PICOT (on Home Health Agency)

Clinical Problem

Obesity is increasingly becoming one of the major global public health challenges of the 21st century. The health problem has tripled in the world since the year 1975. The World Health Organization (2021) estimates that in 2016, over 650 million people who were aged 18 years and above had obesity. More than 4 million people die every year due to obesity and its complications. Previously, obesity was associated with high-income countries. However, the prevalence of the condition in both middle and low income nations is increasing at an alarming rate. An individual is considered to be obese when he or she has abnormal body weight that is not consistent with his or her age and height. Obesity is caused by an energy imbalance which occurs between consumed and expended calories (Igel et al., 2018).  This condition increases the risk for developing chronic conditions such as hypertension, cardiovascular disease, diabetes, and asthma. It also results in mental health problems such as depression and anxiety (Petridou et al., 2019; Schuldt et al., 2020). Despite this, obesity is preventable and manageable. This can be achieved through physical` activity, dietary changes, and health education (Petridou et al., 2019; Thompson et al., 2020). The efficacy of these strategies depends on the severity of one’s condition, and the willingness to embrace a weight-loss plan. Home health care has become one of the main treatment options for obese patients. It is considered to be more cost-effective compared to hospital care. The current PICOT statement paper examines the effectiveness of home health agency programs in promoting weight loss among the elderly people.

PICOT Statement

Among elderly persons with obesity receiving care through a home health agency (P), is regular physical exercise more effective (I) than health education programs (C) in enhancing weight loss (O) within one year (T)?

Evidence-Based Solution

A home health agency is an example of home health care organization that provides nursing and other forms of therapeutic services to patients. Some of the major healthcare services provided through the agency include injections, patient education, nutritional therapy, exercise therapy, and monitoring of serious illnesses (Centers for Medicare & Medicaid Services, 2021). Home health agencies employ physicians and registered nurses in order for them to function well in providing care services to patients. Examples of patients who receive healthcare services through the agencies include those who have obesity, hypertension, heart failure, diabetes, musculoskeletal disease, and respiratory disorders. The aim of any home health agency is to enable patients achieve improved healthcare outcome, regain independence, and become self-sufficient (Institute for Healthcare Improvement, 2021). Unlike hospital care settings, home health agencies are in most cases less expensive, convenient, and effective (Centers for Medicare & Medicaid Services, 2021). These advantages make the agencies the best option for elderly obese patients who are not able to stay in hospitals for long periods due to their conditions. The largest payor for home health agencies is Medicare. Other sources of funding include Medicaid, Veterans’ Administration, and out-of-pocket payment.

Nursing Intervention

Nurses working in home health agencies play a significant role in providing one-on-one care to patients in homes. They attend elderly, disabled and critically ill patients, and those who are recuperating from injuries and surgery. The nurses also provide ongoing support and care as well as patient education (Schuldt et al., 2020).  In terms of what they specifically do in providing care to elderly obese patients, home health agency nurses assess the healthcare needs of the patients. They perform physical assessments, and examine the patients for vital signs. In the process, they help physicians in developing plans of care. The nurses then ensure that the plan of care is adhered to by patients, their family members, and various support staff members. It is also important to note that these nurses administer medication, and provide basic care to the old obese patients. Apart from this, they evaluate and monitor the patients’ response to medication, and treatment. Additionally, the nurses assist patients to carry out daily life activities, including bathing and toileting (Petridou et al., 2019; Schuldt et al., 2020; Thompson et al., 2020).

Patient Care

Just like other healthcare professionals, nurses have the responsibility of ensuring that they provide quality and care services to patients. Such services are important for better patient outcomes. In the recent years, obese patients are increasingly opting for care services provided at their home settings. Such a case is common for the elderly who encounter mobility problems due to their frailty (Schuldt et al., 2020). Nurses working in home health agencies play a vital role in providing care to such patients. One of the main things they do is to help the patients manage their weight (Igel et al., 2018). They encourage them to engage in regular physical activities in order to lose weight. This involves helping them to do lighter exercises such as walking and jogging. The nurses also help the patients to embrace healthy eating habits. They discourage them not to take certain foods that contribute to accumulation of weight in their bodies. Moreover, the nurses provide useful health education to the obese patients (Petridou et al., 2019). This helps them to understand how best to manage their condition.

Health Care Agency

Home health agencies are part of the health care agencies that play a significant role in supporting the elderly people with obesity in order to achieve improved health outcomes. In most cases, the agencies comprise a team of healthcare professionals providing different services to patients. These include nurses, physicians, dietitians, physiotherapists, occupational therapists, and psychologists (Centers for Medicare & Medicaid Services, 2021). The experts coordinate in promoting healthy lifestyle modifications among patients. They encourage the patients to lose weight through healthy exercise, diet, and health education (Igel et al., 2018; Petridou et al., 2019). The efficiency of home health agencies in provision of care to persons living with obesity depends on the ability of the team of experts in treating the symptoms of the condition, and improving their quality of life.

Nursing Practice

The use of home health agencies in the management of obesity among the elderly persons has important implications to nursing practice. To begin with, providing care services in such settings gives nurses the opportunity to embrace interprofessional collaboration (Titler et al., 2016; Petiprin, 2020). It enables them to work together with other healthcare experts in order to provide care of high quality to the patients of obesity. Apart from this, serving in the agencies allows nurses to provide patient-centered care to obese patients (Bowen & Forrest, 2017; Petiprin, 2020). This is necessary for positive treatment outcomes.  It is as well important to note that giving care to obese individuals in a home setting enhances nursing accountability (Mitchell, 2013). It ensures that nurses are keen on what they are doing . This leads to minimization of medical errors, and provision of quality care services.


Bowen, D. M., & Forrest, J. L. (2017). Translating Research for Evidence-Based Practice. Retrieved from https://pubs.royle.com/publication/?i=369630&article_id=2666624&view=articleBrowser&ver=html5

Centers for Medicare & Medicaid Services. (2021). Home Health Providers. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs

Igel, L.I., Saunders, K.H. & Fins, J.J. (2018). Why Weight? An Analytic Review of Obesity Management, Diabetes Prevention, and Cardiovascular Risk Reduction. Curr Atheroscler Rep 20 (39). https://doi.org/10.1007/s11883-018-0740-z

Institute for Healthcare Improvement. (2021). Science of Improvement: Testing Changes. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges.aspx

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nurs Manag (Harrow), 20 (1): 32-37.  doi: 10.7748/nm2013.

Petiprin, A. (2020). Nursing Theory. Retrieved from https://nursing-theory.org/

Petridou, A., Siopi, A., & Mougious, V. (2019). Exercise in the management of obesity. Metabolism, 92: 163-169. https://doi.org/10.1016/j.metabol.2018.10.009

Schuldt, R., Felix, H., & Bradway, C. K. (2020). The Impact of Severe Obesity on Home Health Care Agency Admission: An Organizational Perspective. Home Health Care Services Quarterly, 40(4). DOI:10.1080/01621424.2020.1856747

Thompson, J., Parkinson, M., & Collery, R. (2020). Care home staff’s experiences and views of supporting the dietary management and choices of older residents with obesity. International Journal of Older People Nursing, 15 (4): e12343. https://doi.org/10.1111/opn.12343

Titler, M. G., Conlon, P., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. (2016). The effect of a translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S. Appl Nurs Res, 31:52-9. doi: 10.1016/j.apnr.2015.12.004

World Health Organization. (2021). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

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