There are currently more than 38.9 million people over the age of 65 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 the elderly becoming and remaining housebound. The homebound elderly 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 need, and discuss the care that could help ease their suffering and delay their entry into a nursing home or hospital.

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Abstract. Atmospheric free radicals hydroxyl and hydroperoxyl (OH and HO2, collectively HOx) are the catalysts that cause secondary or photochemical air pollution. Chemical mechanisms for oxidant and acid formation, on which expensive air pollution control strategies are based, must accurately predict these radical concentrations. We have used the fluorescence assay with gas expansion (FAGE) technique to carry out the first simultaneous, in situ measurements of these two radicals in highly polluted air during the Los Angeles Free Radical Experiment. A complete suite of ancillary measurements was also made, including speciated hydrocarbons, carbon monoxide, aldehydes, nitric oxide, nitrogen dioxide, and ozone along with meteorological parameters. Using this suite of measurements, we tested the ability of a lumped chemical mechanism to accurately predict radical concentrations in polluted air. Comparison of model predictions with measured radical concentrations revealed generally good agreement for OH early and late in the day, including the early evening hours, when OH persisted at low concentrations after dark. During midday, however, modeled [OH] was high by about 50%. Agreement for HO 2 was quite good in the early morning hours, but model-calculated HO 2 concentrations were significantly too high during midday. When we used our measured HO 2 concentrations as model input, agreement between calculated and measured OH concentrations was improved. It seems likely that (1) the model's HOx sources are too large, (2) there are unaccounted HO• loss processes in Los Angeles air, and/or (3) the complex parameterization of RO2/HO 2 radical chemistry in the reaction mechanism does not adequately describe the behavior of these radicals in the Los Angeles atmosphere.

BackgroundGlobal climate change impacts on human and natural systems are predicted to be severe, far reaching, and to affect the most physically and economically vulnerable disproportionately. Society can respond to these threats through two strategies: mitigation and adaptation. Industry, commerce, and government play indispensable roles in these actions but so do individuals, if they are receptive to behavior change. We explored whether the health frame can be used as a context to motivate behavioral reductions of greenhouse gas emissions and adaptation measures.MethodsIn 2008, we conducted a cross-sectional survey in the United States using random digit dialing. Personal relevance of climate change from health threats was explored with the Health Belief Model (HBM) as a conceptual frame and analyzed through logistic regressions and path analysis.ResultsOf 771 individuals surveyed, 81% (n = 622) acknowledged that climate change was occurring, and were aware of the associated ecologic and human health risks. Respondents reported reduced energy consumption if they believed climate change could affect their way of life (perceived susceptibility), Odds Ratio (OR) = 2.4 (95% Confidence Interval (CI): 1.4 - 4.0), endanger their life (perceived severity), OR = 1.9 (95% CI: 1.1 - 3.1), or saw serious barriers to protecting themselves from climate change, OR = 2.1 (95% CI: 1.2 - 3.5). Perceived susceptibility had the strongest effect on reduced energy consumption, either directly or indirectly via perceived severity. Those that reported having the necessary information to prepare for climate change impacts were more likely to have an emergency kit OR = 2.1 (95% CI: 1.4 - 3.1) or plan, OR = 2.2 (95% CI: 1.5 -3.2) for their household, but also saw serious barriers to protecting themselves from climate change or climate variability, either by having an emergency kit OR = 1.6 (95% CI: 1.1 - 2.4) or an emergency plan OR = 1.5 (95%CI: 1.0 - 2.2).ConclusionsMotivation for voluntary mitigation is mostly dependent on perceived susceptibility to threats and severity of climate change or climate variability impacts, whereas adaptation is largely dependent on the availability of information relevant to climate change. Thus, the climate change discourse could be framed from a health perspective to motivate behaviour change.