The Effects of Home Visit Healthcare Using a Complex Program on Community-dwelling Frail Elders' Strength, Frailty, and Depression

Hee Gerl Kim

doi:10.12799/jkachn.2015.26.4.405

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Kim: The Effects of Home Visit Healthcare Using a Complex Program on Community-dwelling Frail Elders' Strength, Frailty, and Depression

Original Article

Journal of Korean Academy of Community Health Nursing 2015; 26(4): 405-414.

Published online: 31 December 2015

DOI: https://doi.org/10.12799/jkachn.2015.26.4.405

The Effects of Home Visit Healthcare Using a Complex Program on Community-dwelling Frail Elders' Strength, Frailty, and Depression

Hee Gerl Kim

College of Nursing, Gachon University, Incheon, Korea.

Corresponding author: Kim, Hee Gerl. College of Nursing, Gachon University, 1342 Seongnam-daero, Sujung-gu, Seongnam 13120, Korea. Tel: +82-31-750-5982, Fax: +82-31-750-8859, hgkim@gachon.ac.kr

Received 28 September 2015 Revised 7 December 2015 Accepted 20 December 2015

(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

The purposes of this study were to examine the effects of home visit healthcare using a complex program on community-dwelling frail elders' physical strength, frailty, and depression and to compare the effects among three regions.

Methods

This study was conducted as a quasi-experimental study using one-group pretest-posttest design. A total of 86 subjects were sampled from three regions (metropolis, small city, and rural area). The program was applied for 14 weeks. This program consisted of disease management by a visiting nurse, exercise with a visiting nurse, self exercise, telephone monitoring, health education, counseling, providing handbook, and incentive. Physical strength was measured by balance, upper-limb, and lower-limb muscle strength. Frailty was measured by the Korean Frail Scale and depression was measured by the Geriatric Depression Scale. Paired t-test and ANCOVA were used to analyze the effects.

Results

Physical strength, frailty, and depression were significantly improved after applying the complex program. There were not differences among the regions.

Conclusion

Home visit healthcare using a complex program was effective in improving frail elders' physical strength, frailty, and depression. There were not differences among the regions. Therefore, home visit healthcare using a complex program needs to be expanded to other regions.

Keywords: Frail elderly, Motor activity, Depression, Program evaluation

Figures and Tables

Figure 1

Home visit healthcare using complex program.

Table 1

The Visit Health Program Using Complex Program for the Frail Elderly

Domains	Contents	Instruments	Frequency	Personnels
Physical strength & mental status assessment	· Measurement · Planning	· Items · Physical strength (Balance, upper-limb, and lower-limb strength) · Frailty · Depression · Providing health mileage handbook, and poster on exercise, and self ckecklist	· Pre: at the beginning class · Post: at the ending class	Visit nurse, physical therapist, exercise therapist
Complex exercise	· Exercise without tools for muscle strength · Hand exercise for preventing dementia · Laughter Therapy · Exercise with tools (Sera band, bean bag)	· Exercise with visit nurse · Self ckecklist after exercise at home · Telephone monitoring · Providing mileage stickers	· 1 / week · 2~3 / week · 1 / week · 1 / week	Visit nurse, physical therapist, exercise therapist
Health education	· Nutrition · Oral care · Chronic disease management	· Providing mileage stickers	· 1 / 4~6week	Visit nurse, dietitians, dental hygiene agents

Table 2

General Characteristics of the Subjects

Variables	Categories	n (%) or M±SD
Region	Metropolis	24 (27.90)
	Small city	48 (55.81)
	Rural area	14 (16.27)
Gender	Male	9 (10.46)
Gender	Female	77 (89.53)
Age (year)		78.5±5.50
	<80	55 (63.95)
	≥80	31 (36.05)
Total		86 (100.00)

Table 3

Physical Function, Frailty, and Depression Before Home Visit Healthcare Using Complex Program

Indicators		Region	Pre	F (p)
Indicators		Region	M±SD	F (p)
Physical function	Balance (second)	D-gu	4.13±6.16	0.53 (.594)
		S-si	5.42±5.18
		Y-gun	5.71±6.01
	Low-limb strength (frequency)	D-gu	6.50±2.99^a	7.12 (.001) b>a
		S-si	10.02±4.18^b
		Y-gun	8.14±3.13^ab
	Upper-limb strength (frequency)	D-gu	11.08±9.30	1.89 (.157)
		S-si	13.19±4.95
		Y-gun	9.86±3.84
Frailty		D-gu	3.38±1.86	0.79 (.456)
		S-si	3.58±1.39
		Y-gun	4.00±1.11
Depression		D-gu	4.96±3.94	0.42 (.662)
		S-si	5.56±3.25
		Y-gun	4.71±4.12
Physical function	Balance (second)	<80	6.11±6.37	2.27 (.008)
	Balance (second)	≥80	3.32±3.10	2.27 (.008)
	Low-limb strength (frequency)	<80	9.15±4.25	1.26 (.210)
	Low-limb strength (frequency)	≥80	8.00±3.62	1.26 (.210)
	Upper-limb strength (frequency)	<80	12.47±6.92	0.80 (.427)
	Upper-limb strength (frequency)	≥80	11.32±5.40	0.80 (.427)
Frailty		<80	3.44±1.49	-1.32 (.191)
Frailty		≥80	3.87±1.43	-1.32 (.191)
Depression		<80	5.05±3.83	-0.69 (.490)
Depression		≥80	5.61±3.08	-0.69 (.490)

Table 4

Differences in Physical Function, Frailty, and Depression Before and After Home Visit Healthcare Using Complex Program

Indicators		Pre	Post	t (p)	Post-Pre
Indicators		M±SD	M±SD	t (p)	M±SD
Physical function	Balance (second)	5.31±5.70	9.85±12.63	-4.08 (<.001)	4.54±9.96
	Lower-limb strength (frequency)	8.85±4.08	11.68±4.80	-6.10 (<.001)	2.83±3.85
	Upper-limb strength (frequency)	12.12±6.46	17.16±5.82	-6.93 (<.001)	5.04±6.54
Frailty		3.59±1.52	2.19±1.69	1.77 (<.001)	-1.41±1.63
Depression		5.22±3.58	4.35±3.57	1.64 (.025)	-0.88±4.37

Table 5

Differences in Physical Function, Frailty, and Depression Before and After Home Visit Healthcare Using Complex Program by Regions and Age

Indicators		Region	Post-Pre		Source	F (p)
			<80	≥80
			M±SD	M±SD
Physical function	Balance (second)	D-gu	2.94±4.71	2.29±2.69	Region	1.51 (.228)
		S-si	8.00±14.85	3.81±6.08	Age	0.66 (.418)
		Y-gun	1.75±7.25	0.20±1.31	Region^*Age	0.24 (.778)
	Low-limb strength (frequency)	D-gu	3.88±4.19	2.71±1.70	Region	1.09 (.340)
		S-si	3.24±4.81	2.43±3.39	Age	0.89 (.766)
		Y-gun	0.75±1.16	1.80±1.41	Region^*Age	0.35 (.709)
	Upper-limb strength (frequency)	D-gu	7.69±9.47	8.57±6.80	Region	3.73 (.029)
		S-si	4.41±5.66	4.56±5.60	Age	0.41 (.525)
		Y-gun	1.00±2.00	3.20±2.73	Region^*Age	0.13 (.883)
Frailty		D-gu	-0.88±1.50	-2.00±1.15	Region	0.45 (.643)
		S-si	-1.70±1.67	-1.44±1.67	Age	0.33 (.566)
		Y-gun	-1.13±1.46	-1.00±2.45	Region^*Age	1.22 (.301)
Depression		D-gu	-1.19±2.61	-3.00±4.65	Region	3.03 (.054)
		S-si	-1.45±3.26	0.06±4.02	Age	0.15 (.698)
		Y-gun	0.25±2.87	1.60±2.87	Region^*Age	1.68 (.194)

Notes

This research was supported by the National Health Insurance Corporation research fund of 2014(GCU-2015-0161).

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