurement, care improvement, 25 research, 26,27 and identification of hospitalization risk factors. 28 Unstructured narrative data are included in nursing, therapy, and social work visit notes, care coordination documentation, and clinical notes from referral settings (e.g., discharge summaries).…”

Continuous monitoring of eating and sleeping behaviors in the home environments of older adults: a case study demonstration

“…We cannot assume that ADLs observed in a single clinic or laboratory visit will generalize to other times or environments. In sum, current ADL measurement approaches have limited power for predicting ADL-associated health outcomes or informing healthcare planning (11,12). ADL monitoring that is capable of automatically capturing objective, continuous activity data in an ecologically valid approach can aid in the detection and prediction of clinically significant changes while facilitating supportive interventions to minimize adverse events.…”