Initial Home Visit Research Articles

Risk factors associated with default among tuberculosis patients in Darjeeling district of West Bengal, India.

Background:The treatment outcome “default” under Revised National Tuberculosis Control Program (RNTCP) is a patient who after treatment initiation has interrupted treatment consecutively for more than 2 months.Aims:To assess the timing, characteristics and distribution of the reasons for default with relation to some sociodemographic variables among new sputum-positive (NSP) tuberculosis (TB) patients in Darjeeling District, West Bengal.Settings and Design:A case-control study was conducted in three tuberculosis units (TUs) of Darjeeling from August’2011 to December’2011 among NSP TB patients enrolled for treatment in the TB register from 1st Qtr’09 to 2nd Qtr’10. Patients defaulted from treatment were considered as “cases” and those completed treatment as “controls” (79 cases and 79 controls).Materials and Methods:The enrolled cases and controls were interviewed by the health workers using a predesigned structured pro-forma.Statistical Analysis Used:Logistic regression analysis, odds ratios (OR), adjusted odds ratios (AOR).Results:75% of the default occurred in the intensive phase (IP); 54.24% retrieval action was done within 1 day during IP and 75% within 1 week during continuation phase (CP); cent percent of the documented retrieval actions were undertaken by the contractual TB program staffs. Most commonly cited reasons for default were alcohol consumption (29.11%), adverse effects of drugs (25.32%), and long distance of DOT center (21.52%). In the logistic regression analysis, the factors independently associated were consumption of alcohol, inadequate knowledge about TB, inadequate patient provider interaction, instances of missed doses, adverse reactions of anti-TB drugs, Government Directly Observed Treatment (DOT) provider and smoking.Conclusions:Most defaults occurred in the intensive phase; pre-treatment counseling and initial home visit play very important role in this regard. Proper counseling by health care workers in patient provider meeting is needed.

The Psychometric Properties of the Barkin Index of Maternal Functioning

To evaluate the psychometric properties of the Barkin Index of Maternal Functioning (BIMF). Principal component factor rotation was used to conduct an exploratory factor analysis of the BIMF to determine if more concise versions exist. Patients were recruited from a large, urban medical center in the Northeast. The BIMF was administered at an initial home visit along with several other self-report and clinical assessments to women who scored≥10 on the Edinburgh Postnatal Depression Scale during the 4- to 6-week postpartum period. The BIMF was administered between October 2008 and September 2010. The distribution of BIMF item responses was examined along with interitem correlations. To establish construct validity, correlation coefficients were produced for the BIMF in relation to several other variables or assessments. A factor analysis was performed using principal component factor rotation. The factor analysis revealed a two-factor solution. The items that loaded on factor 1 gauged the mother's perception of her own competency in the maternal role and the items that made up factor 2 focused on the mother's needs. Items related to judgment from others and anxiety did not load on either factor. The BIMF may be administered in its 18-item version, as two separate subscales, or in its original 20-item format. A clinical threshold should be developed to facilitate accurate identification of mothers who are struggling with functioning during the postpartum period.

Reduction in Symptoms for Homebound Patients Receiving Home-Based Primary and Palliative Care

Increasing numbers of patients are living with multiple, chronic medical conditions and functional impairments that leave them homebound. Home-based primary and palliative care (HBPC) programs provide access to health care services for this vulnerable population. Homebound patients have high symptom burden upon program enrollment. Yet little is known as to how individual symptoms are managed at home, especially over longer time periods. The purpose of this study was to determine whether high symptom burden decreases following HBPC enrollment. All patients newly enrolled in an HBPC program who reported at least one symptom on the Edmonton Symptom Assessment Scale (ESAS) were eligible for telephone ESAS follow-up. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow-up care, interdisciplinary care management including social work, and urgent in-home care as necessary. Multivariate linear mixed models with repeated measures were used to assess the impact of HBPC on pain, depression, anxiety, tiredness, and loss of appetite among patients with moderate to severe symptom levels at baseline. One hundred forty patients were followed. Patient pain, anxiety, depression, and tiredness significantly decreased following intervention with symptom reductions seen at 3 weeks and maintained at 12 weeks. (p<0.01) Loss of appetite trended toward an overall significant decrease and showed significant reductions at 12 week follow-up. In a chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound.

Symptom Management over Time Among Homebound Patients Receiving Home-Based Primary and Palliative Care (SA527-A)

1.Review changes in symptom burden over time among chronically ill homebound.2.Describe management of symptoms among homebound patients receiving home-based primary care services. Increasing numbers of patients, many of whom are frail and elderly, are living with multiple chronic medical conditions and functional impairments that leave them homebound. Home-based primary care (HBPC) programs provide access to healthcare services for this vulnerable population. The Mount Sinai Visiting Doctors Program (MSVD) is a primary and palliative care program that cares for over 1,000 homebound patients annually. Our previous study showed that homebound patients have high symptom burden upon program entry including pain (47%) presumably due to the conditions and/or treatments that contribute to their homebound state. Yet little is known as to how individual symptoms are treated at home and how they respond to intervention, especially over longer time periods. The purpose of this study was to see how symptoms change over time following HBPC enrollment. HBPC patients who reported any symptoms on the Edmonton Symptom Assessment Scale (ESAS) at program entry between 2008 and 2010 were eligible for telephone ESAS follow-up at 3 week and 12 week intervals. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow up care, interdisciplinary care management including social work, and urgent in home care as necessary. Paired t-tests assessed change between baseline and subsequent time points. 130 patients were followed. For each individual symptom, among those with baseline moderate or severe symptoms, mean symptom score decreased at 3 week follow up (p < .05). Patient pain, anxiety, depression, lack of well-being, loss of appetite, drowsiness, nausea, and tiredness remained significantly decreased at 12 week follow-up. In a non-hospice chronically ill population of urban homebound, patient symptoms can be successfully managed in the home.

Towards Achieving Personalized Palliative Care: Predicting Symptom Burden in Community-Dwelling Patients With Advanced Illness (SA527-B)

palliative care program that cares for over 1,000 homebound patients annually. Our previous study showed that homebound patients have high symptom burden upon program entry including pain (47%) presumably due to the conditions and/or treatments that contribute to their homebound state. Yet little is known as to how individual symptoms are treated at home and how they respond to intervention, especially over longer time periods. Research Objectives. The purpose of this study was to see how symptoms change over time following HBPC enrollment. Method. HBPC patients who reported any symptoms on the Edmonton Symptom Assessment Scale (ESAS) at program entry between 2008 and 2010 were eligible for telephone ESAS follow-up at 3 week and 12 week intervals. Patients received a comprehensive initial home visit and assessment by a physician with subsequent follow up care, interdisciplinary care management including social work, and urgent in home care as necessary. Paired t-tests assessed change between baseline and subsequent time points. Result. 130 patients were followed. For each individual symptom, among those with baseline moderate or severe symptoms, mean symptom score decreased at 3 week follow up (p< .05). Patient pain, anxiety, depression, lack of well-being, loss of appetite, drowsiness, nausea, and tiredness remained significantly decreased at 12 week follow-up. Conclusion. In a non-hospice chronically ill population of urban homebound, patient symptoms can be successfully managed in the home. Implications for Research, Policy, or Practice. Future work should continue to explore symptom assessment and management over time for the chronically ill homebound who are cared for in HBPC programs.

Falls Risk Assessment Begins With Hello

Identifying older adults at risk for falls is a challenge all home healthcare agencies (HHAs) face. The process of assessing for falls risk begins with the initial home visit. One HHA affiliated with an academic medical center describes its experience in development and use of a Falls Risk Assessment (FRA) tool over a 10-year period. The FRA tool has been modified since initial development to clarify elements of the tool based on research and to reflect changes in the Outcome and Assessment Information Set (OASIS) document. The primary purpose of this article is to share a validated falls risk assessment tool to facilitate identification of fall-related risk factors in the homebound population. A secondary purpose is to share lessons learned by the HHA during the 10 years using the FRA.

The Impact of a Healthy Media Use Intervention on Sleep in Preschool Children

Although observational studies have consistently reported an association between media use and child sleep problems, it is unclear whether the relationship is causal or if an intervention targeting healthy media use can improve sleep in preschool-aged children. We conducted a randomized controlled trial of a healthy media use intervention in families of children aged 3 to 5 years. The intervention encouraged families to replace violent or age-inappropriate media content with quality educational and prosocial content, through an initial home visit and follow-up telephone calls over 6 months. Sleep measures were derived from the Child Sleep Habits Questionnaire and were collected at 6, 12, and 18 months after baseline; repeated-measures regression analyses were used. Among the 565 children analyzed, the most common sleep problem was delayed sleep-onset latency (38%). Children in the intervention group had significantly lower odds of "any sleep problem" at follow-up in the repeated-measures analysis (odds ratio = 0.36; 95% confidence interval: 0.16 to 0.83), with a trend toward a decrease in intervention effect over time (P = .07). Although there was no significant effect modification detected by baseline sleep or behavior problems, gender, or low-income status, there was a trend (P = .096) toward an increased effect among those with high levels of violence exposure at baseline. The significant effects of a healthy media use intervention on child sleep problems in the context of a randomized controlled trial suggest that the previously reported relationship between media use and child sleep problems is indeed causal in nature.

A Trans-Disciplinary Approach to Weight Loss in the Super Super Morbidly Obese

A Trans-Disciplinary Approach to Weight Loss in the Super Super Morbidly Obese

The importance of knowing the home conditions of patients receiving long-term oxygen therapy

PurposeLong-term oxygen therapy (LTOT) is one of the main treatments for patients with chronic obstructive pulmonary disease. Patients receiving LTOT may have less than optimal home conditions and this may interfere with treatment. The objective of this study was, through home visits, to identify the characteristics of patients receiving LTOT and to develop knowledge regarding the home environments of these patients.MethodsNinety-seven patients with a mean age of 69 plus or minus 10.5 years were evaluated. This study was a cross-sectional descriptive analysis. Data were collected during an initial home visit, using a questionnaire standardized for the study. The results were analyzed retrospectively.ResultsSeventy-five percent of the patients had chronic obstructive pulmonary disease, and 11% were active smokers. The patients’ mean pulse oximetry values were 85.9% plus or minus 4.7% on room air and 92% plus or minus 3.9% on the prescribed flow of oxygen. Most of the patients did not use the treatment as prescribed and most used a humidifier. The extension hose had a mean length of 5 plus or minus 3.9 m (range, 1.5–16 m). In the year prior to the visit, 26% of the patients received emergency medical care because of respiratory problems. Few patients reported engaging in leisure activities.ConclusionThe home visit allowed us to identify problems and interventions that could improve the way LTOT is used. The most common interventions related to smoking cessation, concentrator maintenance and cleaning, use of a humidifier, and adjustments of the length of the connector hose. Therefore, the home visit is a very important tool in providing comprehensive care to patients receiving LTOT, especially those who show lack of adequate progress and those who show uncertainty about the treatment method.

Attitudes and adjustment to the parental role in mothers following treatment for postnatal depression

BackgroundFew intervention studies of postnatal depression (PND) have evaluated accompanying changes in parenting, in spite of mounting evidence that exposure to chronic depression is detrimental to infant development. This study examined maternal attitudes and adjustment over the first postnatal year within a treatment trial. The aim was to examine whether maternal adjustment improved with earlier remission, and with combined medical and psychological treatment. MethodsAs part of a multicentre pragmatic randomised controlled trial of treatment for PND, mothers completed a measure of maternal adjustment and attitudes and the Edinburgh Postnatal Depression Scale at an initial home visit (week 0) and three follow-ups (weeks 4, 18 and 44). ResultsMaternal attitudes and adjustment improved with PND remission; earlier remission conferred no additional benefit by 44-week follow-up. In line with previous studies, no particular treatment modality (antidepressant or health-visitor delivered non-directive counselling), or combination of treatments, was more effective for improving adjustment to parenthood. However, the earlier start of antidepressant treatment provided a short-term advantage for improving attitudes and reducing perceived stress. LimitationsAs a result of the study's pragmatic trial design, there was high treatment non-compliance and no ‘pure’ control group. More depressed mothers may have been less likely to complete the maternal adjustment and attitudes measure. ConclusionsEffective treatment of PND is important not only for the mother's wellbeing but also for healthy adjustment to parenthood. Provision of treatment choice and early antidepressant treatment are suggested for optimising maternal attitudes and adjustment.

Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care

The effectiveness of a collaborative pharmacist-nurse intervention on resolving detected medication discrepancies as patients transitioned from hospital to home health care was evaluated. Patients age 50 years or older who were transitioning from hospital to home health care with qualifying diagnoses were eligible for study inclusion. Patients were assigned to a control or intervention group based on the geographic location of the patients' home. For the intervention group, the study coordinator initiated consultation with the nurse case manager to facilitate discrepancy resolution. Patients in the control group received usual care after the initial home visit by the study coordinator. Rehospitalization rates and the number of planned and unplanned physician visits were analyzed. Descriptive statistics were used to characterize and contrast patients in each study group. Equivalency testing was conducted to evaluate group comparability for demographic and health status variables and the use of health care services. A total of 490 medication discrepancies were identified. The discrepancy resolution rates in the intervention and control groups were 67.0% and 54.6%, respectively. Assignment to the intervention group was associated with enhanced medication discrepancy resolution (r = 0.539, p = 0.001). There was a trend toward more planned and unplanned physician visits, and a trend toward a greater number of rehospitalization days. A pharmacist-nurse collaboration designed to identify and resolve medication-related discrepancies in patients transitioning from the hospital to home health care led to significant improvement in medication discrepancy resolution.

Effect of Maternal Egg Consumption on Breast Milk Ovalbumin Concentration

Palmer D, Gold M, Makridess M. Clin Exp Allergy. 2008;38(7):1186–1191PURPOSE OF THE STUDY. To assess human milk ovalbumin concentrations after daily maternal ingestion of 1 cooked egg for a 3-week period.STUDY POPULATION. There were 32 mothers of singleton, breastfed, egg-sensitive infants with moderate-to-severe eczema. Egg sensitivity was identified by a positive skin-prick test result. Eczema was evaluated by using a standardized scoring system.METHODS. Families had an initial home visit by an experienced dietitian, which involved collection of demographic and dietary information. All women and children were asked to follow an egg-free diet from day 1 through the duration of the trial. Adherence to the egg-free diet was assessed via detailed dietary intake records for both mothers and children on days 1 to 3, 10 to 12, and 21 to 23. Mothers were randomly allocated to receive identical-appearing egg-free muffins or muffins containing 1 (55 g) whole egg. Each mother was given a 3-week supply of frozen muffins corresponding to her randomization group and consumed 1 muffin per day on days 3 through 23. Atopic dermatitis assessments were performed for each child at the commencement and completion of the trial. The mothers completed the Infant's Dermatitis Quality of Life Index 3 times during the trial. On days 3, 12, and 23, the mothers manually expressed 5 mL of breast milk into sterile containers before and 2, 4, and 6 hours after eating the test muffin. Breast milk samples were stored in the home freezer and collected on day 24. The breast milk samples were queried for ovalbumin concentration by using a sandwich enzyme-linked immunosorbent assay method. Breast milk ovalbumin concentrations (nanograms per milliliter) were plotted against time, and the resulting curve was used to determine peak ovalbumin concentrations and total ovalbumin excretions (nanograms per milliliter per hour). Independent-sample t tests, Mann-Whitney U tests, and Pearson's χ2 tests were used to investigate differences between the diet groups.RESULTS. Women in the egg group had higher ovalbumin concentrations in breast milk than did the control group at all time points. Within each dietary group, the frequency of ovalbumin detection, peak ovalbumin concentration, and total ovalbumin excretion did not differ at days 3, 12, and 23. Ovalbumin was not detected in the breast milk of 25% of the women in the egg group. Infant eczema symptom scores were significantly reduced with time for both groups.CONCLUSIONS. Human milk ovalbumin is related to maternal dietary egg intake. Comparable detection of ovalbumin across time suggests that ovalbumin does not accumulate in human milk. One quarter of the women had no ovalbumin detected in their breast milk on any of the study days, which suggests that some women either do not excrete ovalbumin in their breast milk when challenged with 1 egg or have delayed excretion beyond 6 hours. Maternal dietary avoidance of well-cooked egg may not be necessary for all breastfed infants with egg sensitivity and eczema.REVIEWERS COMMENTS. For breastfed infants with food allergy, strict avoidance of the offending food proteins for both mother and child is frequently recommended. Total dietary avoidance of egg is difficult for patients to achieve. Additional study is needed to substantiate or to refute the preliminary observation that regular maternal ingestion of a small quantity of well-cooked egg did not markedly exacerbate eczema symptoms in egg-sensitive breastfed infants.

Survivors of Childhood Cancer and Comparison Peers: The Influence of Peer Factors on Later Externalizing Behavior in Emerging Adulthood

To examine group differences and predictors of externalizing behavior and substance use during the transition to emerging adulthood (i.e., ages 18-25) among survivors of childhood cancer and comparison peers. Peer acceptance and social behavior were assessed in classrooms of 55 children (ages 8-15) during cancer treatment. Children with cancer, comparison peers (n = 60), and parents completed measures of externalizing behavior and/or substance use during an initial home visit and soon after participants turned 18. At follow-up, survivors and peers exhibited similar externalizing behaviors and substance use, except peers were more likely to use marijuana. Substance use was associated with earlier peer acceptance and social behavior. Survivors who were older at diagnosis were at greater risk for later externalizing behavior and substance use. Mean externalizing behaviors and substance use generally fell within normative ranges for both survivors and peers. Some survivors may benefit from interventions to reduce risk behavior.

Comparison of Home Health Care Physical Therapy Outcomes Following Total Knee Replacement With and Without Subacute Rehabilitation

Few studies have examined the rehabilitation progression of patients managed through home health care physical therapy services following total knee replacement surgery. This study compares the episodes of care and functional outcomes of patients sent directly home to those discharged to a subacute rehabilitation setting prior to home health care. Prospective data were collected from 212 consecutive home health care patients referred for physical therapy following total knee replacement surgery. Data routinely recorded by the physical therapist at each home visit related to ambulatory progression and physical status was used in analysis. Patients admitted to the subacute facilities on hospital discharge were older and less likely to have a caregiver in or near the home. Equivalent physical therapy outcomes were seen regardless of hospital discharge disposition, although patients admitted to subacute rehabilitation settings required an additional 12.4 days. Younger patients admitted to subacute rehabilitation settings demonstrated less desirable outcomes at time of initial home visit, although these differences disappeared by time of discharge from home health care. Findings suggest that direct discharge home following total knee replacement surgery is a viable option for many patients. The application of evidence to physical therapy practice can promote more informed decision-making and foster the use of best practice in the home health care setting.

Results of a Focused Scald-Prevention Program

Scalds are a leading cause of burn injury for young children. A focused prevention program was developed in the zip code accounting for the majority of scald burns. This study investigated the effect of the program. Families in the high-risk area were identified at clinics, community centers, and schools. Parent workshops and home visits were the interventions used. A pretest was administered at the workshop to measure baseline knowledge. A post-test was administered at either the home visit or by telephone to measure change in knowledge. A survey was used to measure baseline scald risks in the home. Home visits were used to reinforce information from workshops, evaluate the home environment, and assist parents to make environmental changes. Changes to the home environments were made, with antiscald devices installed in the shower, sink, or bathtub depending on parent preference. The survey was repeated on a follow-up home visit to determine whether parents adhered to environmental changes and safety practices. The postmeasurements were performed from 6 to 12 months after the initial measurement. More than 900 parents attended the initial workshops, and 173 consented to participate in the follow-up study and took the pretest. Of these, 62 completed the post-test, and 48 participated in a home visit. The mean pretest score was 72 +/- 1%, and mean post-test score was 85 +/- 1% (P < .01). The initial home visit surveys revealed an average of 7 +/- 2 scald risks per household, whereas follow-up surveys showed an average of 2 +/- 1 risks (P < .01). Antiscald devices were installed in 37 households on the initial visit and remained in place and functioning in 22 households (60%) on the follow-up visit. Before the focused prevention program, the admission rate from the target zip code was 137 per 100,000 children ages 0 to 5 years. After the intervention, there was a greater than 2-fold reduction, to 59 per 100,000 (P < .01). In addition, there were no new scald burns in the homes in which the focused prevention program took place. This study demonstrates that a focused burn-prevention program can identify high-risk groups, decrease the number of scald risks per home, and decrease the rate of scald burns in the population. This straightforward program could be used to intervene in high-risk groups in other communities.

Computerized Adaptive Testing for Follow-Up After Discharge From Inpatient Rehabilitation: I. Activity Outcomes

Haley SM, Siebens H, Coster WJ, Tao W, Black-Schaffer RM, Gandek B, Sinclair SJ, Ni P. Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes. Objective To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home. Design Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit. Setting Follow-up visits conducted in patients’ home setting. Participants Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions. Interventions Not applicable. Main Outcome Measures Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66). Results AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77–.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients’ own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval. Conclusions Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.

Reducing Home Triggers for Asthma: The Latino Community Health Worker Approach

This study assessed the ability of a community health worker asthma intervention to change home asthma triggers. A total of 56 children and 47 adults with asthma were enrolled. Home trigger scores for the children averaged 2.8 at the initial home visit and then 2.3, 2.1, and 2.0 at 3, 6, and 12 months. Home trigger scores for the adults showed a similar trend. Every home visit was associated with a 0.32 reduction in home trigger score (p < 0.01) for children and a 0.41 reduction (p < 0.01) for adults. This intervention shows promise as a way to reduce asthma triggers in urban low-income Latino communities.

Standards for Specialized Nutrition Support: Home Care Patients

Standards for Specialized Nutrition Support: Home Care Patients

Prevalence of chronic kidney disease and anemia among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study: Baseline results

Prevalence of chronic kidney disease and anemia among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study: Baseline results

A Pilot of a Gerontological Advanced Practice Nurse Preventive Intervention

Background Persons with an intellectual and developmental disability frequently face barriers in accessing preventive services in community‐based health care systems. As they age into middle years, they are at increased risk for functional decline. This paper presents a description of an advanced practice nurse (APN) intervention used in a pilot study that explored the feasibility of using an in‐home preventive model based on a comprehensive geriatric assessment with persons ageing with an intellectual and developmental disability.Method The APN intervention was fully provided to a sub‐sample (n = 70) of 201 participants with an intellectual and developmental disability enrolled in a programme called ‘Stay Well and Healthy!’ The APN intervention included an initial home visit for a comprehensive geriatric assessment with follow‐up home visits to review health status and assess adherence with recommendations and provide education and support to promote health and prevent functional decline.Results Advanced practice nurses identified a number of active health‐related problems for persons ageing with an intellectual and developmental disability (mean 5.2; range 1–14) that had potential effects on function and survival. The majority of recommendations (mean 14.4; range 6–35) were for clinical preventive services (42.2%) and self‐care for health‐related issues (36.8%).Conclusions This study showed that there were problems consistent with persons ageing with an intellectual and developmental disability and older adults without disability. The in‐home preventive APN intervention to promote healthy ageing and reduce health disparities in this population is feasible, needed, and warrants further study.