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Sun, Xiaocao, Minhui Liu, Christina Miyawaki, Yuxiao Li, Tianxue Hou, Siyuan Tang, and Sarah Szanton. "Longitudinal Relationships Between Favorite Activities and Homebound Status in Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 496. http://dx.doi.org/10.1093/geroni/igaa057.1603.
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Abstract Favorite activities are usually meaningful to older adults and may influence their homebound status and vice versa. Using Round 1 (R1, in 2011) and Round 5 (R5, in 2015) data from the National Health and Aging Trends Study, we examined the patterns of favorite activity by homebound status and investigated their relationship among community-dwelling older adults (N=3,332). Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency, difficulty, and needing help of outdoor mobility. Favorite activities were named by participants verbatim and then were classified into two categories (active and non-active) based on the estimated energy needed to perform the activity. Logistic regression models were used to determine whether homebound status at R1 predicted the types of favorite activity in R5, and ordinal logistic regression models for predictions from the types of favorite activity at R1 to homebound status at R5, adjusting for demographics and health conditions. The sample was, on average, 76±7.23 years old, non-Hispanic White (72.9%), and female (59.7%). Regardless of the homebound status, reading and walking are the top two favorite activities. Homebound older adults enjoyed “non-active” activities (e.g., watching TV), while non-homebound counterparts preferred “active” outdoor maintenance. Being homebound at R1 predicted non-active favorite activity in R5 (OR=.257, p<0.001), and R1 non-active favorite activity also predicted homebound status in R5 (OR=1.219, p =0.039). These findings provide new information on the activity preferences of older adults with different homebound status and how their preferences may influence their future homebound status.
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Sheehan, Orla, Karen Bandeen-Roche, Christine Ritchie, Shang-En Chung, Jeremy Walston, David Roth, and Bruce Leff. "Are all homebound older adults frail?" Innovation in Aging 4, Supplement_1 (December 1, 2020): 777–78. http://dx.doi.org/10.1093/geroni/igaa057.2812.
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Abstract Seven million adults in the United States are homebound and suffer the negative, powerful synergies of multiple chronic conditions, functional impairment, social stressors, and limited social capital. The prevalence of frailty in this vulnerable homebound population is unknown. Using representative data from the National Health and Aging Trends study (NHATS) study linked to Medicare claims (n=4756) we sought to assess the prevalence of frailty in the homebound population (n=361). Among the homebound, 68.5% met the frailty criteria compared to 12.3% of the non-homebound population. The frail homebound had lower educational attainment, were more likely to live alone, self-reported poorer health and more chronic physical and mental health conditions than the non-frail homebound (p<0.05 for all). Frail homebound older adults utilized more health services utilization than non-frail homebound and were twice as likely to be hospitalized (49.8% versus 28.0%, p=0.004).
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Sun, Xiaocao, Minhui Liu, Christina E. Miyawaki, Yuxiao Li, Tianxue Hou, Siyuan Tang, and Sarah Szanton. "The Association Between Personality and Homebound Status in Older Adults: Results From the NHATS." Innovation in Aging 4, Supplement_1 (December 1, 2020): 233. http://dx.doi.org/10.1093/geroni/igaa057.751.
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Abstract Personality is associated with predictors of homebound status like frailty, incident falls, and depression. It has been rarely investigated whether personality predicts homebound status among older adults. Using the combining cross-sectional data of the Year 2013 and Year 2014 data from the National Health and Aging Trends Study (NHATS), this study examined the association between personality traits and homebound status in a sample of community-dwelling older adults aged 65 years and older (N=2,788). Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency, difficulty, and help of outdoor mobility. Personality traits, including conscientiousness, agreeableness, openness, extraversion, and neuroticism were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Each personality trait was included as a predictor in an ordinal logistic regression model to examine its association with homebound status after adjusting demographic and health-related covariates. The sample was on average 79±7.53 years old, non-Hispanic White (72.0%), female (58.6%), living alone (35.4%) or with spouse/partner only (37.4%). Seventy-four percent, 18%, and 8% of participants were non-homebound, semi-homebound, and homebound, respectively. Homebound participants tended to be less-educated older females. The average scores of conscientiousness, agreeableness, openness, extraversion, and neuroticism were 3.19±0.75, 3.57±0.56, 2.81±0.83, 3.13±0.75, and 2.22±0.86, respectively. Among these five personality traits, high conscientiousness (OR=1.34, p<0.001) and extraversion (OR=1.16, p=.03) were associated with a reduced likelihood of being homebound. These findings provided a basis for potential personality assessment to identify and protect individuals with high homebound risk.
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Chen, Tao, Shuangshuang Wang, and Nengliang (Aaron) Yao. "Mental Health of Homebound Older Adults in China: The Moderating Effect of Loneliness." Innovation in Aging 4, Supplement_1 (December 1, 2020): 95. http://dx.doi.org/10.1093/geroni/igaa057.313.
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Abstract Homebound older adults are confined to their homes due to physical, mental, or social limitations, which contributes to elevated levels of depression. However, the mental health status of the homebound population in China is relatively overlooked. This study compares mental health status between homebound and non-homebound older adults, and examines the moderation effect of loneliness. The sample consists of 1,301 older adults aged 60 and over (39% homebound, 49% females, mean age = 69) from Shandong Aging and Health Survey, conducted by Shandong Provincial Government in 2019. Mental health status was measured by feelings of depression, not cheerful, bored, not calm or peaceful, and not happy. Compared to non-homebound older adults, homebound older adults tend to be older, lower educated, live in rural areas, and in worse health conditions. Results from generalized linear regression models show that controlling for demographic and physical health status, homebound population were more likely to have worse mental health status than other Chinese older adults. Feeling lonely, isolated, or lack of companionship intensifies the adverse effects of being homebound on older adults’ mental health. Findings from this study suggest that homebound older adults in China had both physical and psychological sufferings. Social programs and interventions may be designed to improve homebound older adults’ mental health. As the number of homebound older adults increases in China, medical care models may be tailored to improve the accessibility of healthcare services among people who are confined to their homes.
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Liu, Minhui, Yuxiao Li, Xiaocao Sun, Christina Miyawaki, Tianxue Hou, Siyuan Tang, and Sarah Szanton. "Bidirectional Longitudinal Relationships Between Homebound Status and Falls Among Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 267–68. http://dx.doi.org/10.1093/geroni/igaa057.856.
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Abstract Research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. Using the National Health and Aging Trends Study, we examined 1) whether prior-wave falls predicted homebound status in a later wave in 2,916 non-homebound participants in Wave 1 and 2) whether prior-wave homebound status predicted falls in 2,512 participants with no falls in Wave 1. Homebound status (non-homebound and homebound) was determined by the frequency, difficulty, and needing help of outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine their bidirectional association, adjusting for demographics, health-related, and behavioral factors. Participants who had fallen in later waves were more likely to be older non-Hispanic black, comorbid, and have more pain, depression, disabilities, worse health status vision impairment, and low physical activities. Participants who were homebound in later waves tended to older, female, non-Hispanic black, less-educated, living alone or with others only, comorbid, obese, and have more pain, depression, disabilities, worse health status, more hospitalizations, vision and hearing problems, and low physical activities. Previous falls significantly predicted later homebound status (adjusted odds ratio [OR]: 1.28, 95% CI: 1.09-1.50). Prior wave homebound status also significantly contributed to falls in the next year (adjusted OR: 1.28, 95% CI: 1.12-1.46). The bidirectional longitudinal association between homebound status and falls suggests a vicious circle between them. Fall prevention programs should particularly target homebound older adults for falls reduction.
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Ornstein, Katherine, Jennifer Reckrey, Evan Bollens-Lund, Katelyn Ferreira, Mohammed Husain, Shelley Liu, and Albert Siu. "How Long Do Older Adults Remain Homebound in the Community? Implications for Long-Term Services and Support Systems." Innovation in Aging 4, Supplement_1 (December 1, 2020): 711–12. http://dx.doi.org/10.1093/geroni/igaa057.2504.
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Abstract A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community but are homebound (never/rarely leave home). While homebound status is associated with decreased access to medical services and poor health outcomes, it is unclear how long individuals remain homebound. We used the National Health and Aging Trends Study (NHATS), a nationally representative sample of Medicare beneficiaries age 65 and over, with survey weighting to assess duration of homebound status in the community. Among the incident homebound in 2016 (n=253) , only 28% remained homebound after 1 year. 21% died, 18% were recovered, and one-third left the home but still reported difficulty. As the locus of long-term care shifts from nursing homes to the community and models of care expand to serve the needs of the homebound, it is critical that we better understand the heterogeneity and transitions of the homebound population.
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Casteel, Carri, Jennifer Jones, Paula Gildner, James M. Bowling, and Susan J. Blalock. "Falls Risks and Prevention Behaviors Among Community-Dwelling Homebound and Non-Homebound Older Adults." Journal of Applied Gerontology 37, no. 9 (October 16, 2016): 1085–106. http://dx.doi.org/10.1177/0733464816672043.
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The objectives were to examine falls risk factors to determine how the magnitude of risk may differ between homebound and non-homebound older adults, and to describe falls prevention behaviors and participation in falls prevention education. A cross-sectional survey was conducted with convenience samples of community-dwelling older adults recruited through Meals on Wheels programs (homebound, n = 80) and senior centers (non-homebound, n = 84) in North Carolina. Data were collected during home visits and included an interview and medication inventory. Multivariate negative binomial regression with robust variance estimation modeled risk factors for falls. Risk factors for falls observed in both the homebound and non-homebound populations are consistent with what is known in the literature. However, the magnitude of the risk was higher in the homebound than in the non-homebound population with respect to vision impairments, number of high-risk and over-the-counter medications, and use of walking aids .Few participants reported participating in a falls prevention program.
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Catterson, Thomas M. "HOMEBOUND." Critical Perspectives on Accounting 11, no. 2 (April 2000): 214. http://dx.doi.org/10.1006/cpac.1999.0402.
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Black, Erik W., Richard E. Ferdig, April Fleetwood, and Lindsay A. Thompson. "Hospital homebound students and K-12 online schooling." PLOS ONE 17, no. 3 (March 24, 2022): e0264841. http://dx.doi.org/10.1371/journal.pone.0264841.
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The flexibility afforded by online education may provide opportunities for learners with disability who require absence from traditional learning environments. This study sought to describe how a subset of learners with disability, those with hospital-homebound designation, perform in K-12 online classes, particularly as compared to non-hospital homebound counterparts. A cross-sectional analysis was performed of all Florida Virtual School course enrollments from August 1, 2012 to July 31, 2018. Researchers analyzed 2,534 course enrollments associated with K-12 students who, at the time of their course enrollment, had hospital-homebound designation, and a comparison group of 5,470,591 enrollments from K-12 students without hospital-homebound status. Data analysis showed three important outcomes. First, hospital-homebound designated student academic performance was equivalent to their non-hospital homebound counterparts. Second, however, hospital-homebound course enrollments were 26% more likely to result in a withdrawal prior to grade generation. Third, these withdrawals were potentially mitigated when H/H designated students were enrolled in five or more classes or in classes with five or more students. The results of this study provided evidence that when they can remain enrolled, hospital-homebound learners experience equivalent academic outcomes in online learning environments. These findings suggest that healthcare professionals should be made aware of the potentially equivalent outcomes for their patients. Moreover, virtual schools should seek to identify and create supports for these students.
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Dostal, Patrick J. "Vulnerability of Urban Homebound Older Adults in Disasters: A Survey of Evacuation Preparedness." Disaster Medicine and Public Health Preparedness 9, no. 3 (April 24, 2015): 301–6. http://dx.doi.org/10.1017/dmp.2015.50.
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AbstractObjectiveRecent disasters within the United States, such as Hurricanes Katrina and Sandy, have highlighted the vulnerability of older adults, and recent litigation has upheld the responsibility of government in assisting the public during mandatory evacuations. Older adults designated as homebound due to their disabilities are at greatest risk of poor outcomes in disasters. This study aimed at assessing the willingness and ability of homebound older adults to evacuate, as well as categorizing their medical needs in the event they are relocated to an emergency shelter.MethodsFifty-six homebound older adults and medical decision surrogates from 1 homebound primary care practice in Philadelphia were assessed with a novel structured interview.ResultsRespondents reported limitations in both their ability and their willingness to evacuate their neighborhoods. Medical needs of homebound older adults were on par with those of nursing home residents.ConclusionsMany homebound older adults are unable or unwilling to evacuate in a mandatory evacuation situation, highlighting a need for public assistance. Their complex medical needs will require significant preparation by special needs shelters. (Disaster Med Public Health Preparedness. 2015;9:301-306)
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Sakurai, Ryota, Masashi Yasunaga, Mariko Nishi, Taro Fukaya, Masami Hasebe, Yoh Murayama, Takashi Koike, et al. "Co-existence of social isolation and homebound status increase the risk of all-cause mortality." International Psychogeriatrics 31, no. 5 (July 19, 2018): 703–11. http://dx.doi.org/10.1017/s1041610218001047.
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ABSTRACTBackground:Social isolation and homebound statuses are possible risk factors for increased mortality among older adults. However, no study has addressed the impact of accumulation of these two factors on mortality. The aim of this study was to examine whether such accumulation increased the risk of all-cause mortality.Methods:The analyzed sample was drawn from a mail survey of 1,023 older adults without instrumental activities of daily living disability. Participants were classified into four groups according to the frequency of both face-to-face and non-face-to-face interactions with others (social isolation and non-social isolation) and the frequency of going outdoors (homebound and non-homebound). Social isolation and homebound statuses were defined as having a social interaction less than once a week and going outdoors either every few days or less, respectively. All-cause mortality information during a six-year follow-up was obtained.Results:In total, 78 (7.6%) participants were both socially isolated and homebound. During the follow-up period, 65 participants died, with an overall mortality rate of 10.6 per 1000 person-years. Cox proportional hazards regression analyses demonstrated that older adults who were socially isolated and homebound showed a significantly higher risk of subsequent all-cause mortality compared with healthy adults who were neither socially isolated nor homebound, independent of potential covariates (aHR, 2.19; 95% CI: 1.04–4.63).Conclusion:Our results suggest that the co-existence of social isolation and homebound statuses may synergistically increase risk of mortality. Both active and socially integrated lifestyle in later life might play a major role in maintaining a healthy status.
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Burgdorf, Julia, and Jennifer Reckrey. "SUBJECTIVE COGNITIVE DECLINE AS A PREDICTOR OF INCIDENT HOMEBOUND STATUS AMONG OLDER ADULTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 26. http://dx.doi.org/10.1093/geroni/igac059.096.
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Abstract In the US, over 2 million older adults are homebound, meaning they never or rarely leave their home. Being homebound increases risk for negative outcomes, including depression and mortality. Dementia diagnosis is a risk factor for becoming homebound, but over half of those with dementia do not receive a formal diagnosis. Subjective cognitive decline (SCD)—self-reported increase in memory loss over a given timeframe—is an early indicator of dementia that can be easily determined during routine medical encounters. SCD screening could be a valuable tool for identifying older adults at risk of becoming homebound—a critical first step towards supporting these individuals and their caregivers—but its predictive value is not yet known. We examined a nationally representative sample of 4,914 (weighted n=34,381,060) community-living older adults who responded to the 2016 and 2017 National Health and Aging Trends Study (NHATS). We modelled incident homebound status as a function of SCD using weighted, multivariable logistic regression while adjusting for older adult sociodemographic characteristics, health status, and caregiving support. In adjusted models, those who reported SCD experienced 43% greater odds of becoming newly homebound from 2016-2017 (aOR: 1.43; p=0.03). This relationship persisted among individuals without a formal dementia diagnosis (n=4,735); among these individuals, those who reported SCD experienced 50% greater odds of becoming newly homebound (aOR: 1.50; p=0.02). Findings suggest the potential value of SCD screening as an efficient method of identifying older adults who may benefit from resources that reduce the risk and/or mitigate the negative effects of becoming homebound.
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Ida, Satoshi, Ryutaro Kaneko, Kanako Imataka, Kaoru Okubo, Yoshitaka Shirakura, Kentaro Azuma, Ryoko Fujiwara, Hiroka Takahashi, and Kazuya Murata. "Factors associated with social isolation and being homebound among older patients with diabetes: a cross-sectional study." BMJ Open 10, no. 11 (November 2020): e037528. http://dx.doi.org/10.1136/bmjopen-2020-037528.
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ObjectiveWe aimed at investigating factors associated with social isolation and being homebound in older patients with diabetes.DesignCross-sectional study.SettingsThose undergoing outpatient treatments at Ise Red Cross Hospital, Mie Prefecture.ParticipantsPatients with diabetes aged ≥65 years.Primary and secondary outcome measuresSocial isolation was defined as indulging in less than one interaction per week with individuals other than cohabiting family members. We defined homebound as going outside home less than once a day. To identify factors associated with social isolation and being homebound, we performed logistic regression analysis. The dependent variable was social isolation or homebound and independent variables were basic attributes, glycaemic parameters, complications and treatment details.ResultsWe analysed 558 cases (320 men and 238 women). Among these, 174 (31.2%) were socially isolated; meanwhile, 87 (15.6%) were homebound. The glycoalbumin/haemoglobin A1c ratio (OR 4.52; 95% CI 1.07 to 19.1; p=0.040) and the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) scores (OR 0.72; 95% CI 0.57 to 0.90; p=0.006) had significant associations with social isolation. TMIG-IC scores (OR 0.78; 95% CI 0.66 to 0.92; p=0.003) and insulin use (OR 4.29; 95% CI 1.14 to 16.1; p=0.031) were associated with being homebound.ConclusionIn older patients with diabetes, glycaemic fluctuations and insulin use are associated with social isolation and being homebound, respectively. In addition, a decline in higher level functional capacity is a common factor associated with social isolation and being homebound. Thus, it is important to pay attention to social isolation and being homebound when a decline in higher level functional capacity, increased glycaemic fluctuations and insulin use in older patients with diabetes are observed.
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Xiang, Xiaoling, Jieling Chen, and MinHee Kim. "Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older." Gerontologist 60, no. 1 (March 13, 2019): 101–11. http://dx.doi.org/10.1093/geront/gnz023.
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Abstract Background and Objectives The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories. Research Design and Methods The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1–Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories. Results Three trajectory groups were identified: the “never” group (65.5%) remained nonhomebound; the “chronic” group were largely persistently homebound (8.3%); and the “onset” group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the “onset” and “chronic” versus the “never” trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the “chronic” trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk. Discussion and Implications The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.
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Petit, Constance C., and Philip P. Patterson. "There's No Place Like Home: Training, Practices and Perceptions of Homebound Services." Physical Disabilities: Education and Related Services 33, no. 2 (November 19, 2014): 36–52. http://dx.doi.org/10.14434/pders.v33i2.13071.
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Homebound services involve the delivery of special education in settings other than school sites. Such settings typically include students’ homes or hospitals. Most often associated with early childhood special education and with students who are medically or physically fragile, homebound services can also be for those in need of interim alternative educational settings (IAES). Although homebound services have been available to some students with disabilities for more than 50 years, little research exists on that delivery model. This study investigated the training, practices and perceptions of service providers who work in homebound settings. Data from a self-administered survey of a national sample were analyzed. Key findings included: a widespread lack of training for professionals who delivered homebound services; an absence of school district or agency policies or procedure concerning the delivery of such services; and statistically significantly higher perceptions of self-efficacy by those who did receive training.
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Benigno, Vincenza, Giovanni Paolo Caruso, Francesca Maria Dagnino, Edoardo Dalla Mutta, and Chiara Fante. "Enhancing Home Education in Italian Context: Teachers’ Perception of a Hybrid Inclusive Classroom." Education Sciences 12, no. 8 (August 18, 2022): 563. http://dx.doi.org/10.3390/educsci12080563.
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Homebound Education in Italy is based on one-to-one teaching conducted by teachers who visit the sick student at home. This modality does not include interactions between homebound students and classmates, thus inhibiting the educational aspect of peer relationships. With the outbreak of the COVID-19 pandemic and the consequent dispositions of the Ministry of Education regarding remote education and integrated digital didactic (DID), new opportunities became available for homebound students. In this research, we applied and tested in the context of homebound education a model of hybrid inclusive classroom developed in a previous project ((TRIS), addressing homebound students that could not permanently attend school and followed lessons remotely. The present study involved two homebound students affected by chronic and acute diseases. During the 2020/21 school year, the model was proposed to the two school councils (22 teachers in all) and the trial monitored; at the end of the school year, semi-structured interviews were conducted with teachers and transcriptions analyzed using a deductive approach based on the model. Results confirm some findings of the TRIS project, while new aspects emerged linked to the specific context. Overall, the implemented hybrid classroom seems to have positively affected both the learnings and students’ inclusion.
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Xiang, Xiaoling, Ruopeng An, and Hyunsung Oh. "The Bidirectional Relationship Between Depressive Symptoms and Homebound Status Among Older Adults." Journals of Gerontology: Series B 75, no. 2 (January 25, 2018): 357–66. http://dx.doi.org/10.1093/geronb/gbx180.
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Abstract Objectives This study aimed to examine the bidirectional relationship between depressive symptoms and homebound status among older adults. Method The study sample included 7,603 community-dwelling older adults from the National Health and Aging Trends Study. A bivariate latent state-trait model of depressive symptoms and homebound status was estimated via structural equation modeling. Results The model fit the data well (Root Mean Square Error of Approximation = .02, Comparative Fit Index = .97, Standardized Root Mean Square Residual = .06). The relationship between homebound status and depressive symptoms can be decomposed into three parts: a moderate correlation between the stable trait components (r = .56, p <.001); a contemporary association of the state components (b = .17, p <.001); and bidirectional lagged effects between the state components. Change in homebound status was as a stronger predictor of depressive symptoms (b = .19, p < .001) than change in depressive symptoms was of homebound status (b = .06, p < .001; test of difference: Δ scaled χ2(1) = 24.2, p < .001). Discussion Homebound status and depressive symptoms form a feedback loop to influence each other. Improving the outdoor mobility of older adults may have immediate benefits for reducing depressive symptoms.
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Adebayo, Christianah, and Alex Bishop. "Exploring Application of Smart Companion Robots to Facilitate Faith-Based Ministries for Older Homebound Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 315–16. http://dx.doi.org/10.1093/geroni/igaa057.1009.
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Abstract This study examined perceptions regarding application of smart robot companions to facilitate homebound religious ministry programming to older adults. A total of N= 7 participants consisting of ministers, pastoral volunteers, and older adult members from Methodist, Presbyterian, and Roman Catholic traditions engaged in a 60-minute focus group. One key goal was to address the question: If you could design a robot for ministry to homebound older adults what would you want it to do? All responses were recorded, transcribed and coded for thematic content. Three core themes emerged relative to spiritual privacy, prospective intervention, and inclusive monitoring. Relative to spiritual privacy, participants expressed concern regarding robotic ability to maintain the spiritual privacy of the older homebound adult, especially when engaged in faith-based behaviors such as private prayer, confession, and pastoral counseling. Second, participants suggested that a robot companion serve as a memory aide for older homebound members. In particular, participants acknowledged a need for robot intervention relative to sending alerts concerning prayer requests, reminders of upcoming church-related events, and notices concerning future homebound ministry visitations. Finally, participants indicated an interest for the robot to actively monitor community inclusion, noting that many older homebound adults are left out of weekly church-related services or events and experience seclusion, yet most “retain a desire be included and remain an integral part of their faith community.” Results will be used to present a conceptual model for a smart robotic faith assistant designed for delivery of homebound ministries to older adults.
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Khan, Shehroz, Can (Shirley) Cui, and Andrea Iaboni. "MACHINE LEARNING TO PREDICT HOMEBOUND STATUS IN OLDER ADULTS USING CANADIAN LONGITUDINAL STUDY ON AGING DATASET." Innovation in Aging 6, Supplement_1 (November 1, 2022): 764. http://dx.doi.org/10.1093/geroni/igac059.2770.
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Abstract Individuals who are unable to leave their home or with great difficulty are considered homebound or semi-homebound. Homebound status is strongly associated with disability, social isolation, healthcare use and costs, and mortality. Most homebound older adults have multiple chronic conditions and poor health. There is not enough information about homebounded older adults in Canada. The Comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA) presents an excellent opportunity to study the complex factors associated with homebound status and the interplay between physical, social, psychological, and environmental determinants over time. This is a population-level study which makes use of provincial healthcare registration data to sample older adults across the country. We obtained the first wave of CLSA dataset containing samples from 21667 individuals over 3223 variables. We developed a definition of ‘homeboundedness’ in using life-space index variables present in the CLSA datatset. The dataset contained numerical, categorical and missing values. After preprocessing, we selected 1101 Homebound and 20521 Non-Homebound individuals, and 1771 variables. We showed that Random Forest classifier (with missing values) provided an AUC ROC and PR of 0.89 and 0.49. The missing value imputation did not improve the results significantly. Using feature hashing, we converted the dataset to numerical values; the AUCs improved to 0.96 and 0.71 at the cost of losing interpretation. In future, we will consult clinical experts in choosing the relevant features and use analytical methods to select features and compare. We will also test these predictive models on the next wave of this dataset.
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Conroy, Karl, Shaun Bhatia, Mohammed Islam, and Leonard A. Jason. "Homebound versus Bedridden Status among Those with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome." Healthcare 9, no. 2 (January 20, 2021): 106. http://dx.doi.org/10.3390/healthcare9020106.
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Persons living with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) vary widely in terms of the severity of their illness. It is estimated that of those living with ME/CFS in the United States, about 385,000 are homebound. There is a need to know more about different degrees of being homebound within this severely affected group. The current study examined an international sample of 2138 study participants with ME/CFS, of whom 549 were severely affected (operationalized as ‘Homebound’). A subsample of 89 very severely affected participants (operationalized as ‘Homebound-bedridden’) was also examined. The findings showed a significant association between severely and very severely affected participants within the post-exertional malaise (PEM) symptom domain. The implications of these findings are discussed.
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Reckrey, Jennifer M., Linda V. DeCherrie, Micheline Dugue, Anna Rosen, Theresa A. Soriano, and Katherine Ornstein. "Meeting the Mental Health Needs of the Homebound: A Psychiatric Consult Service Within a Home-Based Primary Care Program." Care Management Journals 16, no. 3 (September 2015): 122–28. http://dx.doi.org/10.1891/1521-0987.16.3.122.
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The growing population of homebound adults increasingly receives home-based primary care (HBPC) services. These patients are predominantly frail older adults who are homebound because of multiple medical comorbidities, yet they often also have psychiatric diagnoses requiring mental health care. Unfortunately, in-home psychiatric services are rarely available to homebound patients. To address unmet psychiatric need among the homebound patients enrolled in our large academic HBPC program, we piloted a psychiatric in-home consultation service. During our 16-month pilot, 10% of all enrolled HBPC patients were referred for and received psychiatric consultation. Depression and anxiety were among the most common reasons for referral. To better meet patients’ medical and psychiatric needs, HBPC programs need to consider strategies to incorporate psychiatric services into their routine care plans.
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Peng, Wenting, Christina E. Miyawaki, Safiyyah M. Okoye, Wenru Wang, Yuqian Luo, Cen Mo, and Minhui Liu. "Mediating role of homebound status between depressive symptoms and cognitive impairment among community-dwelling older adults in the USA: a cross-sectional analysis of a cohort study." BMJ Open 12, no. 10 (October 2022): e065536. http://dx.doi.org/10.1136/bmjopen-2022-065536.
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ObjectiveDepressive symptoms are known modifiable factors of cognitive impairment in older adults. However, the pathway through which depressive symptoms lead to cognitive impairment is not well understood. This study aimed to investigate whether homebound status (defined as usually unable to leave home unassisted) mediates the association between depressive symptoms and cognitive impairment in community-dwelling older adults in the USA.DesignA secondary analysis of cross-sectional data.Setting(s)Communities in the USA.ParticipantsCommunity-dwelling older adults (N=7537) from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the USA.Main outcome measuresParticipants’ cognitive impairment status was classified using a composite measure. Depressive symptoms were assessed using Patient Health Questionnaire-2. Homebound status was determined by the frequency, difficulty and needing help in getting outdoors. We used logistic regression and the Paramed command in STATA to analyse whether homebound mediated the association between depressive symptoms and cognitive impairment.ResultsParticipants were on average, 77.7 years old, female (58.3%) and non-Hispanic white (68.1%). About 26% of the participants were classified as having cognitive impairment, 16% reported depressive symptoms and 25% were homebound. Depressive symptoms (adjusted OR, 1.60; 95% CI 1.36 to 1.89) and homebound status (adjusted OR, 1.58; 95% CI 1.34 to 1.86) were independently associated with cognitive impairment. Homebound significantly mediated 12.5% of the total effect between depressive symptoms and cognitive impairment, with significant indirect effect (OR, 1.07; 95% CI 1.04 to 1.10), direct effect (OR, 1.61; 95% CI 1.36 to 1.91) and total effect (OR, 1.72; 95% CI 1.46 to 2.03).ConclusionsThis study supports a mediating role of homebound status in the relationship between depressive symptoms and cognitive impairment. Interventions to promote outdoor mobility should be studied for their ability to delay cognitive impairment for older adults with depressive symptoms.
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Thomas, Jennifer E., Robin J. Jacobs, Joshua Caballero, Raymond L. Ownby, Elizabeth M. Lessmann, Kayla Mallare, and Mark Adler. "Factors to assess depression in homebound older adults." Mental Health Clinician 6, no. 5 (September 1, 2016): 236–41. http://dx.doi.org/10.9740/mhc.2016.09.236.
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Abstract Introduction: The number of homebound older adults is expected to increase as the elderly population grows. Many homebound older persons may be at high risk for depression, which has been associated with adverse health outcomes. The objective of this study was to identify selected factors that may predict depression in the homebound older population. Methods: Data from 340 homebound adults, aged 65 and older who were enrolled in Broward Meals on Wheels and who participated in a telephone survey were analyzed. Participants were asked to report demographic information, health status, medication-taking behaviors, mental health, and life satisfaction. Multiple regression analysis was used to identify predictors of depressed mood in this sample of older adults. Results: The majority of the sample (aged 65–95 years; mean, 77 years) were female (76.5%), white (77.1%), and living alone (52.6%). Multivariate modeling indicated that difficulty remembering the number of prescribed medications to be taken, feeling groggy after taking certain medications, poor self-reported health status, taking anxiety medications, and less satisfaction with life explained 34% (adjusted R2) of the variance in predicting depressed mood (F = 33.1, df = 5, P < .001). Discussion: Multiple factors related to medication use were identified that may contribute to higher levels of depressed mood in homebound older adults. These factors found in our study may be used to create a screening model to be used by pharmacists to identify homebound older adults who would benefit from further assessment for depression.
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Fujita, Koji, Sachiko Yamazaki, Hiromi Imuta, Roseline Yong, Hiroko Matsunaga, and Yoshinori Fujiwara. "DEPRESSIVE TENDENCIES AND NEGATIVE LIFE EVENTS AS PREDICTORS OF HOMEBOUND STATUS AMONG OLDER ADULTS IN JAPAN." Innovation in Aging 7, Supplement_1 (December 1, 2023): 833. http://dx.doi.org/10.1093/geroni/igad104.2687.
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Abstract This study aimed to examine negative life events (NLEs) and depressive tendencies as predictors of homebound status, which poses a risk of long-term frailty in older adults. A population-based cohort study (2018-2020) using self-administered questionnaires was conducted with older adults (65-94 years) in the rural community of Akita Prefecture, Japan. The response rate at the baseline survey in 2018(T1) was 61.5%. About 81.1% (1,048 out of 1,291) of the participants at T1 responded to the follow-up survey in 2020 (T2). Among them, 77.3% (810) were not homebound at T1. After data cleaning, 790 participants’ data were analyzed. A frequency of going out less than once a week was considered a homebound status. In this study, NLEs included 1) loss of a close relative, 2) major illness or injury to oneself, 3) major illness or injury to a family member, 4) financial difficulties, and 5) loss of one’s role (family, workplace, society, others). Depressive tendencies were evaluated using the 6-item Kessler Psychological Distress Scale (0-24 scale). A K6 score ≥ 9 indicates depressive tendencies. Logistic regression analysis was adjusted for potential confounders. The incidence of being homebound at two years was 10.1% for men and 17.1% for women, with a significant gender difference (p< 0.01). The adjusted odds ratio for depressive tendencies was 3.37 (95%CI= 1.62-7.01) among homebound (vs. non-homebound) individuals. However, the five NLEs were not statistically significant. Our results suggest that depressive tendencies, but not NLEs, can cause older adults to remain housebound.
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Lee, Sun Young, Hyein Chu, and Yu-Mi Kim. "Characteristics of Homebound and Patients with Disability Who Use Home-Based Primary Care in Korea: A Retrospective Study for 2018–2022." Journal of Clinical Medicine 13, no. 6 (March 11, 2024): 1604. http://dx.doi.org/10.3390/jcm13061604.
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(1) Background and Methods: This study evaluated characteristics of South Korean patients necessitating home-based primary care (HBPC) from 2018 to 2022, distinguishing between homebound individuals with chronic conditions and those with registered disabilities. (2) Result: Among 171 HBPC recipients, 56.1% were homebound, predominantly older with a median age of 81 years (interquartile range (IQR 68.5–86.0)), while 43.9% were disabled, generally younger with a median age of 39 years (IQR, 28–64). Activities of daily living were assessed, revealing a median score of 14 (IQR, 10–19), indicative of high care dependency. The most common conditions among homebound patients were dementia (27.1%) and physical mobility difficulties (21.9%), whereas mental disabilities (53.3%) and mobility issues (36.0%) prevailed in disabled patients. The primary HBPC needs for homebound patients included management of acute medical conditions (27.1%) and sores (17.7%). Conversely, regular health check-ups (46.7%) and management of neuropsychiatric symptoms (26.7%) were prevalent among the disabled group. (3) Conclusion: Notably, over 90% of HBPC patients required assistance with daily activities, highlighting significant differences in the needs and characteristics between older, homebound individuals with multiple comorbidities and younger, disabled patients receiving medical aid. These insights emphasize the necessity to develop customized HBPC programs to adequately cater to the diverse patient needs within South Korea.
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DICICCO-BLOOM, BARBARA, SHARON SPACE, and ROTHLYN P. ZAHOUREK. "THE HOMEBOUND ALCOHOLIC." AJN, American Journal of Nursing 86, no. 2 (February 1986): 167–70. http://dx.doi.org/10.1097/00000446-198602000-00029.
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Shaefer, Sarah J. M., and Janice M. Emerling. "Homebound Pregnant Adolescents." Home Health Care Management & Practice 9, no. 3 (April 1997): 23–32. http://dx.doi.org/10.1177/108482239700900308.
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Sterling-Fox, Cynthia. "Access to Five Nonprimary Health Care Services by Homebound Older Adults: An Integrative Review." Home Health Care Management & Practice 31, no. 1 (November 8, 2018): 55–69. http://dx.doi.org/10.1177/1084822318810384.
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Globally, the number of homebound older adults is rising exponentially as the aging population increases. Homebound older adults have complex medical and psychological issues for which many receive home-based primary care services. The purpose of this integrative review was to identify, analyze, and synthesize the existing literature regarding homebound older adults’ need for, use of, and access to five nonprimary health care services. They are dental, nutritional, optical, pharmacy, and psychological services. The integrative review was conducted using a database search of CINAHL, Health Source: Nursing Education, PubMed, Medline, PsycINFO, and Cochrane, that was supplemented by a hand search. Little research was found addressing the five nonprimary health care services. Five themes emerged from the 10 studies. They were (1) complex and interrelated health problems require more health care services; (2) perceived unimportance of nonprimary health care services; (3) barriers to use of and access to nonprimary health care services; (4) the impact of socioeconomic and demographical factors on access to services; and (5) the impact of psychological factors (depression and social isolation) on the use and access to health care services. These findings suggest further inequity and barriers to health care services by homebound older adults. Future research is needed with nonprimary health care providers to examine the clinical outcomes and costs of providing the services to homebound older adults.
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Xiang, Xiaoling, and Jessica Brooks. "Correlates of Depressive Symptoms among Homebound and Semi-Homebound Older Adults." Journal of Gerontological Social Work 60, no. 3 (January 27, 2017): 201–14. http://dx.doi.org/10.1080/01634372.2017.1286625.
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Leandro, Telma Alteniza, Allana Mirella Alves, Ana Karina Bezerra Pinheiro, Thelma Leite de Araujo, Glauberto da Silva Quirino, and Dayanne Rakelly de Oliveira. "Nurses’ competencies in health promotion for homebound older people." Revista Brasileira de Enfermagem 72, suppl 2 (2019): 311–18. http://dx.doi.org/10.1590/0034-7167-2018-0446.
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ABSTRACT Objective: to identify competencies related to health promotion targeting homebound older people, as they appear in the literature. Method: systematic review using the LILACS, Scopus, CINAHL, PubMed and Cochrane Library databases. The search was performed in November 2017. Selected articles were analyzed according to nine competency domains: enable change; advocate for health; mediate through partnership; communication; leadership; assessment; planning; implementation, and evaluation and research. Results: nine clinical trials were included. All health promotion competency domains were identified in the reviewed research interventions, performed with homebound older people. Conclusion: studies showed that the employed treatments were beneficial for the homebound older population. Interventions based on health promotion competencies were positively identified, and are linked to an effective and high-quality health care practice.
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Phanhdone, Tiffany, Patrick Drummond, Talia Meisel, Naomi Friede, Alessandro Di Rocco, Joshua Chodosh, and Jori Fleisher. "Barriers to Vaccination Among People with Parkinson’s Disease and Implications for COVID-19." Journal of Parkinson's Disease 11, no. 3 (August 2, 2021): 1057–65. http://dx.doi.org/10.3233/jpd-202497.
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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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Miura, Hisayuki, and Yuko Goto. "Comparison of the Life-Sustaining Treatment, Cardiopulmonary Resuscitation, and Palliative Care Implementation Rates between Homebound Patients with Malignant and Nonmalignant Disease Who Died in an Acute Hospital Setting: A Single-Center Retrospective Study." Healthcare 12, no. 2 (January 8, 2024): 136. http://dx.doi.org/10.3390/healthcare12020136.
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Objective: This study investigated and compared the implementation of life-support treatment (LST), cardiopulmonary resuscitation (CPR) implementation rates, and the influence of acute illnesses on the introduction of palliative care (PC) to homebound patients with malignant and nonmalignant disease, who subsequently died in an acute hospital setting. Methods: Among the homebound patients admitted to the ward in our hospital from 2011 to 2018, we investigated and compared the attributes, underlying diseases, causes of death, and rates of implementation of LST, CPR, and PC between patients with malignant and nonmalignant disease who died in the ward, using data obtained from hospitalization records. Furthermore, acute illnesses related to the introduction of PC were examined. Results: Of the 551 homebound patients admitted to the ward of an acute hospital, 119 died in the ward. Of the deceased patients, 60 had malignant disease and 59 had nonmalignant disease. Patients with nonmalignant disease had higher rates of LST implementation and CPR and a lower rate of PC. Patients with infectious disease, who required antimicrobial drugs, had significantly lower PC introduction rates. Conclusion: Understanding the influence of the timing of PC introduction in acute care for homebound patients with advanced chronic illness are issues to be considered.
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O’Brien, Katherine, Sara Bradley, Vanessa Ramirez-Zohfeld, and Lee Lindquist. "Stressors Facing Home-Based Primary Care Providers." Geriatrics 4, no. 1 (January 28, 2019): 17. http://dx.doi.org/10.3390/geriatrics4010017.
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The numbers of homebound patients in the United States are increasing. Home-based primary care (HBPC) is an effective model of interdisciplinary care that has been shown to have high patient satisfaction rates and excellent clinical outcomes. However, there are few clinicians that practice HBPC and clinicians that do face additional stressors. This study sought to better understand the stressors that HBPC providers face in caring for homebound patients. This was a cross-sectional qualitative survey and analysis of HBPC providers. Responses were categorized into four themes: The patient in the home setting, caregiver support, logistics, and administrative concerns. This research is the first to analyze the stressors that providers of HBPC face in serving the needs of complex homebound patients. Awareness and attention to these issues will be important for the future sustainability of home-based primary care.
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Kulshreshtha, Ambar, Joseph C. Kvedar, Abhinav Goyal, Elkan F. Halpern, and Alice J. Watson. "Use of Remote Monitoring to Improve Outcomes in Patients with Heart Failure: A Pilot Trial." International Journal of Telemedicine and Applications 2010 (2010): 1–7. http://dx.doi.org/10.1155/2010/870959.
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Remote monitoring (RM) of homebound heart failure (HF) patients has previously been shown to reduce hospital admissions. We conducted a pilot trial of ambulatory, non-homebound patients recently hospitalized for HF to determine whether RM could be successfully implemented in the ambulatory setting. Eligible patients from Massachusetts General Hospital () were randomized to a control group () or to a group that was offered RM (). The participants transmitted vital signs data to a nurse who coordinated care with the physician over the course of the 6-month study. Participants in the RM program had a lower all-cause per person readmission rate (, ) compared to the usual care group (, ; ) although the difference was not statistically significant. HF-related readmission rate was similarly reduced in participants. This pilot study demonstrates that RM can be successfully implemented in non-homebound HF patients and may reduce readmission rates.
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Choi, Namkee. "ADDRESSING THE MENTAL HEALTH NEEDS OF HOMEBOUND OLDER ADULTS IN AGING SERVICE SETTINGS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 97. http://dx.doi.org/10.1093/geroni/igac059.386.
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Abstract Despite significant and urgent mental health needs among low-income homebound older adults, the existing mental health service systems’ reach for these older adults is almost nonexistent. Given the current and projected geriatric mental health workforce shortages, innovative approaches are needed to better serve these underserved older adults. This presentation will focus on a series of randomized clinical trials that tested acceptable and feasible mental health service delivery models for homebound older adults who are served by aging service network agencies that provide hot meals and case management. Findings from the real-world effectiveness trials of tele-delivered behavioral activation treatment for depression and loneliness by bachelor’s-level lay counselors who are embedded in aging service agencies will be shared. Ways to promote a wider adoption of scalable and sustainable mental health service delivery models for homebound older adults will be discussed.
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Schirghuber, Johannes, and Berta Schrems. "Homebound: A concept analysis." Nursing Forum 56, no. 3 (May 5, 2021): 742–51. http://dx.doi.org/10.1111/nuf.12586.
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STOKER, JEANIE. "The Homebound Issue—Again!" Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 21, no. 11 (November 2003): 778. http://dx.doi.org/10.1097/00004045-200311000-00015.
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E.C. "Homebody." Scientific American 261, no. 4 (October 1989): 77–78. http://dx.doi.org/10.1038/scientificamerican1089-77.
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Goldfine, Shayna, and Meredith Mclnturff. "Mass Vaccination for All: Increasing Inclusivity of Point of Dispensing Plans in New Orleans." Prehospital and Disaster Medicine 38, S1 (May 2023): s209. http://dx.doi.org/10.1017/s1049023x23005344.
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Introduction:In January 2021, the State of Louisiana approved COVID-19 vaccine distribution to elderly and immunocompromised persons. From annual hurricane planning assessments, the city of New Orleans recognized medical and transportation barriers would prevent some eligible residents from accessing vaccines at public point of dispensing (POD) sites. A new vaccine distribution system was needed for homebound individuals and their caregivers. By February, the city developed and implemented a homebound vaccination plan under the direction of New Orleans Emergency Medical Services (NOEMS) and the New Orleans Health Department. This presentation will review this vaccine distribution model and the opportunities and challenges identified in maintaining this model for future medical POD interventions.Method:The City of New Orleans, along with news outlets and service providers, instructed homebound residents and caregivers to self-identify their need for a homebound vaccine by calling 311 and adding their name to a centralized waitlist. NOEMS/NOHD staff would schedule appointments based on resident and provider availability and geography of their home residence. Two 2-person teams were deployed simultaneously to provide ten doses within a five-hour time frame to minimize waste. Each deployment team included one city employee with an EMS certification and one volunteer, along with a cooler, ancillary supplies, registration form, and educational sheet to complete the appointment.Results:350 homebound residents and caregivers were vaccinated with the COVID-19 vaccine from February 2021 to January 2022. Vaccine doses were rarely wasted due to the availability of a centralized city-wide vaccine request list.Conclusion:The COVID-19 pandemic exposed gaps in mass dispensing plans and procedures. This local plan, created in haste to meet community need, became a model practice for other Parishes within the State of Louisiana and nationwide. This distribution modality needs to be maintained and tested, in addition to traditional POD sites, to be utilized in future dispensing events.
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Lai, Patrick Ho Lam, Xiaoling Xiang, Yihang Sun, Joseph Himle, and Ho Lam Lai. "Recruitment of Hard-to-Reach Older Adults in Technology-Based Mental Health Services Studies: Lessons Learned." Innovation in Aging 4, Supplement_1 (December 1, 2020): 412. http://dx.doi.org/10.1093/geroni/igaa057.1328.
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Abstract Homebound older adults are a hard-to-reach population with a high burden of depression and face substantial access barriers to mental health treatments. Internet-based psychotherapy is a promising strategy to address this persistent treatment gap, but older adults are severely underrepresented in internet-based psychotherapy trials. One challenge to advance this area of research and practice is the recruitment and retention of homebound older adults in clinical trials. Previous research has discussed the challenges of recruiting older adults in behavioral interventions and offered useful recommendations. However, recruiting homebound older adults, who face substantial mobility barriers, poses additional challenges not fully addressed in the literature. The expectation of using technology adds another layer of difficulty. In this presentation, we will discuss our group’s experiences working with community partners to recruit and retain homebound older adults for a study on technology-based mental health treatment. We partnered with home care agencies, senior apartment buildings, and Meals-on-Wheels and experimented with a few different ways to recruit study participants. Issues related to accessibility, trust, and stigma emerged as important considerations when designing recruitment strategies and materials. The discussion will be an integration of our experiences and a review of previous literature on the challenges and recommendations for recruiting older adults in mental health services research.
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Zhou, Rui, Joyce Cheng, Shuangshuang Wang, and Nengliang (Aaron) Yao. "A Qualitative Study of Healthcare Experience Among Chinese Homebound Adults Receiving Home-Based Medical Care." Innovation in Aging 4, Supplement_1 (December 1, 2020): 48. http://dx.doi.org/10.1093/geroni/igaa057.157.
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Abstract Home-based medical care (HBMC) is emerging in China, but research understanding the efficiency and effectiveness of this new care model is rare. In this study, researchers interviewed 17 Chinese homebound adults aged 45 and older (53% females, mean age=76) who have received HBMC, and collected detailed information regarding their experiences and attitudes toward HBMC. Participants were recruited from healthcare institutions in Shanghai, Jinan, and Zhangqiu of China. The evaluation of patients’ experiences with HBMC yielded both positive and negative aspects. Positive experiences included 1) the delivery method was convenient for homebound patients; 2) health problems could be detected timely because doctors visited patients regularly; 3) home care providers had better bedside manners and professional skills than hospital-based providers; 4) the medical insurance covered the cost of home care services. Negative experiences related to the supply and quality of care, including 1) the scope of current HBMC services was too limited to meet the needs of homebound patients; 2) the visit time was too short; 3) healthcare providers’ professional skills varied greatly. Findings from this study suggest that the HBMC model benefited Chinese older adults, primarily homebound adults, in terms of convenience and affordability. There are opportunities to expand the scope of home care services and improve the quality of care. Policymakers may consider providing more resources and incentives to enhance HBMC in China. Educational programs may be created to train more HBMC providers and improve their professional skills.
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Weaver, France, Sarah Walsh, and Jennifer Chubinski. "MEALS ON WHEELS UTILIZATION AND THE RISK OF HOSPITALIZATION AMONG MEDICARE ENROLLEES OVER TIME." Innovation in Aging 6, Supplement_1 (November 1, 2022): 184. http://dx.doi.org/10.1093/geroni/igac059.735.
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Abstract Meals on Wheels (MOW) services provide nutritional and social support for clients and may influence acute care use as a result. This study estimates the associations between MOW utilization and the risk of hospitalization for Medicare enrollees aged 65 and over, according to the degree of home-boundness (an eligibility criterion for MOW access). Attention is paid to the heterogenous role of MOW according to gender, race, and ethnicity. The analysis uses the 2014-2020 National Health and Aging Trends Study (NHATS) and includes 17,345 person-year observations. The study uses longitudinal complex survey Probit models of the likelihood of hospitalization, including interaction terms between lagged MOW usage and the extent of home-boundness. Control variables include sociodemographic indicators, living arrangements, health status, region and time fixed effects. Over the study period, the mean probability of hospitalization for Medicare enrollees aged 65+ is 20.5 percent, and the proportion of MOW users is 5.2 percent. Some 11.4 percent report being partially homebound and 5.6 percent mostly/fully homebound. Results reveal that MOW utilization is associated with a lower risk of hospitalization for those who are partly homebound (p= 0.058). This negative association is the largest and statistically significant for males (p=0.034) and whites (p=0.035) only. Further investigations will assess whether these associations are explained by differences between MOW and non-MOW users. The findings suggest that MOW services may delay or limit, to some extent, hospitalizations among partly homebound Medicare enrollees.
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Grain, Madeleine. "Control Beliefs of the Frail Elderly: Assessing Differences Between Homebound and Nursing Home Residents." Care Management Journals 3, no. 1 (January 2001): 42–46. http://dx.doi.org/10.1891/1521-0987.3.1.42.
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Previous age-related sense of control studies have largely focused on active, community-dwelling aged individuals and have excluded elderly persons who are frail. This study compares sense of control and life satisfaction as determined through rating scale administration between two frail, dependent samples: nursing home residents and homebound elderly. Differences in control scores were statistically significant for those who were homebound expressing higher perceived personal control than nursing home residents (p < .001). Sense of control has no correlation with either life satisfaction or length of stay in the nursing home cohort.
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Li, Lydia. "Pre-Pandemic Social Isolation: Protection or Vulnerability in the Time of COVID?" Innovation in Aging 5, Supplement_1 (December 1, 2021): 39. http://dx.doi.org/10.1093/geroni/igab046.146.
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Abstract How do older adults at risk of social isolation before the pandemic fare during the COVID-19 outbreak? Using data from two waves (Round 9 [2019] and COVID-19 Supplement) of the National Health and Aging Trend Study (NHATS), we examined the relationship between pre-pandemic social isolation and psychological distress during the outbreak among community-living older adults (age 65+). Results show that the most socially integrated respondents had more PTSD (β=1.47, SE=.37, p<.001) and depression/anxiety (β=.34, SE=.11, p=.002) symptoms than the most isolated. Older adults who were not homebound had more PTSD (β=2.0, SE= .76, p=.01) and depression/anxiety (β=1.05, SE=.20, p<.001) than the completely homebound. With shelter-in-place and social distancing requirements, older adults who have been socially active and integrated may experience high-stress levels and may need extra support to adjust to the changes. Relatively, those who have been very isolated and homebound may experience fewer changes in their lives.
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Xiang, Xiaoling, Jay Kayser, Yihang Sun, and Joseph Himle. "Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences." JMIR Aging 4, no. 4 (November 22, 2021): e27630. http://dx.doi.org/10.2196/27630.
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Background Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results Three themes and various subthemes emerged related to participants’ experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants’ perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289
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Major-Monfried, Hannah, Linda V. DeCherrie, Ania Wajnberg, Meng Zhang, Amy S. Kelley, and Katherine A. Ornstein. "Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care." American Journal of Hospice and Palliative Medicine® 36, no. 4 (December 26, 2018): 333–38. http://dx.doi.org/10.1177/1049909118820846.
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Background: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound. Objective: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program. Design/Measurements: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment. Results: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period. Conclusions: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.
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Thomas, Kali, Kristen Smith, Jennifer Bunker, and Kim Gans. "USING INTERVENTION MAPPING TO DEVELOP RESOURCES TO PROMOTE SOCIAL ENGAGEMENT WITH HOMEBOUND OLDER ADULTS." Innovation in Aging 7, Supplement_1 (December 1, 2023): 422–23. http://dx.doi.org/10.1093/geroni/igad104.1395.
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Abstract Homebound older adults are at increased risk of social isolation. Drivers who deliver meals to 800,000+ homebound older adults yearly are uniquely positioned to address social isolation through their conversations and daily interactions. The objective of this study was to develop and evaluate resources to educate meal-delivery drivers about social isolation and promote driver-client social engagement. We used Intervention Mapping (IM), a six-step theoretical- and evidence-based planning approach, to develop this intervention. First, we conducted a needs assessment through two focus groups with drivers and 12 interviews with subject matter experts (Step 1). Our literature review revealed the behavior outcomes, determinants, methods, and strategies to target (Steps 2&3). We piloted the intervention materials with stakeholders, meal-delivery drivers, and subject matter experts (Step 4). Our needs assessment indicated that drivers receive no training or education on social isolation. Drawing on the Social Cognitive Theory and Health Belief Model, we developed a 2.5 minute educational video and website with resources for workers who engage with socially isolated homebound older adults. The video and website included the following change methods and strategies: tailoring, modeling, chunking, cuing, raising, framing, and using imagery to influence behaviors. Feedback from drivers and experts on the resources was positive. The presenter will discuss the results implementing and evaluating the intervention (Steps 5&6) with meal-delivery drivers in Mississippi through an online survey. Our findings indicate the benefits of using an iterative, step-by-step intervention development framework to organize and structure an intervention to address social isolation among homebound older adults.
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Kumar, Raj, Katherine Ornstein, Shannon Juengst, Jennifer Reckrey, Amy Wagner, Laura Dreer, Kirk Lercher, and Kristen Dams-O’Connor. "HOME BUT HOMEBOUND AFTER TBI: PREVALENCE AND CORRELATES OF HOMEBOUNDNESS AFTER TBI." Innovation in Aging 7, Supplement_1 (December 1, 2023): 865. http://dx.doi.org/10.1093/geroni/igad104.2786.
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Abstract Discharge home following post-acute care for traumatic brain injury (TBI) has historically been viewed as an unequivocally positive post-treatment outcome. Payors incentivize hospitals to discharge patients home and minimize readmissions. A historically overlooked topic in post-acute TBI care is homeboundness, which is the state where an individual rarely or never leaves home. Homeboundness is associated with premature mortality and poor physical and mental health. Our study investigates the prevalence and correlates of homeboundness among 6,595 non-institutionalized adults (mean age=42, range 16-99) who received inpatient rehabilitation for TBI in the TBI Model Systems National Database, a multicenter prospective cohort study. Our definition of homebound was based on self-reported number of days participants get out of the house in a typical week. We found that 14.2% of participants were completely homebound (never left the home) or partially homebound (left the home 1-2 times/week) 1-year after TBI. Using multivariable regression, we found the following variables were significantly associated with being completely/partially homebound at 1-year post-injury: older age, < college degree, Medicaid insurance, living alone and rural settings, not driving independently, and having functional needs for walking, upper body dressing, bowel and bladder, problem solving, and social interactions. These variables together had an area-under-the-curve of 0.81 distinguishing homeboundness. Our study elucidates an invisible subgroup of non-institutionalized adults living with TBI in the community who require ongoing support services or other follow-up care to improve functional status and participation. Implications for community integration will be discussed.
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Parson, Laurie J. "Impacting Depression in Homebound Elderly." Journal of Christian Nursing 36, no. 2 (2019): 96–103. http://dx.doi.org/10.1097/cnj.0000000000000593.
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STOKER, JEANIE. "Updated Definition of Homebound Status." Home Healthcare Nurse 19, no. 5 (May 2001): 311. http://dx.doi.org/10.1097/00004045-200105000-00015.
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