Improvement in Activities of Daily Living Among Older Adults With Physician-Led Home Visits: A Multicenter Retrospective Cohort Study in Japan

BACKGROUND: Japan is promoting physician-led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician-led home care and to identify associated factors. METHODS: This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician-led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10-point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause-specific Cox regression was conducted to identify factors associated with BI improvement. RESULTS: A total of 660 patients were analyzed, with a median follow-up of 308 days. The one-year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause-specific Cox regression showed that patients with MMSE-J scores < 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement. CONCLUSION: Following the initiation of physician-led home visits, approximately one-quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care.