Epidemiology of the Homebound Population in the United States

Abstract

Increasing numbers of older, community-dwelling adults have functional impairments that prevent them from leaving their homes. It is uncertain how many people who live in the United States are homebound.OBJECTIVES To develop measures of the frequency of leaving and ability to leave the home and to use these measures to estimate the size of the homebound population in the US population. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional data from the National Health and Aging Trends Study collected in 2011 in the contiguous United States. Participants were a nationally representative sample of 7603 noninstitutionalized Medicare beneficiaries 65 years and older. MAIN OUTCOMES AND MEASURESWe defined homebound persons as those who never (completely homebound) or rarely (mostly homebound) left the home in the last month. We defined semihomebound persons as those who only left the home with assistance or had difficulty or needed help leaving the home. We compared demographic, clinical, and health care utilization characteristics across different homebound status categories. RESULTSIn 2011, the prevalence of homebound individuals was 5.6% (95% CI, 5.1%-6.2%), including an estimated 395 422 people who were completely homebound and 1 578 984 people who were mostly homebound. Among semihomebound individuals, the prevalence of those who never left home without personal assistance was 3.3% (95% CI, 2.8%-3.8%), and the prevalence of those who required help or had difficulty was 11.7% (95% CI, 10.9%-12.6%). Completely homebound individuals were more likely to be older (83.2 vs 74.3 years, P < .001), female (67.9% vs 53.4%, P < .006), and of nonwhite race (34.1% vs 17.6%, P < .001) and have less education and income than nonhomebound individuals. They also had more chronic conditions (4.9 vs 2.5) and were more likely to have been hospitalized in the last 12 months (52.1% vs 16.2%) (P < .001 for both). Only 11.9% of completely homebound individuals reported receiving primary care services at home. CONCLUSIONS AND RELEVANCEIn total, 5.6% of the elderly, community-dwelling Medicare population (approximately 2 million people) were completely or mostly homebound in 2011. Our findings can inform improvements in clinical and social services for these individuals.

Prevalence and factors associated with functional dependency in homebound elderly people in Brazil

“…In addition, these participants had spent most of their life in the city and currently live in a high-income neighbourhood and have a caregiver. These characteristics are in agreement with worldwide studies 9,16,18,19 and emphasise the feminisation of ageing. Among all the independent variables influencing functional dependency, having a caregiver was the most significant factor, which suggests that having someone to provide assistance can increase, on average, 40.2 times (CI95% 4.8; 355.4) the chance of being functionally dependent.…”

“…The results of this study showed that 48% of the homebound elderly included in the study were functionally dependent. Conversely, evidence provided by the literature shows a higher prevalence of functional dependency among the homebound elderly 15 and suggests that the higher the functional dependency, the higher the chance of the person being homebound 15,16 . However, the variability among functional independence measurement instruments and procedures makes it difficult to compare prevalence between studies.…”

Association Between Symptom Burden and Time to Hospitalization, Nursing Home Placement, and Death Among the Chronically Ill Urban Homebound

“…The estimated 2 million elderly homebound living in the US have a disproportionate chronic disease burden (14). The homebound often have complex and interrelated medical and social comorbidities that contribute both to substantial functional and cognitive limitations, greater use of health care services, and higher mortality rates compared to the non-homebound elderly population (11, 14–19).…”

Using Nurse Practitioner Co-Management to Reduce Hospitalizations and Readmissions Within a Home-Based Primary Care Program

“…Homebound individuals have considerable difficulty leaving the home without assistance (Centers for Medicare and Medicaid Services, 2009). Almost 6% of community-dwelling, elderly Medicare beneficiaries are either mostly or completely homebound, which translates to more than two million Americans and encompasses more people than the current U.S. nursing home population (Ornstein et al, 2015). Homebound patients tend to be frail, elderly, and medically complex (Qiu et al, 2010), often having multiple chronic conditions (Kellogg & Brickner, 2000; American Academy of Home Care Physicians, Public Policy Statement).…”