Homebound Status and the Critical Role of Caregiving Support

Paid Care Services and Transitioning out of the Community Among Black and White Older Adults With Dementia

OBJECTIVES

Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia.

METHODS

Using data from 303 participants (29.4% Black) with probable dementia in the 2011 National Health and Aging Trends Study, competing risk hazards models estimated the association between receiving paid care at baseline and the probability of transitioning out of the community over 8 years (through 2019). Covariate selection was guided by the Andersen model of health care utilization.

RESULTS

Paid care was associated with lower risk of transitioning out of the community (subhazard ratios [SHR] = 0.70, 95% CI [0.50, 0.98]). This effect was similar after controlling for predisposing factors and most prominent after controlling for enabling and need for services factors (SHR = 0.65, 95% CI [0.44, 0.95]). There was no racial difference in the use of paid care despite evidence of greater care needs in Blacks. Furthermore, Black participants were less likely to transition out of the community than Whites.

DISCUSSION

Paid care services may help delay transitions out of the community. Future research should seek to explain racial differences in access to and/or preferences for home-based, community-based, and residential care.

Feasibility and acceptance of self-hypnosis to reduce chronic stress levels on family in-home caregivers of elderly people: protocol for the POSSAID pilot, randomised, wait-list controlled trial

INTRODUCTION

Family members who care for elderly people experience high levels of chronic stress because of the intensive assistance they provide permanently to those who are losing their autonomy. Often considered a burden, this stress causes serious consequences to their health and worsens their quality of life (QoL). Reducing caregivers' chronic stress via self-hypnosis protocols may be an effective treatment. The objective is to evaluate the feasibility and acceptance of self-hypnosis protocols taught by hypnotherapy-trained nurses to reduce the chronic stress of in-family caregivers.

METHODS AND ANALYSIS

This study is a prospective, monocentric, non-blinded, parallel, pilot, randomised waitlist-controlled trial that will be conducted at the University Hospital of Reunion Island. Sixty participants will be randomly allocated to one of two groups: a self-hypnosis group (intervention) or a waitlist control group. After an 8-week training programme, intervention participants will practice self-hypnosis for ten minutes/day over 8 weeks and subsequently be followed up for 16 weeks thereafter. The primary outcome is to assess the feasibility of a 16-week self-hypnosis protocol for in-family caregivers. Secondary outcomes include the evaluation of the effects of practising self-hypnosis among in-family caregivers of elderly people concerning their stress levels, sleep disorders, levels of fatigue, and QoL at 2, 4 and 8 months on an exploratory basis.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Institutional Ethics Committee CPP Ile de France VI-Groupe Hospitalier Pitié Salpêtrière on 14 April 2021 (ID RCB: 2021-A00009-32). All participants will receive information about the trial in verbal and written forms. They will give an oral consent which is notified in a dedicated research file prior before enrolment. Results will be published in peer-reviewed journals as well as presented and disseminated at conferences.

TRIAL REGISTRATION NUMBER

NCT04909970.

Educational Attainment Differences in Attitudes toward Provisions of IADL Care for Older Adults in the U.S

Educational attainment is increasingly associated with family inequality in the U.S., but there is little understanding about whether and how education stratifies attitudes toward eldercare. Using the General Social Survey 2012 Eldercare Module, I test the association between educational attainment and attitudes toward eldercare provisions of Instrumental Activities of Daily Living (IADL) including different combinations of help and payment for help. IADLs are the most common care received by older adults and needs are projected to grow, so understanding attitudes toward this type of care is timely and relevant. Results show that adults with a bachelor's degree or graduate/professional degree, compared to adults with less than a high school degree, are more likely to support complete family IADL eldercare, where families provide the care and any payment necessary for care, compared to complete outside IADL eldercare, where outside institutions provide both care and payment. Educational attainment is an important axis of stratification in the U.S. and may explain potentially bifurcated policy solutions desired among different groups.

The Experience of Homebound Older Adults During the COVID-19 Pandemic

BACKGROUND

Homebound older adults have heightened risks for isolation and negative health consequences, but it is unclear how COVID-19 has impacted them. We examine social contact and mood symptoms among previously homebound older adults during the COVID-19 pandemic.

DESIGN/SETTING

Cross-sectional analysis using data from the National Health and Aging Trends Study (NHATS), a nationally-representative longitudinal study of aging in the USA.

PARTICIPANTS

A total of 3,112 community-dwelling older adults in 2019 who completed the COVID-19 survey in the summer/fall of 2020.

MEASUREMENTS

Homebound status was defined via self-report as rarely/never leaving home or leaving the house with difficulty or help in the prior month. We measured limited social contact during COVID-19 (in-person, telephone, video or email contacts

RESULTS

Among homebound older adults, 13.2% experienced limited social contact during COVID-19 vs. 6.5% of the non-homebound. Differences in social contact were greatest for contacts via email/text/social media: 54.9% of the homebound used this

DISCUSSION

Isolation among homebound older adults increased during COVID-19, partially due to differences in technology use. We must ensure that homebound persons have the connection and care they need including new technologies for communication during and beyond COVID-19.

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Key Words

• COVID-19
• Homebound
• Isolation
• NHATS
• Social contact

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MESH Headings

• Aged
• COVID-19/epidemiology
• Cross-Sectional Studies
• Homebound Persons
• Humans
• Loneliness
• Longitudinal Studies
• Pandemics

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Grants

• P01 AG066605 NIA NIH HHS
• R01 AG060967 NIA NIH HHS
• K23 AG066930 NIA NIH HHS
• P30 AG044281 NIA NIH HHS
• P30 AG028741 NIA NIH HHS
• K01 AG059831 NIA NIH HHS
• K23 AG065438 NIA NIH HHS
• L30 AG060590 NIA NIH HHS
• K76 AG064427 NIA NIH HHS
• National Institute on Aging

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Affiliation(s)

Claire K Ankuda Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, USA.
Ashwin Kotwal Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
Jennifer Reckrey Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, USA
Krista L Harrison Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, CA, USA Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
Katherine A Ornstein Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, NY, USA

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The burden of boundedness and the implication for nursing: A scoping review

Background

In the COVID‐19 pandemic, many people experienced temporal boundedness in different ways (e.g., home, country, persons, and rules). However, being bound is also a permanent experience for chronically ill or handicapped people with sometimes serious consequences. To be able to recognize the phenomenon, a clear definition is necessary. In the literature, though, boundedness shows up as a very multifaceted phenomenon.

Objectives

Exploring and conceptualizing the phenomenon of boundedness taking into account the various forms and the consequences for nursing.

Methods

A scoping review using the framework of Arksey and O'Malley and the PRISMA statement (PRISMA‐ScR) to verify the fullness of the review.

Data Sources

Online dictionaries and theoretical and empirical publications in CINAHL, Medline via PubMed, PsycINFO, PsycArticles, Scopus, WISO. A total of 34 sources were included.

Results

Boundedness as a contextual concept is ambiguous. There are three basic causes: an acquired condition, personal obligations, arranged conditions, two principal courses: enduring and temporary, and seven types of being bound: to one or more person(s), to a place/position, to/in an object, to thoughts/opinions, to activities, to/in substances and to time. Examples of types are bedbound, culture‐bound, homebound, time‐bound, wheelchair‐bound and are particularly relevant for care. The consequences are manifold, physically, as well as mentally, and socially.

Conclusion

To reduce or avoid the burdens caused by boundedness, the concept must be implemented in nursing education and nursing practice. To this end, nursing research must further specify the types of boundedness in concept analyses and develop suitable interventions.