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APHA Scientific Session and Event Listing

Recorded presentation

Dianne Liebel, RN, MSEd¹, Bruce Friedman, PhD, MPH², Nancy Watson, RN, PhD¹, and Bethel Powers, RN, PhD¹. (1) School of Nursing, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, 585-275-2375, dianne_liebel@urmc.rochester.edu, (2) Department of Community and Preventive Medicine, University of Rochester, 601 Elmwood Avenue Box 644, Rochester, NY 14642

The prevalence of disability dramatically increases with age, and its presence in community-dwelling older adults increases the onset of chronic illness, healthcare utilization, and mortality. Since almost 95% of older adults with disability reside in the community, preventive home visiting by nurses offers an approach to deliver targeted geriatric strategies to maintain functional status. Over the last 20 years a number of geriatric nurse home visiting interventions have been developed and tested. Although the results of these interventions are equivocal, there has been some evidence supporting better outcomes for disability. Improving and sustaining successful nurse home visiting interventions depends on the ability to identify which key components of the intervention are most effective. The Nurse intervention of the Medicare Primary and Consumer-Directed Care Demonstration had a statistically significant effect (p=.033) on number of activities of daily living in which the patient was dependent. We will conduct a process evaluation of the Nurse intervention which will include descriptive measurement of the specific structural characteristics (framework of service delivery) and critical processes (ways in which the services were delivered) used by the nurses across participants. Linear and logistic regression analyses will be used to test the impact of these processes on disability (adjusting for potential variables known to be associated with functional decline). The fidelity analysis will consider inter-individual variability in the intervention dosage. This study is essential to the improvement of subsequent nursing interventions, transfering these roles into existing home visiting and creating policy change in community health nursing.

Learning Objectives:

• 1.Evaluate the specific structural characteristics (framework of service delivery) and critical processes (way in which the services were delivered)used by nurses to impact functional status among high risk Medicare beneficiaries.
• 2.Discuss the benefit of nurse home visiting to high risk Medicare beneficiaries including the impact on future policy changes for community health nursing

Keywords: Home Visiting, Disability

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation