Multidimensional factors affecting homebound older adults: A systematic review

Effective Interventions for Homebound Older Adults With Type 2 Diabetes: A Systematic Review

PURPOSE OF REVIEW

Homebound older adults with type 2 diabetes (T2DM) have worse outcomes compared to older adults with diabetes who are not homebound. This systematic review aimed to summarize evidence on interventions aimed to improve outcomes in homebound older adults with T2DM. The PRISMA guidelines for reporting of systematic reviews were followed. PubMed, CINAHL, SCOPUS, and PsycINFO databases were searched. To be included, studies were published from database inception until November 6, 2023. Eligible studies included Participants who were older adults with a mean age of 60 or older; Interventions of any type; Comparators of any type; Outcomes of hemoglobin A1c (HbA1c), blood pressure, cholesterol, quality of life (QOL), healthcare utilization, depression, anxiety, psychological distress, or mortality; Study designs of clinical trials.

RECENT FINDINGS

There were 2,280 articles identified by the search, with nine articles included in the final review. Eight studies were conducted in the United States and one in Japan. Seven used pre-post designs and two were randomized controlled trials. Sample sizes ranged from 11 to 8,318,291. Study participants had a mean age of 60-82 years. Interventions included telehealth, home-based health care with in-home primary care visits, nutrition counseling, and meal delivery programs. We found a paucity of studies tailored to homebound older adults with T2DM. Results suggest that interventions provided to homebound older adults with T2DM in the home, including home-based primary care, case management/care coordination, joint patient and caregiver/family education, and home telemonitoring integrated into electronic medical systems, hold promise for improving clinical outcomes.

Digital Technology Use in US Community-Dwelling Seniors With and Without Homebound Status

OBJECTIVES

To examine (1) the prevalence of digital technology use, including information and communication technology devices, everyday technology use, and digital health technology use among community-dwelling older adults with or without homebound status and (2) the associations of digital technology use with homebound status.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

We used the 2022 National Health and Aging Trends Study (NHATS) data that included 5510 community-dwelling older adults.

METHODS

Digital technology use was assessed using self-reported outcomes of the technological environment component of the NHATS, including information and communication technology devices, everyday technology use, and digital health technology use. Homebound status was measured with 4 mobility-related questions regarding the frequency, independence, and difficulties of leaving home. Survey-weighted, binomial logistic regression was used to examine the associations of 17 technological-related outcomes and homebound status.

RESULTS

Overall, the prevalence of homebound older adults was 5.2% (95% CI, 4.4%-6.1%), representing an estimated 2,516,403 people. The prevalence of digital technology use outcomes varied according to homebound status. The prevalence of any technology used in homebound, semi-homebound, and non-homebound populations was 88.5%, 93.3%, and 98.5%, respectively. Compared with non-homebound older adults, semi-homebound older adults had lower odds of emailing (OR, 0.71; 95% CI, 0.53-0.94), using the internet for any other reason (OR, 0.70; 95% CI, 0.49-0.99), visiting medical providers (OR, 0.68; 95% CI, 0.48-0.95), and handling insurance (OR, 0.75; 95% CI, 0.56-0.99); homebound older adults had lower odds of using a phone (OR, 0.41; 95% CI, 0.28-0.59), using any everyday technology (OR, 0.58; 95% CI, 0.38-0.89), visiting medical providers (OR, 0.52; 95% CI, 0.35-0.76), and handling insurance (OR, 0.57; 95% CI, 0.38-0.86).

CONCLUSIONS AND IMPLICATIONS

Non-homebound older adults are more likely to use digital technology than those who are semi-homebound or homebound. Public health care providers should prioritize efforts to enhance digital inclusion to ensure that all older adults can benefit from the advantages of digital technology.

Estimating the Effect of Engagement in Community-Based Going-Out Program on Incidence Disability in Older Adults

OBJECTIVES

Although going out has been reported to be associated with the incidence of disability, few studies have investigated the effect of community-based programs to promote going out on the incidence of disability. This study aimed to estimate the effects of a program fostering going-out on the incidence of disability in community-dwelling older adults.

DESIGN

Longitudinal, observational study.

SETTING AND PARTICIPANTS

Nonengaged (n = 1086) and engaged older adults (n = 1086) enrolled in the National Center for Geriatrics and Gerontology Study of Geriatric Syndrome by using a one-to-one nearest neighbor propensity score-matching scheme.

METHODS

After the baseline assessments, participants in the community-based going-out program received a specialized physical activity tracker, monitored their daily physical activity, and received personalized feedback on going out to community facilities with a system for reading the device for 12 months. Disability onset was defined as a new case of long-term care under the public insurance certification in Japan within 48 months of program completion. The absolute risk reduction and the number needed to treat for the incidence of disability were calculated for the nonengaged and engaged groups. Cox proportional hazard regression analysis, using inverse probability weighting was used to obtain the hazard ratio.

RESULTS

Disabilities occurred in 112 individuals in the matched nonengaged group and 51 individuals in the engaged group. The absolute risk reduction was 5.67% (95% CI 3.46%-7.88%). The number needed to treat was 18 (95% CI 13-29). The hazard ratio, with the nonengaged group as the reference, was 0.49 (95% CI 0.36-0.67).

CONCLUSIONS AND IMPLICATIONS

This longitudinal observational study suggested that a community-based program could prevent 1 disability in every 18 participants. This program does not require a professional instructor, only the distribution of devices and system installation, and it could be beneficial as a population-based approach to preventing disabilities.

Homebound older adults who live independently in rural Japan: Prevalence and contributing factors during the COVID-19 pandemic

Being homebound is a phenomenon of confining older adults to their homes owing to health, social, and psychological factors. During the COVID-19 pandemic, people were requested to refrain from going out to prevent infection. Consequently, the homebound status of older adults was influenced by social and environmental factors, resulting in an increase in the number of homebound older adults during the pandemic. This study aimed to determine the homebound prevalence and related factors among homebound older adults during the COVID-19 pandemic. In 2021, a cross-sectional study conducted in rural Saitama, Japan, included 1,020 participants aged 65 years and above who did not have long-term care insurance certification and were independent in instrumental activities of daily living. Herein, homebound individuals were defined as those who went out once a week or less. The relationships of homebound status with demographic, health, social, and psychological factors in older adults were examined. The prevalence of homebound independent older adults was estimated as 10.4 % (6.6 % males, 13.8 % females). Homebound status was significantly associated with one or more medical histories (odds ratio [OR] = 1.98, 95 % confidence interval [CI] = 1.00-3.90), no social or family roles (OR = 1.95, 95 % CI = 1.09-3.48), and no hobbies (OR = 1.84, 95 % CI = 1.02-3.34). Establishing social or family roles and promoting participation in hobbies may prevent older adults from being homebound. The social environment, which changed during the pandemic, should be improved to encourage older adults to go out.

HEPPI: a randomized controlled trial of the efficacy of a cognitive-emotional intervention for homebound older adults

OBJECTIVES

This randomized controlled trial aimed to assess the efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI), a home-delivered cognitive-emotional intervention, among the homebound older population presenting with mild cognitive impairment and depressive or anxiety symptoms.

METHODS

Participants were randomly assigned either to the intervention group or the treatment-as-usual group and completed baseline, post-intervention, and three-month follow-up assessments. Changes in episodic memory and symptoms of depression and anxiety were the primary outcomes. Secondary outcomes included changes in global cognition, attentional control, subjective memory complaints, functional status, and quality of life. Data were analyzed on an intention-to-treat basis employing a linear mixed models approach. ClinicalTrials.gov identifier: NCT05499767.

RESULTS

Compared with the treatment-as-usual group, the HEPPI group reported significant immediate improvement in cognition, mood, and daily functional performance. Positive effects of HEPPI were maintained over the follow-up phase only in depressive symptomatology, perceived incapacity to perform advanced instrumental activities of daily living, and self-reported emotional ability. A significant impact of the intervention on the subjective memory complaints level was observed only three months after the intervention.

CONCLUSIONS

This study suggests that HEPPI may be a promising home-delivered cognitive-emotional intervention to help homebound older adults improve their mental health.

Changes of trunk muscle stiffness in individuals with low back pain: a systematic review with meta-analysis

BACKGROUND

Low back pain (LBP) is one of the most common musculoskeletal conditions. People with LBP often display changes of neuromuscular control and trunk mechanical properties, including trunk stiffness. Although a few individual studies have examined back muscle stiffness in individuals with LBP, a synthesis of the evidence appears to be lacking. Therefore, the aim of this systematic review with meta-analysis was to synthesize and evaluate the available literature investigating back muscle stiffness in association with LBP.

METHODS

We conducted a systematic review of the literature according to the PRISMA guidelines. We searched Pubmed, Scopus, Web of Science and ScienceDirect for studies, that compared back muscle stiffness, measured either by ultrasound-based elastography or myotonometry, between individuals with and without LBP. Pooled data of the included studies were presented descriptively. Additionally, we performed two meta-analyses to calculate the standardized mean difference between the two groups for resting stiffness of the multifidus and erector spinae muscle. For both meta-analyses, the random effect model was used and the weight of individual studies was calculated using the inverse-variance method. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional studies. Furthermore, the certainty of evidence was evaluated using the GRADE approach.

RESULTS

Nine studies were included in our systematic review. Our results suggest that individuals with LBP have higher stiffness of the multifidus (SMD = 0.48, 95% CI: 0.15 - 0.81, p < 0.01; I2 = 48 %, p = 0.11) and erector spinae at rest (SMD = 0.37, 95% CI: 0.11 - 0.62, p < 0.01; I2 = 39 %, p = 0.14) compared to asymptomatic controls. On the other hand, the evidence regarding muscle stiffness during submaximal contractions is somewhat contradictory.

CONCLUSIONS

Based on the findings of this systematic review we conclude that people with LBP may have higher back muscle stiffness compared to asymptomatic controls. Addressing muscle stiffness might represent an important goal of LBP treatment. Nevertheless, our findings should be interpreted with extreme caution due to a limited quality of evidence, small number of included studies and differences in measurement methodology.

Proteins Associated with Persistent Apical Periodontitis: A Scoping Review

This scoping review aimed to assess immunohistochemical markers associated with the physiopathogenesis of Persistent Apical Periodontitis. The protocol was adapted from the Joanna Briggs Institute Reviewer's Manual (2017) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews. A total of 239 articles were considered potentially eligible, and their full texts read by two reviewers. Six articles were included. The included articles were published between 1999 and 2017. A total of 12 biomarkers were identified, forkhead box P3, cluster of differentiation (CD)3, CD8, CD450, CD68, transforming growth factor alpha, transforming growth factor-beta1, matrix metalloproteinase-9, receptor activator of nuclear factor kappa beta ligand, osteoprotegerin, CD90 and sex-determining region Y-box 2; categorized according to their applicability. Among the biomarkers identified, receptor activator of nuclear factor kappa beta ligand and osteoprotegerinare were related to bone remodeling in apical periodontitis and may also be associated with persistent apical periodontitis.

Contributing factors involved in the safety of elderly people with chronic illness in home healthcare: a qualitative study

INTRODUCTION

Patients receiving home care are often elderly people with chronic illnesses that increasingly experience patient safety barriers due to special care needs.

OBJECTIVE

The present study was conducted to determine the factors involved in the safety of elderly patients with chronic illnesses receiving home care.

METHODS

A qualitative study with a conventional content analysis method was conducted in home care agencies of Tehran, Iran from August 2020 to July 2022. For data generation, semistructured interviews were conducted with 11 nurses, 2 nurse assistants, 1 home care inspector (an expert working at the deputy of treatment) and 3 family caregivers. Moreover, four observational sessions were also held. Data analysis was done using the five-step Graneheim and Lundman method.

RESULTS

According to the results, the facilitators of the safety of the elderly patients with chronic illnesses included the family's participation, nurse's competence, efficiency of the home care agency management and patient's participation in patient safety. The barriers to patient safety included problems created by the family, nurse's incompetence, inefficiency of the home care agency, patient's prevention of patient safety, home care setting limitations and health system limitations.

CONCLUSION

The majority of the factors involved in the safety of elderly patients with chronic diseases receiving home care had dual roles and could serve as a double-edged sword to guarantee or hinder patient safety. Identification of the facilitators and barriers can assist nurses and the healthcare system in planning and implementing patient safety improvement programmes for elderly patients with chronic illnesses.

The bidirectional relationship between homebound status and falls among older adults: a longitudinal study

BACKGROUND

Previous research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. This study aimed to determine the bidirectional relationship between homebound status and falls among older adults in the community.

METHODS

We used data of the community-dwelling older adults from 2011 to 2015 of the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (Sample 1 [No falls at baseline]: N = 2,512; Sample 2 [Non-homebound at baseline]: N = 2,916). Homebound status was determined by the frequency, difficulty, and needing help for outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine the bidirectional association between homebound status and falls longitudinally.

RESULTS

Participants with no falls at baseline (n = 2,512) were on average, 76.8 years old, non-Hispanic whites (70.1%), and female (57.1%). After adjusting for demographics and health-related variables, prior year homebound status significantly contributed to falls in the following year (Odds ratio [OR], 1.28, 95% CI: 1.09-1.51). Participants who were non-homebound at baseline (n = 2,916) were on average, 75.7 years old, non-Hispanic white (74.8%), and female (55.8%). Previous falls significantly predicted later homebound status (OR, 1.26, 95% CI: 1.10-1.45) in the full adjusted model.

CONCLUSION

This is the first longitudinal study to determine the bidirectional association between homebound status and falls. Homebound status and falls form a vicious circle and mutually reinforce each other over time. Our findings suggest the importance of developing programs and community activities that reduce falls and improve homebound status among older adults.