An investigation into which individual instrumental activities of daily living are affected by a home visiting nurse intervention

Objective: to investigate the effects of an HVN intervention on the difficulty or dependence in six individual IADLs. Design: a secondary analysis of a randomised controlled study comparing an HVN intervention (n = 237) with usual care (n = 262) at 22 months after study entry. Setting: home care linked to primary care. Subjects: a total of 499 Medicare patients needing or receiving help with at least three IADLs or two ADLs, who had recent significant health-care use. Methods: the intervention consisted of monthly home visits by trained nursing staff. Unadjusted and adjusted (binary and multinomial logistic regression) analyses were performed. Results: unadjusted analyses found less difficulty or dependence for the HVN group for meal preparation, telephone use, shopping and ordinary housework, and more difficulty or dependence for medication management. After adjustment, in addition to an effect through health-care services use, the HVN group had less difficulty or dependence for meal preparation and shopping and more difficulty or dependence for medication management. Conclusions: an HVN intervention had mixed results for individual IADLs. The negative effect on medication management questions the validity of a total IADL score as an outcome measure, and implies that other medication management measures should be considered for outcome evaluation. Future research is needed to confirm and better understand these findings.