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Factors Associated with the Changes in Activities of Daily Living in Older Adults with Stroke: A Comparison of Home Care and Institutional Care

Article information

Res Community Public Health Nurs. 2016;27(4):388-398
Publication date (electronic) : 2016 December 31
doi : https://doi.org/10.12799/jkachn.2016.27.4.388
Woon-Sook Jung1, Eun-Shil Yim2
1Division of Occupational Therapy, Kyungdong University, Wonju, Korea.
2Division of Nursing, Daegu Health College, Daegu, Korea.
Corresponding author: Yim, Eun-Shil. Division of Nursing, Daegu Health College, 15 Youngsong-ro, Buk-gu, Daegu 41453, Korea. Tel: +82-53-320-1467, Fax: +82-53-320-1470, yim7604@hanmail.net
Received 2016 October 25; Revised 2016 December 11; Accepted 2016 December 11.

Abstract

Purpose

To compare the changes in activities of daily living (ADLs) in older adults with stroke in different modalities of long term care (LTC) services, which include home care and institutional care.

Methods

This is a comparative study using secondary data from the Korean national LTC insurance. Home care (HC) services users (n=3,494) and institutional care (IC) users (n=1,428) were extracted and compared in terms of ADLs and changes in ADLs to investigate the effects of HC and IC services in LTC.

Results

All of the ADLs and LTC services benefit levels for 2 years had improved in both HC and IC services. The ADLs of older adults with stroke who received HC improved, while those who received IC experienced deterioration. The LTC services benefit levels of the HC and IC groups were significantly different after 2 years.

Conclusion

The study has found that HC services may lead ADLs better for older adults with stroke. We recommend LTC policy makers to further develop HC and IC service programs to deliver quality LTC services.

Keywords: Activities of daily living; Stroke; Long-term care

References

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Article information Continued

© 2016 Korean Academy of Community Health Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Table 1

Baseline Characteristics according to Service Type (N=4,922)

Characteristics Categories Home care Institutional care p
n (%) or M±SD n (%) or M±SD
Grade Grade-1 894 (25.6) 410 (28.7) .025
Grade-2 2,600 (74.4) 1,018 (71.3)
Gender Male 1,672 (47.9) 482 (33.8) <.001
Female 1,822 (52.1) 946 (66.2)
Age (year) 65~69 1,351 (38.7) 391 (27.4) <.001
70~74 755 (21.6) 239 (16.7)
75~79 641 (18.3) 326 (22.8)
80~84 449 (12.9) 279 (19.5)
≥85 298 (8.5) 193 (13.5)
71.41±10.01 74.37±9.78 <.001
Care-giver Yes 3,154 (90.3) 500 (35.0) <.001
No 340 (9.7) 928 (65.0)
Insurance type Medicaid 398 (11.4) 294 (20.6) <.001
NHI 3,096 (88.6) 1,134 (79.4)
Dementia No 2,633 (75.4) 893 (62.5) <.001
Yes 861 (24.6) 535 (37.5)
Disease number 1.68±1.21 1.63±1.17 .600
Care need 0 2,919 (83.5) 1,073 (75.1) <.001
1 465 (13.3) 240 (16.8)
≥2 110 (3.1) 115 (8.1)
0.21±0.58 0.37±0.78 <.001
Cognitive function 5.77±2.55 6.01±2.54 .255
Rehabilitation function 16.88±3.89 16.07±3.98 .703

NHI=national health insurance.

Table 2

Profiles of Activities of Daily Living according to Service Type (N=4,922)

Variables Service type 2009 2010 2011 Time Group Time×group
M±SD M±SD M±SD p p p
ADL Home care 30.90±3.75 28.17±4.95 28.02±5.69 <.001 <.001 <.001
Institutional care 31.69±4.11 29.89±5.16 30.00±5.74
Dressing Home care 2.77±0.42 2.65±0.49 2.62±0.49 <.001 <.001 <.001
Institutional care 2.75±0.43 2.65±0.49 2.67±0.48
Washing face Home care 2.32±0.48 2.13±0.45 2.10±0.46 <.001 <.001 <.001
Institutional care 2.27±0.46 2.12±0.40 2.12±0.42
Gargling Home care 2.35±0.48 2.17±0.45 2.15±0.45 <.001 <.001 <.001
Institutional care 2.32±0.48 2.17±0.42 2.18±0.44
Bathing Home care 2.91±0.28 2.78±0.41 2.73±0.44 <.001 <.001 <.001
Institutional care 2.90±0.29 2.81±0.39 2.77±0.42
Eating Home care 1.93±0.66 1.63±0.64 1.61±0.68 <.001 <.001 <.001
Institutional care 1.83±0.71 1.54±0.61 1.56±0.67
Transfer Home care 1.88±0.72 1.64±0.69 1.65±0.72 <.001 <.001 <.001
Institutional care 1.84±0.75 1.72±0.73 1.75±0.77
Sit up Home care 2.35±0.75 1.97±0.82 1.95±0.83 <.001 <.001 <.001
Institutional care 2.29±0.78 2.08±0.85 2.10±0.87
Sitting move Home care 2.39±0.77 2.09±0.85 2.09±0.87 <.001 <.001 <.001
Institutional care 2.50±0.74 2.36±0.81 2.38±0.83
Emerging out of the room Home care 2.76±0.52 2.53±0.66 2.50±0.68 <.001 <.001 <.001
Institutional care 2.77±0.54 2.61±0.68 2.62±0.67
Toileting Home care 2.74±0.44 2.55±0.55 2.53±0.55 <.001 <.001 <.001
Institutional care 2.83±0.37 2.73±0.47 2.71±0.50
Bowel control Home care 1.72±0.82 1.57±0.77 1.63±0.81 <.001 <.001 <.001
Institutional care 2.16±0.87 2.07±0.86 2.11±0.88
Bladder control Home care 1.86±0.80 1.65±0.76 1.73±0.80 <.001 <.001 <.001
Institutional care 2.29±0.78 2.21±0.79 2.24±0.81
Shampoo Home care 2.92±0.28 2.79±0.42 2.74±0.44 <.001 <.001 <.001
Institutional care 2.94±0.29 2.82±0.39 2.79±0.42

ADL=activities of daily living.

Table 3

Maintenance, Improvement and Worsening of Outcomes over Time according to Service Type (N=4,922)

Variables Outcome Home care Institutional care p
n (%) n (%)
ADL Maintenance & improved 2,553 (73.1) 926 (64.8) <.001
Worsened 941 (26.9) 502 (35.2)
Dressing Maintenance & improved 3,176 (90.9) 1,268 (88.8) .026
Worsened 318 (9.1) 160 (11.2)
Washing face Maintenance & improved 3,238 (92.7) 1,297 (90.8) .031
Worsened 256 (7.3) 131 (9.2)
Gargling Maintenance & improved 3,235 (92.6) 1,271 (89.0) <.001
Worsened 259 (7.4) 157 (11.0)
Bathing Maintenance & improved 3,349 (95.9) 1,357 (95.0) .220
Worsened 145 (4.1) 71 (5.0)
Eating Maintenance & improved 3,080 (88.2) 1,187 (83.1) <.001
Worsened 414 (11.8) 241 (16.9)
Transfer Maintenance & improved 3,003 (85.9) 1,160 (81.2) <.001
Worsened 491 (14.1) 268 (18.8)
Sit up Maintenance & improved 3,055 (87.4) 1,198 (83.9) .001
Worsened 439 (12.6) 230 (16.1)
Sitting move Maintenance & improved 3,049 (87.3) 1,217 (85.2) .058
Worsened 445 (12.7) 211 (14.8)
Emerging out of Maintenance & improved 3,251 (93.0) 1,330 (93.1) .951
Worsened 243 (7.0) 98 (6.9)
Toileting Maintenance & improved 3,218 (92.1) 1,325 (92.8) .444
Worsened 276 (7.9) 103 (7.2)
Bowel control Maintenance & improved 2,864 (82.0) 1,118 (78.3) .003
Worsened 630 (18.0) 310 (21.7)
Bladder control Maintenance & improved 2,882 (82.5) 1,109 (77.7) <.001
Worsened 612 (17.5) 319 (22.3)
Shampoo Maintenance & improved 3,368 (96.4) 1,377 (96.4) .514
Worsened 126 (3.6) 51 (3.6)

ADL=activities of daily living.

Table 4

Multiple Logistic Regression to Predict Change of Activities of Daily Living by 2009~2010 (N=4,922)

Variables Comparative group Reference group ADL worsened (ref. Improved) Adj or (95 CI) p
Odd ratios 95% CI
Type Institutional care Home care 1.68 1.42 1.99 <.001
Grade Grade-2 Grade-1 3.54 2.93 4.27 <.001
Gender Female Male 1.04 0.91 1.19 .596
Age (year) 70~74 65~69 0.97 0.81 1.17 .767
75~79 65~69 1.07 0.89 1.29 .480
80~84 65~69 1.19 0.97 1.46 .095
≥85 65~69 1.41 1.12 1.77 .003
Care-giver No Yes 1.36 1.14 1.63 <.001
Insurance Medicaid NHI 0.98 0.82 1.19 .868
Dementia Yes No 1.27 1.10 1.47 .002
Nursing need score at baseline 1.09 0.97 1.22 .141
Cognitive function score at baseline 0.99 0.96 1.02 .361
Rehabilitation function score at baseline 0.98 0.96 0.99 .006

ADL=activities of daily living; NHI=national health insurance.