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

Woon-Sook Jung; Eun-Shil Yim

doi:10.12799/jkachn.2016.27.4.388

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

Original Article

Journal of Korean Academy of Community Health Nursing 2016; 27(4): 388-398.

Published online: 31 December 2016

DOI: https://doi.org/10.12799/jkachn.2016.27.4.388

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

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 25 October 2016 Revised 11 December 2016 Accepted 11 December 2016

(open-access):

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.

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

Figures and Tables

Table 1

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

Characteristics	Categories	Home care	Institutional care	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	p
Grade	Grade-1	894 (25.6)	410 (28.7)	.025
Grade	Grade-2	2,600 (74.4)	1,018 (71.3)	.025
Gender	Male	1,672 (47.9)	482 (33.8)	<.001
Gender	Female	1,822 (52.1)	946 (66.2)	<.001
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
Care-giver	No	340 (9.7)	928 (65.0)	<.001
Insurance type	Medicaid	398 (11.4)	294 (20.6)	<.001
Insurance type	NHI	3,096 (88.6)	1,134 (79.4)	<.001
Dementia	No	2,633 (75.4)	893 (62.5)	<.001
Dementia	Yes	861 (24.6)	535 (37.5)	<.001
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
Variables	Service type	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
ADL	Institutional care	31.69±4.11	29.89±5.16	30.00±5.74	<.001	<.001	<.001
Dressing	Home care	2.77±0.42	2.65±0.49	2.62±0.49	<.001	<.001	<.001
Dressing	Institutional care	2.75±0.43	2.65±0.49	2.67±0.48	<.001	<.001	<.001
Washing face	Home care	2.32±0.48	2.13±0.45	2.10±0.46	<.001	<.001	<.001
Washing face	Institutional care	2.27±0.46	2.12±0.40	2.12±0.42	<.001	<.001	<.001
Gargling	Home care	2.35±0.48	2.17±0.45	2.15±0.45	<.001	<.001	<.001
Gargling	Institutional care	2.32±0.48	2.17±0.42	2.18±0.44	<.001	<.001	<.001
Bathing	Home care	2.91±0.28	2.78±0.41	2.73±0.44	<.001	<.001	<.001
Bathing	Institutional care	2.90±0.29	2.81±0.39	2.77±0.42	<.001	<.001	<.001
Eating	Home care	1.93±0.66	1.63±0.64	1.61±0.68	<.001	<.001	<.001
Eating	Institutional care	1.83±0.71	1.54±0.61	1.56±0.67	<.001	<.001	<.001
Transfer	Home care	1.88±0.72	1.64±0.69	1.65±0.72	<.001	<.001	<.001
Transfer	Institutional care	1.84±0.75	1.72±0.73	1.75±0.77	<.001	<.001	<.001
Sit up	Home care	2.35±0.75	1.97±0.82	1.95±0.83	<.001	<.001	<.001
Sit up	Institutional care	2.29±0.78	2.08±0.85	2.10±0.87	<.001	<.001	<.001
Sitting move	Home care	2.39±0.77	2.09±0.85	2.09±0.87	<.001	<.001	<.001
Sitting move	Institutional care	2.50±0.74	2.36±0.81	2.38±0.83	<.001	<.001	<.001
Emerging out of the room	Home care	2.76±0.52	2.53±0.66	2.50±0.68	<.001	<.001	<.001
Emerging out of the room	Institutional care	2.77±0.54	2.61±0.68	2.62±0.67	<.001	<.001	<.001
Toileting	Home care	2.74±0.44	2.55±0.55	2.53±0.55	<.001	<.001	<.001
Toileting	Institutional care	2.83±0.37	2.73±0.47	2.71±0.50	<.001	<.001	<.001
Bowel control	Home care	1.72±0.82	1.57±0.77	1.63±0.81	<.001	<.001	<.001
Bowel control	Institutional care	2.16±0.87	2.07±0.86	2.11±0.88	<.001	<.001	<.001
Bladder control	Home care	1.86±0.80	1.65±0.76	1.73±0.80	<.001	<.001	<.001
Bladder control	Institutional care	2.29±0.78	2.21±0.79	2.24±0.81	<.001	<.001	<.001
Shampoo	Home care	2.92±0.28	2.79±0.42	2.74±0.44	<.001	<.001	<.001
Shampoo	Institutional care	2.94±0.29	2.82±0.39	2.79±0.42	<.001	<.001	<.001

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

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
Variables	Comparative group	Reference group	Odd ratios	95% CI		p
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.

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