Elderly housebound: changes over time

Homebound older persons: prevalence, characteristics, and longitudinal predictors

The current study examines the prevalence and correlates of homebound status aiming to elucidate the predictors and implications of being homebound. Analyzed sample was drawn from two representative cohorts of older persons in Israel, including 1191 participants (mean age=83.10 ± 5.3 years) of the first wave of the Cross-Sectional and Longitudinal Aging Study (CALAS) and 418 participants (mean age=83.13 ± 5.2 years) of the Israeli Multidisciplinary Aging Study (IMAS). Cross-sectional and longitudinal analyses were conducted. Homebound prevalence rates of 17.7-19.5% were found. Homebound participants tended to be older, female, have obese or underweight body mass index (BMI), poorer health, lower functional status, less income, higher depressed affect, were significantly lonelier (in CALAS), and more likely to have stairs and no elevators, than their counterparts. Predictors of becoming homebound include low functional IADL status, having stairs and no elevator (in both cohorts), old age, female gender, and being obese or underweight (in CALAS). The study shows that homebound status is a prevalent problem in old-old Israelis. Economic and socio-demographic resources, environment, and function play a role in determining the older person's homebound status. Implications for preventing homebound status and mitigating its impact with regards to the Israeli context are discussed.

The effect of homebound status on older persons

OBJECTIVES

To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization.

DESIGN

Cross-sectional and longitudinal analysis using existing data sets of a national survey.

SETTING

A national survey.

PARTICIPANTS

The analyzed sample was drawn from a representative cohort of 1,191 older persons in Israel (mean age 83.1±5.3) in the first wave of the Cross-Sectional and Longitudinal Aging Study and 621 participants in the second wave of the study.

MEASUREMENTS

Homebound status, health, function, environment, mental health, distal events, mortality, activities daily living (ADLs), instrumental activities of daily living (IADLs), Orientation-Memory-Concentration Test, and Center for Epidemiologic Studies Depression Scale. Mortality data were recorded from the Israeli National Population Registry.

RESULTS

Homebound participants had a significantly higher risk of mortality than their non-homebound counterparts, even after controlling for background variables, health, and function (risk ratio=1.33, 95% confidence interval=1.08-1.63). In cross-sectional analysis, homebound status was related to depressed affect even after controlling for demographics, health, and function. In longitudinal analysis, homebound status predicted future depressed affect and ADL and IADL difficulties when controlling for demographics and health, but only IADL prediction was statistically significant when baseline levels of the outcome variable were entered into the regression.

CONCLUSION

The results highlight the detrimental effects of homebound status, underscoring the importance of preventing this state, of interventions to assist those who are homebound, and of future research to examine the efficacy and coverage of services to this population.

Life satisfaction and its correlates in older women with osteoarthritis

PURPOSE

To identify the relationships among functional disability, chronic daily stress, coping strategies, beliefs about personal control, social support, and life satisfaction in older women with osteoarthritis.

DESIGN

A descriptive, correlational design was used.

SAMPLE

The study participants were 107 women aged 60 years or older.

METHOD

Study participants completed six survey questionnaires and a demographic form.

FINDINGS

Bivariate correlational analyses showed that older women with poorer functional ability experienced greater chronic daily stress, reported more frequent use of emotion-focused coping strategies, and had a higher chance health locus of control. A hierarchic regression analysis revealed that the perceived social support and internal health locus of control significantly contributed to the prediction of life satisfaction after demographic, illness-related, and stress-related variables were controlled.

IMPLICATIONS

Stress management strategies matched to the participants' style of coping process can increase their sense of control over their health and enhance their social networks and activities.

Homebound status in a community-dwelling elderly population in Japan

The present study investigated the association between sociodemoraphic profiles, health condition and functional disabilities of subjects with a homebound status in a rural community setting. The subjects were residents aged 65 years or over in a mountain village of Japan. A comprehensive questionnaire was used to obtain their data. Among the 1,002 residents, the information of 866 residents (85%), who voluntarily completed the entire survey, was obtained for this study. All the subjects were native Japanese. Of the 866 subjects investigated, 301 (34.8%) were homebound as defined by the parameters of this study. Univariate analysis revealed age, female gender, functional impairment (vision, hearing and memory), all the ADL impairments, and the use of a portable toilet were associated with homebound status. Multivariate analysis revealed that older age, female gender, visual and two ADL impairments (moving inside the home and bathing) and use of a portable toilet remained significantly related to homebound status. Homebound elderly people have more functional limitation and disability related factor than their nonhomebound counterparts. Functional impairment, particularly in the mobility domain and sensory disturbances, was associated with homebound status. These data indicate the importance of assessment in the provision of home care for elderly people.

Characteristics of rural homebound older adults: a community-based study

OBJECTIVE

To determine the frequency and characteristics of homebound older adults in a rural community.

DESIGN

An epidemiological survey of an age-stratified random community sample.

SETTING

The rural mid-Monongahela Valley in Southwestern Pennsylvania.

PARTICIPANTS

A total of 878 noninstitutionalized persons aged 68 years and older, fluent in English, and with at least grade 6 education.

MEASUREMENTS

The frequency with which subjects left their homes, the Mini-Mental State Examination (MMSE) score, and additional information on demographics, self-reported health problems, health services utilization, IADLs, depression, and social support were measured.

RESULTS

10.3% of the sample was classified as homebound. In univariate analyses, being homebound was found to be associated significantly (P < .001) with being older, female, and widowed and with MMSE and IADL impairment, with more depressive symptoms and worse social supports, fair to poor self-rated general health, weight loss, and histories of stroke, angina, arthritis of the spine, and falls. In a multiple regression model, variables associated independently with homebound status were gender (odds ratio = 9.4, 95% confidence interval = 3.6 - 24.9), weight loss (OR = 3.7, CI = 1.7 - 8.2), IADL impairment (OR = 2.6, CI = 2.1 - 3.1), and depressive symptoms (OR = 2.1, CI = 1.3 - 3.2). Being homebound was also associated with recent acute hospitalization and use of home health and social services.

CONCLUSIONS

These data provide evidence that homebound older adults have a disproportionate share of morbidity and disability and suggest a sociodemographic and clinical profile to help identify those older people at risk of being or becoming homebound. They also point to the need for home-based health services for the older adults, particularly in medically underserved communities such as rural areas.