ArticleLiterature Review

Physical and Mental Health of Homebound Older Adults: An Overlooked Population

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Abstract

There are currently more than 38.9 million people aged 65 an older in the United States. Up to 3.6 million of these people are considered housebound and in need of home-based care. Although homebound status is not defined specifically, with a broad range of disability levels, it is evident that people who are homebound suffer from a multitude of medical and psychiatric illnesses. This review examines the current literature to identify the specific physical and psychiatric factors most responsible for older adults becoming and remaining housebound. Homebound older adults suffer from metabolic, cardiovascular, cerebrovascular, and musculoskeletal diseases, as well as from cognitive impairment, dementia, and depression, at higher rates than the general elderly population. The information in this review will explain the specific types of care the homebound population needs and discuss the care that could help ease their suffering and delay their entry into a nursing home or hospital.

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... The different definitions of homebound in the scientific literature are in discussion. 30,34 Similarly, culture-bound is defined in five studies [13][14][15][16][17] : "Culturebound syndromes are considered to be illnesses limited to specific societies or culture areas." 15 The bedbound status includes people who spend all their time in bed and need help in all activities of daily living. 42 In one other study, 9 bedbound is defined as the situation where people are unable to reposition, check or maintain their skin health. ...
... 22 Elder homebound adults have often complex medical comorbidities interrelated with social problems. 34 The most relevant medical factors are metabolic, 30 cardiovascular (e.g., angina), cerebrovascular (e.g., stroke), and musculoskeletal (e.g., arthritis of the spine) diseases, as well as cognitive impairment 21,30 as dementia, 30 and depression. 21,30 Falls are risk factors, especially if people also lose weight and/or develop a functional impairment. ...
... 22 Elder homebound adults have often complex medical comorbidities interrelated with social problems. 34 The most relevant medical factors are metabolic, 30 cardiovascular (e.g., angina), cerebrovascular (e.g., stroke), and musculoskeletal (e.g., arthritis of the spine) diseases, as well as cognitive impairment 21,30 as dementia, 30 and depression. 21,30 Falls are risk factors, especially if people also lose weight and/or develop a functional impairment. ...
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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.
... Homebound older adults are physically, mentally, and socially more vulnerable than their non-homebound counterparts. Previous studies have reported that homebound older adults are less mobile, have more chronic diseases, have a higher prevalence of cognitive impairment and severe depression, and have low social support compared to their non-homebound counterparts [15]. In particular, the homeboundness of older adults living alone requires dedicated attention. ...
... In particular, older adults living alone have an inadequate social support system compared to their counterparts in other types of households, and for this reason, they are less likely to receive prompt treatment for physical or mental illnesses [13]. Thus, depression is highly likely to progress to severe mental disorders in older adults living alone compared to those who live with their families [15]. As older adults living alone are at greater odds of experiencing social isolation, loss, and depression, it is important to implement measures to manage their mental health. ...
... Moreover, a lack of exercise or walking may lead to muscle weakening, limited ambulation, and physical frailty, which, in turn, discourage older adults from going out and elevates their risk of homeboundness [15]. As shown here, the results of this study show that such general characteristics elevate the risk for homeboundness. ...
Article
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This study examines the levels of social interaction, depression, and homeboundness, and the effects of social interaction and depression on homeboundness in community-dwelling older adults living alone. Survey data were collected from 6444 older adults aged 65 and over, living alone, who registered for individualized home care services at 42 public health centers in Gyeonggi Province. A total of 5996 participants with complete questionnaire data were included in the analysis. The mean social interaction score was 2.90 out of 6, and the mean depression score was 6.21 out of 15. The mean homeboundness score was 0.42 out of 2. A hierarchical multiple regression analysis was performed with general characteristics, health factors, social interaction, and depression to identify their effects on homeboundness. In general characteristics and health factors, homeboundness is associated with decreasing social interaction (β = 0.17, p < 0.001) and increasing depression (β = 0.25, p < 0.001) in older adults living alone. Homeboundness was severe among participants aged 80 and over (β = 0.04, p = 0.015) and those with several chronic diseases (β = 0.04, p < 0.001), falling history (β = 0.14, p < 0.001), and lack of exercise (β = −0.20, p < 0.001). Thus, interventions that target social interaction, depression, and health functions are important for this demographic.
... [6] In relation to that, elderly people who are sent to the old-age home hold on to the stigma that they are not appreciated and are neglected by their children. [7] Along with the perception, the stigma is well proved by most of the journals in which research is published on the effects of different places of residence on the level of depression among the elderly. A study in one of the journals reported that the prevalence of depression was high among inmates of old-age homes (80%) compared to those living in the community (52%). ...
... Once the age group was categorized into 60-69, 70-79, and 80 and above, it was found that elderly aged 60-69 were more depressed comprising 20%, which is almost similar (27.5%) to a study done by Marx et al. [14] This points out that early-phase elderhood seems to be a challenge for them to handle depression as they are still adapting and are not ready to face the fear that comes along with further aging such as fear of memory loss and fear of death. [15] These findings were completely in contrast to a study conducted by Qiu et al. [7] where the depression level among the elderly aged above 80 was the highest compared to the elderly aged below 80, yet statistically no significant difference was seen in both the studies in relation to age groups and depression. [7] The depression level among the elderly females (52.8%) is more than the elderly males (47.2%) in Muar; this is in accordance with a study by Mohd. ...
... [15] These findings were completely in contrast to a study conducted by Qiu et al. [7] where the depression level among the elderly aged above 80 was the highest compared to the elderly aged below 80, yet statistically no significant difference was seen in both the studies in relation to age groups and depression. [7] The depression level among the elderly females (52.8%) is more than the elderly males (47.2%) in Muar; this is in accordance with a study by Mohd. Sidik et al. [17] where it was found that elderly females were thrice more depressed than elderly men. ...
Article
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Background: According to the perception of majority of people, especially the elderly, it is believed that elderly people who are sent to old-age homes are more prone to have depression compared to those who are living with the community. This study was aimed to assess the significance of the place of residence in relation to the presence of depression among the elderly. Materials and methods: A cross-sectional descriptive study was conducted between March and August 2020 to assess the depression among the elderly population residing in the Muar district, of Malaysia. A random table was generated of 250 house numbers in Muar where there is at least one geriatric person was living and a random sampling method was used for data collection. A questionnaire was distributed to a sample size of 250 old folks of Muar: those residing in old-age homes (n = 125) and those residing in their own houses (n = 125). A standard sociodemographic and geriatric depression scale interview was employed for data collection. All details were keyed into the SPSS version 22 software Standard Gradpack 23, and simple description and inferential statistics such as mean, median mode, percentages, and Chi-square tests were performed to compare the effects of different residences toward the mental health of the elderly. Results: The total mean age of the elderly in both the places was 73.06 ± 9.116 years. Female respondents of this research accounted for 52.8%. In terms of religion, Islam had the highest number of respondents of 46.8%, followed by Buddhist (33.6%), Christian (10.8%), and Hindu (8.8%). The percentage of elderly having more than three children was 45.2%. The marital status and employment status of the elderly in Muar area are mostly widowed (40.8%) and retired (50%). They are predominately literate (81.6%) and most have a monthly income less than RM 2000 (90.8%). We found that the prevalence rate of depression was 70.4% in the elderly residing in old-age homes and 24.8% in the elderly living in the community. Females had a higher prevalence of depression than males (60.2% vs. 39.8%) among the elderly in old-age homes, whereas males had a higher prevalence in the community than females (51.6% vs. 48.4%). Logistic regression analysis revealed the place of residence (P < 0.01 and employment status (P = 0.011) as the predictors of depression. Conclusion: Results of this study revealed that the high prevalence rate of depression among the elderly is in old-age homes compared to elderly living in the community.
... outcomes, such as functional impairments [3], multimorbidity [2], frailty [4], falls [5], and depression [6]. Homebound individuals were also more likely to experience hospitalization [2]. ...
... The dependent variable of this study is homebound status. There have been some definitions of homebound status from perspectives of different stakeholders (e.g., Medicare center, researchers, community-based health service providers) [3]. Since no gold standard measurement had been built yet and NHATS has no Sun et al. ...
... Therefore, using the dataset with a large sample was still relatively limited considering our study aim. Nevertheless, the numbers of case proportion were noteworthy on population level, which may call for public health measures and policies [3]. In addition, homebound status was a relatively stable health status, so further longitudinal studies with a longer period of time (i.e., more than 6 years) may be able to clarify this association better. ...
Article
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Background Personality is associated with predictors of homebound status like frailty, incident falls, mobility, and depression. However, the relationship between personality traits and homebound status is unclear. This study aims to examine the longitudinal association between personality traits and homebound status among older adults. Methods Using data of non-homebound community-dwelling adults aged 65 years and older in the 2013 and 2014 waves (baseline) of the National Health and Aging Trends Study (N = 1538), this study examined the association between personality traits and homebound status. Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency of going outside, difficulty in going outside, and whether there was help when going outside. Personality traits, including conscientiousness, extraversion, neuroticism, openness, and agreeableness were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Ordered logistic regression models were used to examine whether personality traits predicted homebound status in later 3 years with and without adjusting covariates. Results The sample was on average 77.0 ± 6.70 years old, and 55% were female. The majority were non-Hispanic whites (76%), and received some college or vocational school education or higher (55%). Homebound participants tended to be less educated older females. Three years later, 42 of 1538 baseline-non-homebound participants (3%) became homebound, and 195 participants (13%) became semi-homebound. Among these five personality traits, high conscientiousness (adjusted odds ratio [OR] = 0.73, p < 0.01) was associated with a low likelihood of becoming homebound after adjusting demographic and health-related covariates. Conclusions These findings provided a basis for personality assessment to identify and prevent individuals from becoming homebound.
... An individual is considered homebound if he or she stays at home for a certain period of time without going out; such individuals are typically socially isolated (Sakurai et al., 2019;Szanton et al., 2016). Homebound older adults experience decreased physical activity, psychological health, and quality of life, which places enormous pressure on their families, society, and themselves (Qiu et al., 2010;Stall et al., 2014). Homebound status further impacts the health care system, directly increasing the cost of care (Musich et al., 2015;Szanton et al., 2016). ...
... Homebound status further impacts the health care system, directly increasing the cost of care (Musich et al., 2015;Szanton et al., 2016). As a result, there is increasing public concern about how to provide this population with healthcare (Musich et al., 2015;Qiu et al., 2010;Szanton et al., 2016). Information on homebound status is critical to maintaining and improving homebound older adults' health and quality of life as well as alleviating the burden on their families and society (Jing et al., 2017). ...
... After the 1990s, the literature expanded to include social and environmental aspects (Cohen-Mansfield, Shmotkin, & Hazan, 2010De-Rosende Celeiro et al., 2017;Ida et al., 2020;Inoue & Matsumoto, 2001;Lindesay & Thompson, 1993;Murayama et al., 2012). However, no study has integrated the existing literature, perhaps because of the differences among the studied populations and the provided definitions (Qiu et al., 2010). ...
Article
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Purpose: To systematically identify the multidimensional factors affecting homebound older adults. Design: Systematic review. Methods: We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment. Findings: Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%. Conclusions: The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses. Clinical relevance: This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.
... The term homebound status typically refers to individuals who are unable to leave their homes or require substantial support to do so, due to their physical or medical limitations [1]. Homeboundness is most prevalent among older adults and the morbidity rate increases with age [2]. ...
... Homeboundness is most prevalent among older adults and the morbidity rate increases with age [2]. The homebound population is increasing in China, as the proportion of older adults is rapidly growing [1,3,4]. According to a 2013 survey of urban older adults conducted in two Chinese provinces, the morbidity rate of being homebound and semi-homebound was 15.5% [2]. ...
Article
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Background Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China. Methods This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi’s method was used to generate qualitative codes and identify themes. Results The evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly. Conclusions Findings from this study suggested that the HHC model benefited Chinese older adults—primarily homebound adults—in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.
... 3,4 It is therefore unsurprising that older adults who are homebound have a higher prevalence of polypharmacy and greater health care service utilization than their counterparts who are not homebound. 5 Home-based primary care services are promoted among the older population to improve their access to health care and their ability to remain safely in their own homes without being institutionalized. 6 Home-based primary care is a multidisciplinary support model involving services ranging from assistance with basic daily living to tertiary-level health care for those who have difficulty accessing office-based primary care. ...
... 14 Older adults who are homebound often rely on other people to undertake activities that require leaving home, such as accessing health care services. 5 Compounded by a decrease in community engagement and functional limitations, 15 these individuals have a greatly compromised sense of self-efficacy, 16 which may hamper their ability to maintain healthy living at home. 15 Self-efficacy is frequently regarded as an indicator of a person's initiation of and motivation for engaging in self-care practice, and previous studies have reported that persons with higher self-efficacy have a better QOL and use fewer hospital services. ...
Article
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Importance Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage. Objective To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic. Design, Setting, and Participants This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months. Interventions Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls. Main Outcomes and Measures The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis. Results A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (β = 1.68; 95% CI, −0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (β = −8.30; 95% CI, −13.14 to −3.47; P = .001) and quality of life (physical component score: β = 4.99; 95% CI, 0.29-9.69; P = .04). Conclusions and Relevance In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results. Trial Registration ClinicalTrials.gov Identifier: NCT04304989
... Of the 45 million adults aged 65 and older currently living in the US, approximately 2-4 million are considered homebound due to serious illness or disability and are unable to readily access office-based healthcare [1][2][3]. Models of home-based medical care, including both home-based primary care and palliative care are emerging to help to meet the healthcare needs of homebound patients with serious medical illness [4][5][6][7]. One emerging model is combined primary and palliative care delivered in patients' communities for patients with serious illness, called community-based serious-illness care. ...
... The REACH program was designed to meet the needs of patients and primary care providers and thus offered an array of services from short-term consultation to ongoing co-management to assuming primary care if needed. The REACH program was interdisciplinary, with a team comprised of [1]: clinicians (MD, DO, nurse practitioner) with expertise in geriatrics and/or palliative care [2]; a clinical pharmacist (PharmD) [3]; a care manager (Master's of Social Work); and [4] a nurse coordinator (RN) who trained in the Guided Care model, a model designed to coordinate care across healthcare settings [19]. The program's goals were for the patients to be seen at least quarterly, or more often as needed based on the evidence that frequent visits were needed to improve care outcomes [20]. ...
Article
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Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n = 159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35, 22, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.
... Homebound is defined as the situation where people cannot leave their homes independently without assistance. 8,[16][17][18][19] Leaving their home is only possible under great difficulty 4,7,9,[20][21][22][23][24] or physical effort and/or only with assistance 25,26 for example, assistive devices, by others, 8,11,24,27,28 or by special transport. 11,24,28 Assistive devices can be walkers, canes or wheelchairs. ...
... Being bedridden is perceived as a loss of power and control within one's own four walls and experienced as a final state or (social) death. 59 Preventing homebound is necessary to avoid admission to a nursing home 20 and to reduce the burden on family and society, 10 the latter concerning the costs of social security systems. 28 ACKNOWLEDGMENT No external funding. ...
Article
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Aim Analysis of the concept and development of a conceptual definition of homebound. Background Homebound persons have a significantly higher mortality risk as well as physical and psychosocial burden. A clarification of the term is necessary to develop preventive measures. Design Concept analysis. Data Sources Scientific literature from electronic databases (CINAHL, Medline via PubMed, PsycINFO, PsycArticles, and Scopus) and definitions from online dictionaries. Review Methods Walker and Avant's method was applied to guide the concept analysis. To prevent arbitrary and empty results in determining the attributes, antecedents, and consequences a thematic analysis was carried out. Results Homebound is defined as an enduring condition in which the life‐space is reduced to the home, but moving around in the home is possible (by walking short distances alone or by holding on to furniture, or with the help of a stick, walker, or another person). Homebound has six attributes: in need of help in ADL/IADL and in leaving the life‐space, powerlessness, life‐space confinement, mobility limitation, endurance, and weakness. Physiological instability and physical immobility are antecedents with wide‐ranging influencing factors as illness, complexity, burden, and endogenous/exogenous booster. Homebound has also wide‐ranging consequences such as the progression of inactivity, physical, psychosocial, and/or spiritual problems. Conclusions The multidimensional concept of homebound modifies the concepts of mobility and immobility. Given the extensive consequences of homebound nurses play a central role in the prevention.
... Compared with their ambulatory peers, homebound older adults are more likely to be older, female, racial and ethnic minorities, and less educated, and have low income (Ornstein et al., 2015). Homebound older adults are also characterised by a high risk of comorbid chronic conditions, frailty, disabilities, cognitive impairment and mortality (Qiu et al., 2010;Soones et al., 2017). ...
... In terms of psychological and social well-being, homebound older adults have more difficulties engaging in social interactions and community activities, and they are more likely to be isolated, lonely, depressed and anxious (Qiu et al., 2010;Rosso, Taylor, Tabb et al., 2013). ...
Article
The ongoing COVID‐19 pandemic has affected multiple aspects of society. Based on data from a community program, this study examined how the pandemic influenced community services for homebound older adults and whether those services could be delivered via internet‐based information and communications technology. Using mixed methods, we collected quantitative data from client profiles and service documents and qualitative data from phone interviews with program staff members and clients. The quantitative results show that during the pandemic, more services were provided for the physical well‐being of homebound older adults than for their psychological and home environment needs. Service duration during the pandemic was significantly longer than prior to the pandemic. The qualitative data indicate that the pandemic has influenced inputs, activities and outcomes of the program. The program staff members and clients expressed concerns about delivering services online. Based on the findings, we provide suggestions for future practice and policy.
... HB people suffer from multiple physical health problems, such as metabolic, cardiovascular, cerebrovascular, and musculoskeletal diseases, as well as psychiatric health problems, such as cognitive impairment, dementia, and depression [3]. Despite the high demand for medical care services, their access to healthcare services is limited because of their physical and economic dependency coupled with a lack of information and support [4]. ...
... (2) How is HB measured? Through this question, we tried to identify any differences in the measurement and methods of HB. (3) What are the factors that influence HB? The last question was aimed at identifying the factors affecting HB, and to classify them systematically. ...
Article
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Being homebound (HB) can affect people’s physical and mental health by decreasing movement, which can itself be exacerbated by the deterioration of people’s health. To break this vicious cycle of HB and being in poor health, it is necessary to identify and address the factors influencing HB status. Thus, we used a scoping review to identify an HB trend, focusing on the definition, measurements, and determinants of HB status. We analyzed 47 studies according to the five-stage methodological framework for scoping reviews. The common attribute of definitions of HB status was that the boundaries of daily life are limited to the home. However, this varied according to duration and causes of becoming HB; thus, the understanding of HB shifted from the presence or absence of being HB to the continuum of daily activity. Various definitions and measurements have been used to date. Many studies have focused on individual factors to analyze the effect of HB. In the future, it will be necessary to develop a standardized measurement that reflects the multidimensional HB state. In addition, it is necessary to utilize a theoretical framework to explore the social and environmental factors affecting HB.
... As a result, pneumonia in those with homeboundness may be severer and result in more hospitalizations. On the other hand, several reports have shown that homebound older adults were physically and psychologically unhealthy compared to those without homebound [28][29][30] . However, the physical and psychological conditions consisting of the IADL, physical strength, nutrition status, oral function, cognitive function and depression status were adjusted for the regression models to analyze the association between the hospitalization and homeboundness in our statistical analyses (Fig. 2). ...
Article
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Pneumonia is a leading cause of mortality among older adults worldwide. Recently, several studies reported that frailty was associated with mortality among older adults hospitalized due to respiratory infectious diseases, including pneumonia. However, it is unknown whether frailty is associated with susceptibility to and severity of pneumonia in functionally-independent community-dwelling older adults. In this study, we examined whether frailty increased the susceptibility to pneumonia and hospitalization in older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study; the data was collected by using mail-based, self-reported questionnaires from 177,991 functionally-independent community-dwelling older adults aged ≥ 65 years. Our results showed that frailty was significantly associated with both occurrence of and hospitalization due to pneumonia after adjustments with covariates; (Preference ratio {PR} 1.92, 95% confidence interval {95% CI} [1.66–2.22] and PR 1.80, 95% CI [1.42–2.28], respectively, p < 0.001 for the both). Pre-frailty was associated only with the occurrence of pneumonia. Besides, the instrumental activity of daily living, physical strength, nutrition status, oral function, homeboundness, and depression status in frail older adults were associated with either or both occurrence of and hospitalization due to pneumonia. Our results suggest that frailty influenced the susceptibility to and severity of pneumonia in older adults.
... The health care system is looking for innovative solutions to rapidly adapt to longer life-expectancies [1] and the increasing number of older adults (OAs) requiring services to maintain at-home independence [2]. The number of OAs aged 85 and older is expected to nearly triple by 2060 [3]. ...
Article
Objectives Ambient assisted living technologies (AALTs) are being used to help community-dwelling older adults (OAs) age in place. Although many AALT are available, their acceptance (perceived usefulness, ease of use, intention to use and actual usage) is needed to improve their design and impact. This study aims to 1) identify AALTs that underwent an acceptance evaluation in rehabilitation contexts, 2) identify methodological tools and approaches to measure acceptance in ambient assisted living (AAL) in rehabilitation research, and 3) summarize AALT acceptance results in existing rehabilitation literature with a focus on peer-reviewed scientific articles. Methods A scoping review was conducted in the following databases: Medline, Embase, Cinahl, and PsycInfo, following the Arksey and O’Malley framework (2009). Four acceptance attributes were extracted: ‘user acceptance’, ‘perceived usefulness’, ‘ease of use’, and ‘intention to use’. Data regarding AALT, participants, acceptance evaluation methods and results were extracted. Results A total of 21 articles were included among 634 studies retrieved from the literature. We identified 51 AALTs dedicated to various rehabilitation contexts, most of which focused on monitoring OAs’ activities and environmental changes. Acceptance of AALT was evaluated using interviews, questionnaires, focus groups, informal feedback, observation, card sort tasks, and surveys. Although OAs intend to use – or can perceive the usefulness of – AALTs, they are hesitant to accept the technology and have concerns about its adoption. Discussion and conclusions The assessment of AALT acceptance in contexts of rehabilitation requires more comprehensive and standardized methodologies. The use of mixed-methods research is encouraged to cover the needs of particular studies. The timing of acceptance assessment should be considered throughout technology development phases to maximize AALT implementation.
... People with dementia can suffer from stigmatisation and all sorts of obstacles that prevent them from feeling like full-fledged members of society (Qiu 2010). In the early stages of the disease, the process of integration of an individual into the social system can help to stop its progression, so patients need to remain among healthy people and be, as far as possible, active members of society. ...
Article
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The article covers the geographical features of the organisation of medical tourism for a group of the world's population suffering from a brain disease – dementia. The main attention is paid to the development of this type of tourism in Russia in comparison with some other countries. The question is raised about the involvement of these people in tourism activities, which could help to improve their health status and improve the living environment of societies. The main problems faced by tourists with the disease dementia are considered. The authors advocate that freedom of movement is the inalienable right of every person. Therefore, the creation of conditions for comfortable travel of people even with mental defects becomes a necessary measure to ensure the sustainable development of accessible tourism infrastructure. The recommendations are given, the implementation of which will allow organising an efficiently working tourist and recreational system that satisfies the needs of these peculiar recreational tourists, as well as the interests of all society representatives.
... to account for ABI patients that do not venture outside their residence too often (Logan et al., 2004;Qiu et al., 2010) The propensity scores of healthy participants and ABI patients were matched using a 1-to-1 nearest neighbour matching algorithm without replacement. To limit inaccurate matching, a calliper with a width equal to 0.2 of the standard deviation of the logit of the propensity score was used (Austin, 2011b). ...
Article
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The ability to travel independently is a vital part of an autonomous life. It is important to investigate to what degree people with acquired brain injuries (ABI) suffer from navigation impairments. The aim of this study was to investigate the prevalence and characteristics of objective and subjective navigation impairments in the population of ABI patients. A large-scale online navigation study was conducted with 435 ABI patients and 7474 healthy controls. Participants studied a route through a virtual environment and completed 5 navigation tasks that assessed distinct functional components of navigation ability. Subjective navigation abilities were assessed using the Wayfinding questionnaire. Patients were matched to controls using propensity score matching. Overall, performance on objective navigation tasks was significantly lower in the ABI population compared to the healthy controls. The landmark recognition, route continuation and allocentric location knowledge tasks were most vulnerable to brain injury. The prevalence of subjective navigation impairments was higher in the ABI population compared to the healthy controls. In conclusion, a substantial proportion (39.1%) of the ABI population reports navigation impairments. We advocate the evaluation of objective and subjective navigation ability in neuropsychological assessments of ABI patients.
... In 2011, an estimated 2 million older adults in the United States were homebound, never or rarely leaving home. 1 Homebound older adults have a 2-year mortality of 40.3%, higher mortality than those not homebound even accounting for sociodemographic characteristics, comorbidities, and functional status. 2 They experience high levels of chronic illness, cognitive impairment, depression, and anxiety as well as anorexia, fatigue, and pain. [3][4][5][6][7] Despite this, the homebound are often invisible to health systems. 8 The COVID-19 pandemic has only exacerbated the high levels of social isolation and care delivery challenges experienced by this population. ...
Article
Background/objectives: Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross-sectional studies, homebound older adults have high levels of morbidity and mortality, but there is little evidence of longitudinal outcomes after becoming homebound. The aim of this research is to prospectively assess over 6 years the dynamics of homebound status, ongoing community residence, and death in a population of community-dwelling older adults who are newly homebound. Design/setting: Prospective cohort study using 2011-2018 data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of aging in the United States. Participants: Two hundred and sixty seven newly homebound older adults in 2012. Measurements: Homebound status was defined via self-report as living in the community but rarely/never leaving home in the prior month. Semi-homebound was defined as leaving the house only with difficulty or help. Results: One year after becoming newly homebound, 33.1% remained homebound, 22.8% were completely independent, 23.8% were semi-homebound, 2.2% were in a nursing home, and 18.0% died. Homebound status is highly dynamic; 6 years after becoming homebound, 13.5% remained homebound and 65.0% had died. Recovering from being homebound at 1 year was associated with younger age and lower baseline rates of receiving help with activities of daily living, in particular, with bathing. Conclusion: Homebound status is a dynamic state. Even if transient, becoming homebound is strongly associated with functional decline and death. Identifying newly homebound older adults and developing interventions to mitigate associated negative consequences needs to be prioritized.
... Previous studies have considered several categories of daily activities that include cognitive, physical, and social elements: self-care (e.g., bathing), chores (e.g., chores, grocery shopping), home-based hobbies and activities (e.g., puzzles, computer use), television viewing, medical appointments, and social activities (e.g., volunteering, visiting, religious activities; Chen et al., 2019;Horgas et al., 1998). We anticipated that functional limitations would be associated with increased activities involving self-care, health, or being sedentary (e.g., television, medical appointments; Mares & Woodward, 2006) and with less engagement in activities that may involve expenditures of energy or leaving home (chores and social activities; Qiu et al., 2010;Van Hees et al., 2020). We also considered sleeping during the day (aka napping); a study of adults aged 18-64 revealed that individuals with physical impairments were at greater risk of shorter or longer sleep patterns than optimal (Shandra et al., 2014). ...
Article
Objectives: Disability in late life has been associated with increases in receiving care and loss of autonomy. The Disablement Process Model suggests that physical impairments lead to functional limitations that contribute to disabilities in managing household, job or other demands. Yet, we know surprisingly little about how functional limitations are related to activities throughout the day among community-dwelling adults, or the possible moderating role of social integration on these associations. Methods: Community-dwelling adults (N = 313) aged 65+ completed a baseline interview assessing their functional limitations, social ties, and background characteristics. Over 5 to 6 days, they answered questions about daily activities and encounters with social partners every 3 hours on handheld Android devices. Results: Multilevel logistic models revealed that functional limitations are associated with increased likelihood of activities associated with poor health (e.g., TV watching, medical appointments), and reduced likelihood of social activities, or physical activities, chores, or leaving the home. Most moderation analyses were not significant; family and friends did not mitigate associations between functional limitations and daily activities, with the exception of medical appointments. Individuals with functional limitations were more likely to attend medical appointments when with their social partners than when alone. Discussion: This study provided modest indication that functional limitations in community-dwelling older adults are associated with patterns of activity that may lead to further limitations, disability or loss of autonomy. Findings warrant longitudinal follow-up to establish subsequent patterns of decline or stability.
... (37,38) Depression, as well as the development of depressive symptoms, can lead to withdrawal for the elderly, which causes not only worsening dementia but also physical decline. (39) It is conceivable that consuming this food could improve depressive symptoms and motivation in elderly people and contribute to the suppression of cognitive decline and activation of total brain health. This result provides an important reminder that we need to understand the potential mechanism of action concerning the improvement of cognitive function by quercetin-rich onion. ...
Article
Quercetin, a type of flavonoid, is believed to reduce age-related cognitive decline. To elucidate its potential function, we carried out a randomized, double-blind, placebo-controlled, parallel-group comparative clinical trial involving 24-week continuous intake of quercetin-rich onion compared to quercetin-free onion as a placebo. Seventy healthy Japanese individuals (aged 60 to 79 years old) were enrolled in this study. We examined the effect of quercetin-rich onion (the active test food) on cognitive function using the Mini-Mental State Examination, Cognitive Assessment for Dementia iPad version, and Neuropsychiatric Inventory Nursing Home version. The Mini-Mental State Examination scores were significantly improved in the active test food group (daily quercetin intake, 50 mg as aglycone equivalent) compared to the placebo food group after 24 weeks. On the Cognitive Assessment for Dementia iPad version for emotional function evaluation, we found that the scores of the active test food group were significantly improved, suggesting that quercetin prevents cognitive decline by improving depressive symptoms and elevating motivation. On the Neuropsychiatric Inventory Nursing Home version, we found significant effects on reducing the burden on study partners. Taking all the data together, we concluded that 24-week continuous intake of quercetin-rich onion reduces age-related cognitive decline, possibly by improving emotional conditions. Clinical trial register and their clinical registration number: This study was registered with UMIN (approval number UMIN000036276, 5 April 2019).
... The purpose of the present study was to examine both (a) the longitudinal change in self-estimated and actual physical ability in old age and (b) their association with reduced frequency of going outdoors (FG, i.e., homebound), which is a measure of poor daily physical activity (Qiu et al., 2010;Stall et al., 2014). To this end, we examined 3-year changes in both self-estimation of, and actual stepover ability, in healthy older adults using our original SOT and whether FG may account for the difference in step-over performance and self-estimation accuracy. ...
Article
Objectives There is a growing body of literature examining age-related overestimation of one’s own physical ability, which is a potential risk of falls in older adults, but it is unclear what leads them to overestimate. This study aimed to examine 3-year longitudinal changes in self-estimated step-over ability, along with one key risk factor: low frequency of going outdoors (FG), which is a measure of poor daily physical activity. Method This cohort study included 116 community-dwelling older adults who participated in baseline and 3-year follow-up assessments. The step-over test was used to measure both the self-estimated step-over bar height (EH) and the actual bar height (AH). Low FG was defined as going outdoors either every few days or less at baseline. Results The number of participants who overestimated their step-over ability (EH>AH) significantly increased from 10.3% to 22.4% over the study period. AH was significantly lower at follow-up than at baseline in both participants with low and high FGs. Conversely, among participants with low FG, EH was significantly higher at follow-up than at baseline, resulting in increased self-estimation error toward overestimation. Regression model showed that low FG was independently associated with increased error in estimation (i.e., tendency to overestimate) at follow-up. Discussion The present study indicated that self-overestimated physical ability in older adults is not only due to decreased physical ability but also due to increased self-estimation of one’s ability as a function of low FG. Active lifestyle may be critical for maintaining accurate estimations of one’s own physical ability.
... Additionally, an estimated 4.5 million community-dwelling Medicare beneficiaries became homebound between 2012 and 2018 (Ornstein et al., 2020). Challenges such as functional impairment, multiple chronic conditions, and frailty make it difficult for homebound individuals to leave their homes and access office-based medical care (Qiu et al., 2010). Home-based medical care (HBMC) addresses part of this challenge by bringing longitudinal health care services to the home. ...
Article
Background and Objectives Homebound older adults and their caregivers have not historically been engaged as advisors in patient-centered outcomes research. This study aimed to understand the attitudes of homebound older adults and their caregivers towards research and participation as research advisors. Research Design and Methods Descriptive thematic analysis of semi-structured interviews conducted with 30 homebound older adults and caregivers recruited from home-based medical care practices. Interview questions addressed opinions on research and preferences for engaging as research advisors. Results Of 30 participants, 22 were female, 17 were people of color, and 11 had Medicaid. Two themes emerged related to perceptions of research overall: 1) utility of research and 2) relevance of research. Overall, participants reported positive attitudes towards research and felt that research could affect people like them. Three themes emerged related to participating as research advisors: 1) motivators, 2) barriers, and 3) preferences. Participants were open to engaging in a variety of activities as research advisors. Most participants were motivated by helping others. Common barriers included time constraints and caregiving responsibilities, and physical barriers for homebound individuals. Participants also reported fears such as lacking the skills or expertise to contribute as advisors. Many were willing to participate if these barriers were accommodated and shared their communication preferences. Discussion and Implications Diverse homebound older adults and caregivers are willing to be engaged as research advisors and provided information to inform future engagement strategies. Findings can inform efforts to meet new age-inclusive requirements of the National Institutes of Health.
... A second explanation for the divergent scores may be due to the population as housebound populations are often frail [23] so the findings from this study may not be comparable to the other studies that targeted total populations, their findings reported much lower levels of frailty [11]. Participants in the other studies that supported the convergent validity of the eFI and CFS were also less frail and younger than this study population [11,17]. ...
Article
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p>Background: Different scales are being used to measure frailty. This study examined the convergent validity of the electronic Frailty Index (eFI) with the Clinical Frailty Scale (CFS). Method: The cross-sectional study recruited patients from three regional community nursing teams in the South East of England. The CFS was rated at recruitment, and the eFI was extracted from electronic health records (EHRs). A McNemar test of paired data was used to compare discordant pairs between the eFI and the CFS, and an exact McNemar Odds Ratio (OR) was calculated. Findings: Of 265 eligible patients consented, 150 (57%) were female, with a mean age of 85.6 years (SD = 7.8), and 78% were 80 years and older. Using the CFS, 68% were estimated to be moderate to severely frail, compared to 91% using the eFI. The eFI recorded a greater degree of frailty than the CFS (OR = 5.43, 95%CI 3.05 to 10.40; p < 0.001). This increased to 7.8 times more likely in men, and 9.5 times in those aged over 80 years. Conclusions: This study found that the eFI overestimates the frailty status of community dwelling older people. Overestimating frailty may impact on the demand of resources required for further management and treatment of those identified as being frail.</p
... Over two million older adults in the United States are homebound and have great difficulty living in their home independently. 1 Homebound older adults have medical and psychiatric illness, higher functional limitations, symptom burden and mortality compared to nonhomebound older adults. [1][2][3][4] These individuals also have poor clinical outcomes, including high hospitalization and emergency room visits. 5,6 Despite being a fragile population, many homebound patients have inconsistent access to office-based care, often only receiving care for medical emergencies. ...
Article
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Background With the shortage of primary care providers to provide home-based care to the growing number of homebound older adults in the U.S. Nurse Practitioners (NPs) are increasingly utilized to meet the growing demand for home-based care and are now the largest type of primary care providers delivering home-visits. Purpose The purpose of this study was to systematically examine the current state of the evidence on health and healthcare utilization outcomes associated with NP-home visits. Method Five Databases (PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library) were systematically searched to identify studies examining NP-home visits. The search focused on English language studies that were published before April 2019 and sought to describe the outcomes associated with NP-home visits. We included experimental and observational studies. Quality appraisal was performed with the Kmet, Lee & Cook tool, and results summarized qualitatively. The impact of NP-home visits on clinical (functional status, quality of life [QOL]), and healthcare utilization (hospitalization, Emergency department(ED) visits) outcomes was evaluated. Results/Discussion A total of 566 citations were identified; 7 met eligibility criteria and were included in the review. The most commonly reported outcomes were emergency department (ED) visits and readmissions. Given the limited number of articles generated by our search and wide variation in intervention and outcomes measures. NP-home visits were associated with reductions in ED visits in 2 out of 3 studies and with reduction in readmissions in 2 out of 4 studies. Conclusion Published studies evaluating the outcomes associated with NP-home visits are limited and of mixed quality. Limitations include small sample size, and variation in duration and frequency of NP-home visits. Future studies should investigate the independent effect of NP-home visits on the health outcomes of older adults using large and nationally representative data with more rigorous study design.
... Additionally, there are many later-life suicides that go unreported and/or are incorrectly categorised (Rodgers, 2010). Older adults who receive home-and community-based services (HCBS) often face additional barriers to accessing mental health care, such as transportation difficulties, high cost of services and inaccessible medical services, which often serve as the access point for mental health services in later life (Qiu et al., 2010). ...
Article
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Suicide in later life is a pressing public health concern, which has likely been exacerbated by the COVID-19 pandemic. Many older adults who need mental health treatment do not have access to necessary services and training for mental health providers to support older adults experiencing suicidality is limited. One solution is developing interventions based in a public health approach to suicide prevention, whereby natural helpers who provide community services are mobilised to respond to older persons-at-risk. Home-delivered meal (HDM) services, for example, are one effective means to reach older adults who are isolated due to being homebound and may be instrumental in preventing suicide. This study examined the experiences of 20 HDM volunteers who received Applied Suicide Intervention Skills Training (ASIST), an evidence-based suicide intervention programme. Phenomenological analysis yielded findings centred on three areas demonstrating the impact of the ASIST training on HDM volunteers: putting asist skills into practice; response to ASIST skills; and role transformation. Implications for integrating suicide prevention efforts with HDM services and directions for future research are discussed.
... Homebound older adults have been defined in research as those who never or rarely leave their homes due to a complex array of chronic health issues. These can include physical limitations, cognitive impairments (e.g., dementia), or psychosocial difficulties due to chronic physical and mental health conditions (Qiu et al., 2010). The Social Security Act (U.S. Congress, 1934) defined homebound status as having a condition that restricts one's ability to leave their home due to an illness or injury, except with the assistance of another person or an assistive device. ...
Article
The Supporting Older Adults & Caregivers: Integrative Service Learning (SOCIAL) partnership trains undergraduate social work students to provide practical home-based support for older adults with chronic illness and their family caregivers, serving as a pipeline for future leaders in older adult care. More than 2 million older adults are homebound, and 5 million need help leaving their homes. Family members often assume daily caregiving tasks to assist their loved ones, navigate health care systems, and provide much needed emotional support. In this teaching note, we provide an example of an integrative service learning model which can serve older adults and caregivers while offering valuable pedagogical experiences to baccalaureate students, along with strategies for curriculum building, community engagement, research and evaluation, and program sustainability.
... Some elderly patients requiring complete denture fabrication are medically frail or are homebound with major limitations in mobility [1]. While some individuals can independently access the dental office, others are institutionalized or require long-term care at home; these individuals might require a dentist to provide care at their place of residence. ...
Article
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A 91-year-old woman was referred to our hospital with a chief complaint of unsatisfactory fit and pain associated with her complete dentures. She had moderate dementia with difficulty in communication (Mini-Mental State Examination, 16; Barthel Index, 15). The closed impressions and jaw record were taken with the digitally fabricated copy dentures as follows. First, the tissue conditioner was used to correct the poor fit of the old dentures, following which minor occlusal alterations were made. Second, the copy dentures that copied the morphology of the corrected old dentures using three-dimensional (3D) scanner were fabricated with a 3D printer. The new dentures were then fabricated using conventional methods as follows. The impressions were cast and articulated, and the dentures were subsequently processed. This case report documented the following results. First, the acceptance of new dentures appeared to be easier since the new dentures copied the morphology of the familiar dentures digitally. Moreover, the 3D data of the dentures could be used for immediate denture fabrication in case of fracture or loss of the dentures. Second, only two visits were required for taking an impression and delivering the complete dentures. In addition, her old dentures were brought to our dental office by the patient's family after the patient's dinner; immediately after copying the dentures' morphology, the dentures were returned to the patient's family, thus avoiding any disturbance to the patient's eating routine. These reduced the burden on the patient and her family.
... Older adults who are homebound, defined as leaving home once a week or less, are often socially isolated, have unmet care needs, and have high mortality. 1,2 In 2011, more older adults in the United States were homebound than living in nursing homes. 1 The COVID-19 pandemic may have led to an increase in the number of homebound older adults who were at heightened risk for infection with SARS-CoV-2. 3 Moreover, although Black non-Hispanic and Hispanic/Latino individuals have disproportionately died from COVID-19, 4 it is unknown whether they were more likely to be homebound during the pandemic. We assessed the size and characteristics of the homebound population in the United States in 2020, including household size, 5 important for disease transmission risks, and digital access, which is important for telemedicine and online vaccination registration. ...
... Currently, an estimated 94,000 out of 160,000 people living with dementia (PlwD) are living at home in Sweden [1]; half of these do not receive any eldercare [2]. Although several studies have been undertaken to analyze the extent and type of home care for older adults in general [3,4], the number of studies about eldercare for PlwD in Sweden is relatively few. ...
Article
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Background The growing number of people living with dementia (PlwD) implies an increase in the demand for eldercare services in Sweden like in many other countries. Few studies have analyzed the use of eldercare services for PlwD. The aim of the present study is to investigate the association between demographic factors (age, sex, cohabiting status) and the use of municipal eldercare services (including both home care and residential care) for older adults with dementia compared to older adults without dementia in Sweden. Methods This study used several nationwide Swedish registers targeting all individuals aged 65 and above living in Sweden in 2014 and still alive 31st of March 2015 ( n = 2,004,409). The primary outcomes variables were different types of eldercare service, and all participants were clustered based on age, sex, cohabiting status, and dementia diagnosis. In addition to descriptive statistics, we performed multivariate logistic regression models for binary outcomes and linear regression models for continuous outcomes. Results Results showed that (1) older age is a significantly strong predictor for the use of eldercare services, although PlwD start using eldercare at an earlier age compared with people without dementia; (2) women tend to receive more eldercare services than men, especially in older age, although men with dementia who live alone are more likely than women living alone to receive eldercare; (3) having a dementia diagnosis is a strong predictor for receiving eldercare. However, it was also found that a substantial proportion of men and women with dementia did not receive any eldercare services. Conclusions We found that people with a dementia diagnosis use more as well as start to use eldercare services at an earlier age than people without dementia. However, further research is needed to investigate why a substantial part of people with a dementia diagnosis does not have any eldercare at all and what the policy implications of this might be.
... [1][2][3] Many elderly or community-dwelling individuals have high symptom burdens that make them di cult to get to the doctor's clinic and receive medical care. 4,5 Home health care (HHC) has therefore became important for these disabled homebound population. HHC represents a comprehensive, longitudinal care provided by a physician-supervised interdisciplinary team in the homes of patients. ...
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Background: In response to the rapidly aging population with anticipated growth of chronic disabling diseases, the National Health Insurance program in Taiwan has established home health care services since 1995. Medically and functionally compromised elders with multiple chronic conditions, tend to have increased need for home health care (HHC) and higher medical costs. Our study aimed to identify health expenditure and its influencing factors among home care patients and to clarify whether regular HHC visits reduce health expenditure. Methods: A retrospective observational cohort study on individuals receiving HHC was conducted at National Taiwan University Hospital Bei-Hu Branch from 2010 to 2015. Patients aged < 20 years, did not receive HHC for at least 6 months, or did not receive regular hospital care at our healthcare system were excluded. The patient characteristics, health service utilization, and health expenditure were collected. Total health expenditure was defined as the sum of outpatient clinic, emergency department and hospitalization cost. Considering the distribution of costs data was highly skewed, a generalized linear model was applied to estimate the impact patient factors on healthcare expenditure. Results: A total of 1,285 home care patients, mean age 79.4±12.9 years and males 50.9%, were enrolled. The majority (85%) of the study population were totally dependent in daily activities with Barthel index 0-20, and had Charlson comorbidity index score≥4. The median monthly total expenditure per person was US$737 (IQR, 229-1,935), which broke down to US$414 (IQR,56-1,234) for hospitalization, US$170 (IQR,73-369) for outpatient clinic, and US$60 (IQR, 9-150) for emergency department. Home care patients with higher need for nursing services utilization (p<0.05), indwelling tracheostomy tube (p<0.05), underlying neoplasm (p<0.05), or registry of catastrophic illness certificate (p<0.001), had higher health expenditure. On the other hand, regular HHC visits significantly lowered total health expenditure (p<0.001). Conclusions: Patient characteristics that incurred higher health expenditure were identified, whereas regular HHC visits have a potential role to reduce expenditure in the disabled homebound population. The visit number and frequency of HHC should be taken into account when making reimbursement policy in order to provide a sustainable and cost-effective HHC program.
... They allow to access samples that cannot come to local research facilities or that are difficult to test with standard stress induction procedures. First and foremost, online applications would allow the assessment of older adults with limited movement space (Jeon and Dunkle, 2009;Osmanovic-Thunström et al., 2015), bedridden, or homebound people (Churproong et al., 2016;Ornstein et al., 2015;Qiu et al., 2010), provided they are easy to use and do not require extensive experience with digital technology. Moreover, home-based stress research also enables access to specific patient groups such as patients with neurodegenerative diseases likes MS for which a dysfunction of stress systems has been discussed as an important factor in pathogenesis as well as disease progression (Gold et al., 2005). ...
Article
The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders.Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups.Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.
... Both are associated with poor health outcomes including comorbid conditions (1), cognitive decline (2,3), and mortality (4). Homebound older adults, comprising 8.3% of communitydwelling older adults in the United States (5), are especially at risk of social isolation and loneliness due to mobility limitations caused by chronic illness, cognitive decline, or injury (6,7). In fact, being homebound and socially isolated have a synergistic effect on increasing risk of mortality (8). ...
Article
Full-text available
Despite substantial evidence of the negative health consequences of social isolation and loneliness and the outsized impact on older adults, evidence on which interventions are most effective in alleviating social isolation and loneliness is inconclusive. Further complicating the translation of evidence into practice is the lack of studies assessing implementation and scalability considerations for socialization programs delivered by community-based organizations (CBOs). Our primary objective was to describe the implementation barriers, facilitators, and lessons learned from an information and communication technology (ICT) training program aimed at reducing social isolation and loneliness for homebound older adults in a home-delivered meals program. Participants received in-home, one-on-one ICT training lessons delivered by volunteers over a 14-week period with the goal of increasing social technology use. To assess implementation facilitators and barriers, 23 interviews were conducted with program staff ( n = 2), volunteers ( n = 3), and participants ( n = 18). Transcripts were analyzed using thematic analysis. Aspects that facilitated implementation included the organization's existing relationship with clientele, an established infrastructure to deliver community-based interventions, alignment of intervention goals with broader organizational aims, and funding to support dedicated program staff. Challenges to implementation included significant program staff time and resources, coordinating data sharing efforts across multiple project partners, participant and volunteer recruitment, and interruptions due to COVID-19. Implications of these facilitators and barriers for scalability of community-based ICT training interventions for older adults are described. Lessons learned include identifying successful participant and volunteer recruitment strategies based on organizational capacity and existing recruitment avenues; using a targeted approach to identify potential participants; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through volunteer-completed reports to mitigate issues. Findings from this formative evaluation provide insight on strategies CBOs can employ to overcome challenges associated with implementing technology training programs to reduce social isolation and loneliness for older adults, and thus improve overall well-being for homebound older adults. Recommendations can be integrated into program design to facilitate implementation of ICT programs in the community setting.
... 26,[30][31][32][33] Home health patients tend to be older, have more comorbidities and functional limitations, and experience greater inpatient and emergency department care utilization than other long-term care patient populations. [34][35][36][37] Yet compared with longterm care users in nursing homes and hospice, home health patients have a lower rate of advance care planning, leaving family members and other stakeholders to negotiate a care plan among themselves without clear guidance. 36 There is a need to acknowledge the relational aspects of patient-caregiver decision making for end-of-life decisions, such as the recognition that decisions can be influenced by others, and acknowledgement for the potential of ethical dilemmas when dyads disagree, or experience an unequal distribution of power such as in controlling or conflictual relationships, which can affect the quality of communication and decision making. ...
Article
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A symposium held at the 42nd annual Society for Medical Decision Making conference on October 26, 2020, focused on intergenerational decision making. The symposium covered existing research and clinical experiences using formal presentations and moderated discussion and was attended by 43 people. Presentations focused on the roles of pediatric patients in decision making, caregiver decision making for a child with complex medical needs, caregiver involvement in advanced care planning, and the inclusion of spillover effects in economic evaluations. The moderated discussion, summarized in this article, highlighted existing resources and gaps in intergenerational decision making in four areas: decision aids, economic evaluation, participant perspectives, and measures. Intergenerational decision making is an understudied and poorly understood aspect of medical decision making that requires particular attention as our society ages and technological advances provide new innovations for life-sustaining measures across all stages of the lifespan.
Article
Objectives In the United States, people with serious illness often experience gaps and discontinuity in care. Gaps are frequently exacerbated by limited mobility, need for social support, and challenges managing multiple comorbidities. The Advanced Illness Care (AIC) Program provides nurse practitioner–led, home-based care for people with serious or complex chronic illnesses that specifically targets palliative care needs and coordinates with patients’ primary care and specialty health care providers. We sought to investigate the effect of the AIC Program on hospital encounters [hospitalizations and emergency department (ED) visits], hospice conversion, and mortality. Design Retrospective nearest-neighbor matching. Setting and Participants Patients in AIC who had ≥1 inpatient stay within the 60 days prior to AIC enrollment to fee-for-service Medicare controls at 9 hospitals within one health system. Methods We matched on demographic characteristics and comorbidities, with exact matches for diagnosis-related group and home health enrollment. Outcomes were hospital encounters (30- and 90-day ED visits and hospitalizations), hospice conversion, and 30- and 90-day mortality. Results We included 110 patients enrolled in the AIC Program matched to 371 controls. AIC enrollees were mean age 77.0, 40.9% male, and 79.1% white. Compared with controls, AIC enrollees had a higher likelihood of ED visits at 30 [15.1 percentage points, confidence interval (CI) 4.9, 25.3; P = .004] and 90 days (27.8 percentage points, CI 16.0, 39.6; P < .001); decreased likelihood of hospitalization at 30 days (11.4 percentage points, CI –17.7, −5.0; P < .001); and a higher likelihood of converting to hospice (22.4 percentage points, CI 11.4, 33.3; P < .001). Conclusions The AIC Program provides care and coordination that the home-based serious illness population may not otherwise receive. Implications By identifying and addressing care needs and gaps in care early, patients may avoid unnecessary hospitalizations and receive timely hospice services as they approach the end of life.
Article
Background Home-Based Primary Care (HBPC) has demonstrated success in decreasing risk of hospitalization and improving patient satisfaction through patient targeting and integrating long-term services and supports. Less is known about how HBPC teams approach social factors.Objective Describe HBPC providers’ knowledge of social complexity among HBPC patients and how this knowledge impacts care delivery.Design, Setting, and ParticipantsBetween 2018 and 2019, we conducted in-person semi-structured interviews with 14 HBPC providers representing nursing, medicine, physical therapy, pharmacy, and psychology, at an urban Veterans Affairs (VA) medical center. We also conducted field observations of 6 HBPC team meetings and 2 home visits.ApproachWe employed an exploratory, content-driven approach to qualitative data analysis.ResultsFour thematic categories were identified: (1) HBPC patients are socially isolated and have multiple layers of medical and social complexity that compromise their ability to use clinic-based care; (2) providers having “eyes in the home” yields essential information not accessible in outpatient clinics; (3) HBPC fills gaps in instrumental support, many of which are not medical; and (4) addressing social complexity requires a flexible care design that HBPC provides.Conclusion and RelevanceHBPC providers emphasized the importance of having “eyes in the home” to observe and address the care needs of homebound Veterans who are older, socially isolated, and have functional limitations. Patient selection criteria and discharge recommendations for a resource-intensive program like VA HBPC should include considerations for the compounding effects of medical and social complexity. Additionally, staffing that provides resources for these effects should be integrated into HBPC programming.
Article
Background: Multiple factors may influence the risk of being homebound, including social isolation and race. This study examines the relationship between social isolation and homebound status by race over 9 years in a sample of adults. Methods: Utilizing a representative sample of 7788 Medicare beneficiaries aged 65+ from 2011-2019, we assessed the odds of becoming homebound by social isolation. We defined social isolation as the objective lack of contact with others. We defined severe social isolation as scoring a 0 or 1 on a social connection scale from 0 to 4. Homebound status was defined as never leaving home or only leaving home with difficulty. Utilizing a multivariate Cox proportional hazards model adjusting for age, gender, marital status, income, and education, we examined the association between social isolation at baseline and becoming homebound during the study in those who were not initially homebound. Results: Older adults in this study were on average 78 years old. Overall, most were white (69%), female (56.3%), and married (57.8%) and reported that they had a college education or higher (43.9%). Also, at baseline, approximately 25% of study participants were socially isolated, 21% were homebound, and 6.3% were homebound and socially isolated or severely socially isolated. Homebound status at baseline varied by race: Black, 23.9% and white, 16.6% (p < 0.0001). After 9 years, socially isolated black (hazard risk ratio, HRR 1.35, 95% confidence interval CI [1.05,1.73], p < 0.05) and white (HRR 1.25, 95% CI [1.09,1.42], p < 0.01) older adults were at higher risk of becoming homebound. Conclusion: Socially isolated black and white adults are more likely to be homebound at baseline and become homebound over time. Further research is needed to determine whether community-based strategies and policies that identify and address social isolation reduce homebound status among community-dwelling older adults.
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Background The world population is presently experiencing population aging. About 8% of older Indians were confined to their home or bed. There is need for a strategy to tackle rural elderly home bound with co-morbid with limited number of doctors, nurses, physiotherapist along with shortage of bed in the country. This study was planned to estimate the prevalence of home bound and the associated comorbidities along with the support system and felt need among rural elderly population. Methodology Cross sectional study was conducted in selected northern districts of Tamilnadu in about 7200 elderly population by using multistage sampling. Standardized tools such as WHO geriatric instrument with modifications including Prasad scale of SES, Katz dependency ADL index along with pretested questionnaire, calibrated instruments and detailed examination by trained doctors were used for data collection. Results The proportion of home bound among elderly was 9.8% and was not having access to health. Physical and economical dependency was observed more among home bound elderly along with a social support system. More than three fourth of the home confined felt need for organization for elderly, need for ambulatory services, transport to hospital and need for mobile clinic for elderly. Conclusion Proportion of Homebound among elderly were increasing with increasing age group and with increasing co-morbid conditions. There is a need to address the health problem of elderly at their homes, to improve the support system and address their felt needs by developing elderly organizations and ambulatory services.
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Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.
Article
Objective : The purpose of the Problem Adaptation Therapy - Montefiore Health System (PATH-MHS) pilot program was to demonstrate the feasibility and effectiveness of PATH across a culturally, educationally, and functionally diverse cohort of older adults. Methods: Clinicians referred 145 participants with depression and cognitive impairment to PATH-MHS. We completed analyses of the change in depression, disability and the association between baseline characteristics and remission of depression. Results: Most participants were Hispanic or Non-Hispanic Black and 54.7% (76) were primary Spanish speakers. Overall, there were significant decreases in the mean PHQ-9 and WHODAS 2.0 scores. In logistic regression models, neither age, education, gender, race/ethnicity, language nor long-term care status was significantly associated with remission of depression. Conclusions: This study demonstrates that we were able to engage a diverse, cognitively impaired, and frail cohort of older adults in PATH-MHS with significant reductions in depression and disability.
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Background: Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but research examining the efficiency and effectiveness of this new care model is rare. This study aimed to investigate care recipients’ experiences with HHC and areas for improvement in China. Methods: This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based clinical care were recruited. Colaizzi’s descriptive phenomenological method was used to generate qualitative codes and identify themes. Results: The evaluations of participants’ experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because doctors visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers’ technical skills varied greatly. Conclusions: Findings from this study suggested that the HHC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills. Trial registration: Not applicable
Article
The mental health status of the homebound population in China is relatively overlooked. A sample of 1,301 older adults from Shandong Province was used to compare the mental health status among homebound, semi-homebound, and non-homebound older adults in China, and examine the moderation effects of loneliness and gender. This study found that, controlling for demographic and physical health status, the homebound population was more likely to have worse mental health status than non-homebound older adults. Experiencing loneliness intensified the adverse effects of being homebound on older adults’ mental health. The negative effects of being semi-homebound on mental health were more pronounced among older males than females. Findings from this study suggested that homebound older adults in China experienced psychological challenges. Social programs and interventions may be designed to improve this population's mental health.
Article
A novel interprofessional clinical experience, entitled POP (Pet Owner and Pet Care), was offered to students from the Colleges of Nursing, Veterinary Medicine, and Social Work at a large Midwest university. The objectives of the clinical experience were to (1) provide students with an opportunity to improve their readiness for interprofessional learning and beliefs about EBP; (2) deliver integrated physical and mental health care to homebound older adults and assess their outcomes; and (3) concurrently provide wellness care to the pets living with homebound older adults and assess their outcomes. Nurse practitioner (NP) faculty led the POP Care clinical rotation teams of NP, veterinary, and social work students in providing home healthcare to homebound adults and their pets. Students were provided with four learning modules prior to starting patient visits. The success of the clinical experience was evaluated via a pre- and post-survey that assessed EBP beliefs and readiness for interprofessional learning. The post-survey also included program satisfaction questions. Health outcomes were measured for the patient and their pets. Patients also answered open-ended program satisfaction questions over the phone. Results indicated that POP Care improved beliefs in EBP and readiness for interprofessional learning, enhanced interprofessional team-based care, and had a positive impact on patient and pet health and well-being.
Article
Objectives: Age-related hearing loss (ARHL) is considered a risk factor for cognitive impairment and falls. The association may be modulated by gait performance because ARHL is related to mobility decline, which strongly contributes to cognitive impairment and falls. We investigated the interactive effects of gait and ARHL on global cognition and falls among older adults. Study design: Retrospective cohort study. Methods: The auditory acuity of 810 community-dwelling older adults was measured using a pure-tone average of hearing thresholds at 1,000 and 4,000 Hz in the better-hearing ear. Participants were then stratified as follows: normal hearing, ≤25 dB; mild hearing loss (HL), >25 and ≤40 dB; and moderate to severe HL, >40 dB. Gait speed was assessed as an indicator of gait performance and fall occurrence within the previous year. Global cognition was determined using the Montreal Cognitive Assessment (MoCA) test. Results: A total of 320 (39.5%) and 233 (28.8%) participants had mild and moderate to severe HL, respectively. Hierarchical multiple and logistic regression analyses showed interactions between gait performance and moderate hearing loss on both global cognition and the occurrence of falls. Specifically, older adults with moderate hearing loss who walked slowly showed lower MoCA scores and a higher incidence of falls, whereas those with decent gait speed did not show such a tendency. Conclusion: Our results suggest that poor gait performance might modulate the effects of ARHL, leading to cognitive decline and falls. Poor cognitive performance and falls may be prevalent in older adults with ARHL, especially in those with slower gait and moderate hearing loss. Level of evidence: 3 Laryngoscope, 2021.
Article
Objectives This qualitative descriptive study aims to explore the meanings of holistic health in the southern Thai culture experienced by homebound older people. Background The ageing society necessitates many services to meet the holistic needs of older people. Homebound older people are commonly an understudied population who may view their holistic health and well‐being differently from others. Due to geographical differences and local Thai cultural context, exploring the holistic health in the southern Thai culture would help promote a healthy lifestyle and improve their health outcomes. Methods Based on purposeful sampling, 16 key informants who were homebound older people (ages ≥ 60 years old) living at home in a rural southern Thai community were participated in semi‐structured interviews. Informants consisted of six males and ten females who were Buddhist and married. Their ages ranged from 79 to 99, including nine homebound older people who lived in a couple, and seven widows and widowers. Eight had completed the primary school, and others were uneducated. The data were analysed with a content analysis. Results Most of the informants had chronic diseases. In a broad main theme, the informants described the holistic health in local context as ‘Bai Lod; which means being alive with positive, active and independent functioning. This theme included three sub‐themes: self‐supporting or taking care of themselves, having the ability to control their health conditions and being proud as a healthy older adult. The older people described self‐supporting as the ability to perform their activities of daily living, take care of their own health and work independently (active living). Having the ability to control their health conditions meant functioning well physically, although being frail, by maintaining their health through self‐management, and having a good mental health during such a life‐changing situation. Older people valued the ability to live by themselves without being a burden to their family. They felt happy with their life. Conclusion Holistic health was described as being positive and active at home, and influenced by beliefs and values related to good physical function, mental health and spiritual activities. These findings could help healthcare professionals better understand older people’ health, well‐being and cultural care in order to develop alternative strategies to maintain, enhance and support an active life for homebound older people.
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Geriatric assessment—broadly defined—has become foundational to systems of care for frail elderly people at risk for functional decline, death, intensification of services, and long-term institutionalization. Its key feature is ascertainment of multiple dimensions of health and health risks—not only medical, but functional, cognitive, psychological, and socioeconomic factors. This multidimensionality is key to systematic screening and targeting using technologies to uncover frail, at-risk elderly people in their neighborhoods, homes, and at various other service contact points, for more intensive evaluation, i.e., “comprehensive geriatric assessment”—a multidisciplinary diagnostic and treatment process that identifies medical, psychosocial, and functional limitations of a frail older person to develop a coordinated plan to maximize overall health with aging. Care models embedding comprehensive and multidimensional assessment—in the community and in institutions—have been studied for years, with evidence supporting the efficacy of some in improving various care outcomes. In fact, early successes are partly responsible for the spread and differentiation of assessment-based programs, involving teams of specially trained health professions, together with the continued growth in the number of frail and at-risk elderly in demographically post-transition populations. From those earlier days, multidimensional geriatric assessment has come to support a variety of “co-care” or collaborative approaches with orthopedics, oncology, emergency medicine, surgery, and other medical disciplines. Now, developing countries are also rapidly aging and becoming wealthier, with improved health and social service resources. Thus, the interest in geriatric medicine and related care systems has been spreading, as well as the need to adapt and evaluate practice and assessment technologies in these new environments. The papers gathered in this Special Issue of Geriatrics all relate in some way to the foundational theme of multidimensional geriatric assessment, as they also exhibit the continuing evolution and differentiation of structures and processes of care built upon it. New technologies, populations, systems of care and financing, and workforce development strategies will need to hold true to these core principles.
Article
More than 7.3 million older adults in the United States have difficulty leaving their homes or are completely homebound, yet little data exist on the experiences of homebound older adults and their caregivers. We conducted 30 semi-structured qualitative interviews with homebound older adults and caregivers recruited through home-based medical care practices in Baltimore and San Francisco. Thematic template analyses revealed that homebound older adults experience varying degrees of independence in activities of daily living, although their degree of dependence increases over time. Caregivers have a multifaceted, round-the-clock role. Both patients and caregivers experience burdens including social isolation and guilt. Navigating medical care and caregiving was further complicated by the complexity of the U.S. health care system; however, home-based medical care was viewed as a high-quality alternative to hospitals or nursing homes. Our findings suggest that providers and health care systems should expand the availability and accessibility of home-based care and improve caregiver support opportunities.
Article
Objectives: To ascertain a comprehensive perspective of the impact of peripheral arterial disease (PAD) on people including needs for access to disease specific information, education, services, and support. Methods: Participants were recruited from outpatient clinics at a tertiary hospital in metropolitan Australia. Telephone and face-to-face semi-structured interviews were conducted with nine individuals living with PAD and analysed using qualitative content thematic analysis. Results: The nine participants were on average 74.2 (SD 10.9) years and predominantly women (67%). Lack of understanding of PAD and inconsistent information resulted in confusion regarding self-management strategies. Effects of pain and mobility problems were amplified for participants who lived alone and did not have an informal carer. Discussion: Poor quality of life in PAD reflects pain, social isolation and fear of falls. Multidisciplinary teams with case managers should consider older people's living situations and needs for additional support services and education to facilitate integrated care.
Article
Objective The number of homebound older adults is increasing in the United States. We aimed to examine their social and lived experiences and to understand their perspectives on their situation, feelings, and coping mechanisms. Methods We conducted a cross-sectional qualitative study using semi-structured interviews with 18 older homebound individuals in Central Virginia. Results Homebound older adults experienced both physical and mental health challenges that restricted their ability to participate in activities of daily living, recreation, and social interactions. Participants often felt dependent, helpless, lonely, and socially isolated. Those who communicated regularly with friends, family, and health care providers reported positive benefits from these interactions. Discussion Participants faced challenges to their physical, emotional, and mental well-being. Our findings might help clinicians, policymakers, and community organizations understand how to better support homebound older adults. We should provide educational opportunities, respect their autonomy, and implement initiatives to address their isolation and loneliness.
This study aimed to explore the level of perceived oral health literacy (OHL) among caregivers of the homebound population in the Chicago metropolitan area and how caregivers’ OHL impacts their oral care to the homebound population. The relationships between demographic characteristics, perceived OHL levels, personal oral health behaviors, and oral health care to clients were also assessed. This cross-sectional survey research examined 69 caregivers of the homebound population employed by home health agencies. The OHL was determined by the validated Health Literacy in Dentistry Scale (HeLD-14). Independent t-tests, chi-square tests set at p < .05 significance level, and logistic regressions were used for analysis. The mean age of participants was 43. The HeLD-14 scores indicated a high perceived OHL among this group. Caregivers came from diverse groups, and the majority spoke a second language at home. About 93% performed oral self-care the recommended amount of time or more, while only 57% did it for their clients. Those who cleaned clients’ mouth twice a day had a higher OHL score ( M = 23 compared to M = 19). About 43% did not check for sores in the client’s mouth, and those who checked had a higher OHL score ( M = 25 compared to M = 19). Controlling for OHL, age was a good predictor of oral care frequency to clients. These findings provide current evidence and add to the body of knowledge on OHL among homebound individuals. The results provide insights for designing a preventive approach in oral health care to the homebound population.
Article
Background: Patients with Parkinson's disease (PD) are at higher risk of vaccine-preventable respiratory infections. However, advanced, homebound individuals may have less access to vaccinations. In light of COVID-19, understanding barriers to vaccination in PD may inform strategies to increase vaccine uptake. Objective: To identify influenza and pneumococcal vaccination rates, including barriers and facilitators to vaccination, among homebound and ambulatory individuals with PD and related disorders. Methods: Cross-sectional US-based study among individuals with PD, aged > 65 years, stratified as homebound or ambulatory. Participants completed semi-structured interviews on vaccination rates and barriers, and healthcare utilization. Results: Among 143 participants, 9.8% had missed all influenza vaccinations in the past 5 years, and 32.2% lacked any pneumococcal vaccination, with no between-group differences. Homebound participants (n = 41) reported difficulty traveling to clinic (p < 0.01) as a vaccination barrier, and despite similar outpatient visit frequencies, had more frequent emergency department visits (31.7% vs. 9.8%, p < 0.01) and hospitalizations (14.6% vs. 2.9%, p = 0.03). Vaccine hesitancy was reported in 35% of participants, vaccine refusal in 19%, and 13.3% reported unvaccinated household members, with no between-group differences. Nearly 13% thought providers recommended against vaccines for PD patients, and 31.5% were unsure of vaccine recommendations in PD. Conclusion: Among a sample of homebound and ambulatory people with PD, many lack age-appropriate immunizations despite ample healthcare utilization. Many participants were unsure whether healthcare providers recommend vaccinations for people with PD. In light of COVID-19, neurologist reinforcement that vaccinations are indicated, safe, and recommended may be beneficial.
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Background: Although quality-of-care domains for home-based primary and palliative programs have been proposed, they have had limited testing in practice. Our aim was to evaluate the care provision in a community-based serious-illness care program, a combined home-based primary and palliative care model. Methods: Retrospective chart review of patients in an academic community-based serious-illness care program in central North Carolina from August 2014 to March 2016 (n=159). Chart review included demographics, health status, and operationalized measures of seven quality-of-care domains: medical assessment, care coordination, safety, quality of life, provider competency, goal attainment, and access. Results: Patients were mostly women (56%) with an average age of 70 years. Patients were multi-morbid (53% ≥3 comorbidities), functionally impaired (45% had impairment in ≥2 activities of daily living) and 32% had dementia. During the study period, 31% of patients died. Chart review found high rates assessment of functional status (97%), falls (98%), and medication safety (96%). Rates of pain assessment (70%), advance directive discussions (65%), influenza vaccination (59%), and depression assessment (54% of those with a diagnosis of depression) were lower. Cognitive barriers, spiritual needs, and behavioral issues were assessed infrequently (35%, 22%, 21%, respectively). Conclusion: This study is one of the first to operationalize and examine quality-of-care measures for a community-based serious-illness care program, an emerging model for vulnerable adults. Our operationalization should not constitute validation of these measures and revealed areas for improvement; however, the community-based serious-illness care program performed well in several key quality-of-care domains. Future work is needed to validate these measures.
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This study evaluated the association between depression and hospitalization among geriatric home care patients. A sample of 477 patients newly admitted to home care over two years was assessed for depression. Bivariate and logistic regression analyses examined the likelihood of hospitalization during a 60-day home care episode. The hospitalization rate was similar for the 77 depressed patients and 400 nondepressed patients (about 7%). However, mean time to hospitalization was 8.4 versus 19.5 days after start of care, respectively. Hospitalization risk was significantly higher for depressed patients during the first few weeks. A main effect for depression and a depression-by-time interaction was found when analyses controlled for medical comorbidity, cognitive status, age, gender, race, activities of daily living and instrumental activities of daily living, and referral to home care after hospitalization. Depression appears to increase short-term risk of hospitalization for geriatric home care patients immediately after starting home care.
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This study compiled national county-level data and examined the geographic distribution of providers in six mental health professions and the correlates of county-level provider supply. Data for six groups--advanced practice psychiatric nurses, licensed professional counselors, marriage and family therapists, psychiatrists, psychologists, and social workers--were compiled from licensing counts from state boards, certification counts from national credentialing organizations, and membership counts from professional associations. The geographic distribution of professionals was examined with descriptive statistics and a national choropleth map. Correlations were examined among county-level totals and between provider-to-population ratios and county characteristics. There were 353,398 clinically active providers in the six professions. Provider-to-population ratios varied greatly across counties, both within professions and overall. Social workers and licensed professional counselors were the largest groups; psychiatrists and advanced practice psychiatric nurses were the smallest. Professionals tended to be in urban, high-population, high-income counties. Marriage and family therapists were concentrated in California, and other mental health professionals were concentrated in the Northeast. Rural, low-income counties are likely candidates for interventions such as the training of local clinicians or the provision of incentives and infrastructure to facilitate clinical practice. Workforce planning and policy analysis should consider the unique combination of professions in each area. National workforce planning efforts and state licensing boards would benefit from the central collection of standardized practice information from clinically active providers in all mental health professions.
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The study examined 1999-2005 data on first-time nursing home admissions of individuals with mental illness, dementia, or both to identify trends and characteristics. The Minimum Data Set was used to estimate the number and percentage of persons newly admitted to nursing homes who had mental illness (schizophrenia, bipolar disorder, depression, or an anxiety disorder), dementia, or both from 1999 to 2005. Data from 2005 were used to compare demographic characteristics and comorbid conditions of the three groups and treatments received. The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. The 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression--from 128,566 to 154,262 in 2005. Persons admitted with depression had higher rates of comorbid conditions than those admitted with dementia or with neither dementia nor mental illness. They also had high rates of antidepressant treatment and high rates of receipt of training in skills required to return to the community. Current trends show that the proportion of nursing home admissions with mental illness, in particular depression, has overtaken the proportion with dementia. These changes may be related to increased recognition of depression, availability of alternatives to nursing homes for persons with dementia, and increased specialization among nursing homes in the care of postacute, rehabilitation residents. In light of these trends, it is critical to ensure that nursing homes have resources to adequately treat residents with mental illness to facilitate community reintegration.
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To screen for undetected cognitive impairment in homebound elders receiving home health care services. A cross-sectional study of adults 60 years of age and older receiving visiting nurse services. A pharmacist administered the Mini-Cog, a rapid screening test for cognitive impairment, during the enrollment home visit. Participants' homes. A consecutive sample of 100 homebound adults, 60 years of age or older with no previous diagnosis of dementia, Alzheimer's disease, or other cognitive impairment. Percentage of participants scoring in the likely impaired range (screen failure) on the Mini-Cog. Seventeen percent of persons with no prior diagnosis of dementia or cognitive decline failed the Mini-Cog. Rates of undetected cognitive impairment are substantial in homebound elders receiving care from a visiting nurse service. The home health setting represents an important point in the continuum of geriatric care for detection of cognitive impairment. Future work should define the types and trajectories of cognitive impairment detected in home care patients by simple screens such as the Mini-Cog and test ways to integrate this knowledge into longitudinal treatment plans across settings of care.
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District nurses (DNs) provide home care for old persons with a mixture of chronic diseases, symptoms and reduced functional ability. Family physicians (FPs) have been criticised for their lack of involvement in this care. The aim of this study was to obtain increased knowledge concerning the FP's experience of providing medical treatment for patients with home care provided by DNs by developing a theoretical model that elucidates how FPs handle the problems they encounter regarding the individual patients and their conditions. Semi-structured interviews were conducted with 13 Swedish FPs concerning one of their registered patients with home care by a DN, and the treatment of this patient. Grounded theory methodology (GTM) was used in the analyses. The core category was the effort to stay in charge of the medical treatment. This involved three types of problems: gaining sufficient insight, making adequate decisions, and maintaining appropriate medical treatment. For three categories of patients, the FPs had problems staying in charge. Patients with reduced functional ability had problems providing information and maintaining treatment. Patients who were "fixed in their ways" did not provide information and did not comply with recommendations, and for patients with complex conditions, making adequate decisions could be problematic. To overcome the problems, four different strategies were used: relying on information from others, supporting close observation and follow-up by others, being constantly ready to change the goal of the treatment, and relying on others to provide treatment. The patients in this study differed from most other patients seen at the healthcare centre as the consultation with the patient could not provide the usual foundation for decisions concerning medical treatment. Information from and collaboration with the DN and other home care providers was essential for the FP's effort to stay in charge of the medical treatment. The complexity of the situation made it problematic for the FP to make adequate decisions about the goal of the medical treatment. The goal of the treatment had to be constantly evaluated based on information from the DN and other care providers, and thus this information was absolutely crucial.
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This study sought to investigate the effect of changes in depression status on physical disability in older persons receiving home care, examine whether the effect is due to concomitant changes in cognitive status, and test whether affective state and cognitive ability interact to influence physical disability. Multilevel analyses were conducted using longitudinal data collected about every 3 months from older participants in Michigan's community-based long-term care programs (N = 13,129). The data set provided an average of nine repeated measures of depressive symptoms, cognitive functioning, and physical disability. We estimated the lag effects of within-person changes in depression and cognitive status, and their interaction, on physical disability measured by activities of daily living (ADL) and instrumental activities of daily living (IADL), controlling for health-related events that occurred in the interim. Changes between not having and having depressive symptoms, including subsyndromal symptoms, are critical to physical disability for home care elders. The effects are independent of concomitant changes in cognitive status, which also have significant adverse effects on physical disability. There is some evidence that improvement of depression buffers the adverse effect of cognitive decline on IADL disability. Providers should monitor changes in depression and cognitive status in home care elders. Early detection and treatment of subthreshold depression, as well as efforts to prevent worsening of cognitive status in home care elders, may have a meaningful impact on their ability to live at home.
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A companion paper reported a very strong cross-sectional association between handicap and late-life depression. Adjusting for handicap weakened associations between sociodemographic variables and depression. It was unclear whether handicap was a confounder, or a useful summary variable, mediating the effect of a range of sociodemographic disadvantages. This paper focuses on the cross-sectional relationship between depression and demographic variables, social support, and life events. A community survey of all residents over the age of 65 years of an electoral district in London, UK. There was a moderate association between SHORT-CARE pervasive depression and the number of life events experienced over the previous year. Personal illness, bereavement and theft were the most salient events. There was a stronger, graded, relationship between the number of social support deficits (SSDs) and depression. Number of SSDs also related to age, handicap, loneliness and use of homecare services. Loneliness was itself strongly associated with depression; odds ratio 12.4 (7.6-20.0). Problems of collinearity, and the cross-sectional design of the study limited interpretation of the exact nature of the relationship between social support, loneliness, handicap and depression. However, the clustering of these four factors can be used to define a large part of the elderly population with a poor quality of life. An important avenue for future research will be the development and implementation of population intervention strategies designed to address some or all of these problems among older people in general.
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Despite the growth of geriatric home health services, little is known about the mental health needs of geriatric patients seen in their homes. The authors report the distribution, correlates, and treatment status of DSM-IV major depression in a random sample of elderly patients receiving home health care for medical or surgical problems. Geriatric patients newly admitted to a large, traditional visiting nurse agency were sampled on a weekly basis over a period of 2 years. The 539 patients ranged in age from 65 to 102 years; 351 (65%) were women, and 81 (15%) were nonwhite. The Structured Clinical Interview for DSM-IV Axis I Disorders was used to interview patients and informants. The authors reviewed the results of these interviews plus the patients' medical charts to generate a best-estimate DSM-IV psychiatric diagnosis. The patients had substantial medical burden and disability. According to DSM-IV criteria, 73 (13.5%) of the 539 patients were diagnosed with major depression. Most of these patients (N=52, 71%) were experiencing their first episode of depression, and the episode had lasted for more than 2 months in most patients (N=57, 78%). Major depression was significantly associated with medical morbidity, instrumental activities of daily living disability, reported pain, and a past history of depression but not with cognitive function or sociodemographic factors. Only 16 (22%) of the depressed patients were receiving antidepressant treatment, and none was receiving psychotherapy. Five (31%) of the 16 patients receiving antidepressants were prescribed subtherapeutic doses, and two (18%) of the 11 who were prescribed appropriate doses reported not complying with their antidepressant treatment. Geriatric major depression is twice as common in patients receiving home care as in those receiving primary care. Most depressions in patients receiving home care are untreated. The poor medical and functional status of these patients and the complex organizational structure of home health care pose a challenge for determining safe and effective strategies for treating depressed elderly home care patients.
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To review the care by general practitioners (GPs), district nurses and assistant nurses of patients receiving home nursing. Retrospective data from questionnaires, records and official statistics. Statistical comparisons. Primary health care from October 1995 to October 1996. One-third (158) of all patients receiving home nursing in a suburban area were sampled; 73% (116) participated. All patients of comparable age in one practice served as a control group. Number of and reasons for visits and other contacts. Nature of care. Relation between patient problems and care given. Most patients were seen by the nurses two to five times a month. They met their GPs less often than other patients. More measures were undertaken without direct contact between GP and patient. The most common measures concerned medication and the assessment of symptoms. Patients with cognitive problems seemed to get less active GP care. GPs played an active role in the care of patients receiving home nursing even though they seldom met them. Many patients were regularly assessed by the nurses, which might have diminished the need for doctor visits. The care of patients with cognitive problems needs further study.
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Gait impairment is common in the elderly, especially those with stroke and white matter hyperintensities on conventional brain MRI. Diffusion tensor imaging (DTI) is more sensitive to white matter damage than conventional MRI. The relationship between DTI measures and gait has not been previously evaluated. Our purpose was to investigate the relationship between the integrity of white matter in the corpus callosum as determined by DTI and quantitative measures of gait in the elderly. One hundred seventy-three participants of a community-dwelling elderly cohort had neurological and neuropsychological examinations and brain MRI. Gait function was measured by Tinetti gait (0 to 12), balance (0 to 16) and total (0 to 28) scores. DTI assessed fractional anisotropy in the genu and splenium of the corpus callosum. Conventional MRI was used to evaluate for brain infarcts and white matter hyperintensity volume. Participants with abnormal gait had low fractional anisotropy in the genu of the corpus callosum but not the splenium. Multiple regressions analyses showed an independent association between these genu abnormalities and all 3 Tinetti scores (P<0.001). This association remained significant after adding MRI infarcts and white matter hyperintensity volume to the analysis. The independent association between quantitative measures of gait function and DTI findings shows that white matter integrity in the genu of corpus callosum is an important marker of gait in the elderly. DTI analyses of white matter tracts in the brain and spinal cord may improve knowledge about the pathophysiology of gait impairment and help target clinical interventions.
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Homebound seniors suffer from high levels of functional impairment and are high-cost users of acute medical services. This article describes a 7-year experience in building and sustaining a physician home visit program. The House Calls for Seniors program was established in 1999. The team includes a geriatrician, geriatrics nurse practitioner, and social worker. The program hosts trainees from multiple disciplines. The team provides care to 245 patients annually. In 2006, the healthcare system (62%), provider billing (36%), and philanthropy (2%) financed the annual program budget of $355,390. Over 7 years, the team has enrolled 468 older adults; the mean age was 80, 78% were women, and 64% were African American. One-third lived alone, and 39% were receiving Medicaid. Reflecting the disability of this cohort, 98% had impairment in at least one instrumental activity of daily living (mean 5.2), 71% had impairment in at least one activity of daily living (mean 2.6), 53% had a Mini-Mental State Examination score of 23 or less, 43% were receiving services from a home care agency, and 69% had at least one new geriatric syndrome diagnosed by the program. In the year after intake into the program, patients had an average of nine home visits; 21% were hospitalized, and 59% were seen in the emergency department. Consistent with the program goals, primary care, specialty care, and emergency department visits declined in the year after enrollment, whereas access and quality-of-care targets improved. An academic physician house calls program in partnership with a healthcare system can improve access to care for homebound frail older adults, improve quality of care and patient satisfaction, and provide a positive learning experience for trainees.
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KEY FINDINGS: Data from the National Health and Nutrition Examination Survey, 2005-2006. In any 2-week period, 5.4% of Americans 12 years of age and older experienced depression. Rates were higher in 40-59 year olds, women, and non-Hispanic black persons than in other demographic groups. Rates of depression were higher among poor persons than among those with higher incomes. Approximately 80% of per sons with depression reported some level of functional impairment because of their depression, and 27% reported serious difficulties in work and home life. Only 29% of all persons with depression reported contacting a mental health professional in the past year, and among the subset with severe depression, only 39% reported contact. Depression is a common and debilitating illness. It is treatable, but the majority of persons with depression do not receive even minimally adequate treatment. Depression is characterized by changes in mood, self-attitude, cognitive functioning, sleep, appetite, and energy level. The World Health Organization found that major depression was the leading cause of disability worldwide. Depression causes suffering, decreases quality of life, and causes impairment in social and occupational functioning. It is associated with increased health care costs as well as with higher rates of many chronic medical conditions. Studies have shown that a high number of depressive symptoms are associated with poor health and impaired functioning, whether or not the criteria for a diagnosis of major depression are met.
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Aged, homebound people are among the medically unreached. Their problems are multifaceted, involving medical and psychological health, finances, housing, and isolation from society. In January 1973 a program was started to meet the needs of this group in some areas of Manhattan surrounding St. Vincent's Hospital by keeping the patients in their own community, out of institutions, in adequate housing, in the best possible state of health, and at the maximum level of independence. Community organizations serve as case finders; physicians, nurses and social workers from St. Vincent's Hospital participate in the delivery of a broad range of services. In the first 16 mth, 200 individuals have been referred and 620 home visits made. This form of health care delivery serves society through substantial financial savings, and it fulfills the wishes of older people themselves for such programs.
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In this report, selected results are presented from the 1987 Kentucky Oral Health Survey, which acquired statewide data on the oral health status and practices of the noninstitutionalized population of Kentucky. In the 1987 epidemiological survey, information about persons who were homebound was also gathered through telephone and in-person interviews. The results of that survey provided a relatively accurate estimate of the number of persons homebound in the state of Kentucky. Although the majority of this population was older than age 60, almost 21% were between the ages of 35 and 59. Household income for persons who are homebound and the amount of money spent on dental care is significantly less than in households not reporting the presence of a person who is homebound. These findings provide baseline data for dentists and health planners interested in serving this population. Also, this data is pertinent to the formation of health policies to create accessible, affordable care for this growing segment of the population.
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To compare the prevalence of specific psychiatric disorders in the homebound elderly to other elders, controlling for demographic, physical health, and socio-economic factors. Survey. Epidemiologic Catchment Area (ECA) project in New Haven, CT. 2,553 non-institutionalized elders representing the total elderly population of the greater New Haven area. None Homebound status determined by self-report; psychiatric status according to DSM III by the Diagnostic Interview Schedule (DIS); cognitive status by Mini-Mental Status Examination. Cognitive impairment (21.8% vs 11.0%, P less than 0.001), depression (2.3% vs 0.7%, P less than 0.01), dysthymia (3.9% vs 1.7%, P less than 0.01), and anxiety disorders (2.2% vs 0.4%, P less than 0.001) were each at least twice as prevalent among elders confined to a bed or chair as among non-homebound elders. Most of this increase was consistent with the poorer physical health status of the homebound; after controlling for health status, only dysthymia (Odds ratio = 2.1, P less than 0.01) was significantly more prevalent among elders confined to a bed or chair. The higher prevalence of disorders among the homebound support recommendations that psychiatric assessments become routine in primary care examinations of homebound elders and that the availability of preventive and therapeutic psychiatric services to the homebound increase.
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Homebound status is a critical eligibility criterion for Medicare reimbursement of some home care services, yet little discussion has been undertaken to establish a valid definition of it. We propose an operational definition of homebound status, and we measure its validity for community-dwelling elderly in the Massachusetts Health Care Panel Study (MHCPS). The MHCPS is a longitudinal study of a cohort of elderly persons (N = 1,625), which began in 1974, with follow-up surveys in 1976, 1980, and 1985. Validity was measured by comparing responses from the operational measure to persons' responses to questions that we judged should be associated with a valid measure of homebound status. This construct validity method resulted in correlations that were significant and in the expected direction, and that suggested that this operational measure is a highly specific, moderately sensitive, valid measure. These results underscore the need for researchers investigating the homebound to discuss the validity and limitations of their homebound measures, and in what context these measures are useful.
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