The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries

Abstract

IMPORTANCE: A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status. OBJECTIVE: To evaluate the association between income and risk of becoming homebound. DESIGN: Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING: Population-based study in the United States. PARTICIPANTS: A total of 7,042 initially nonhomebound community-dwelling older adults. EXPOSURE: Total annual household income at baseline (in 2011) measured via self-report. OUTCOME: Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less. RESULTS: Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20-2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile. CONCLUSION AND RELEVANCE: Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.

The Experience of Homebound Older Adults During the COVID-19 Pandemic

“…"Previously homebound" was broadly defined as those who either rarely or never left home or left the home at least twice/ week but reported either difficulty or receiving help to do so in 2019. 17,18 The primary outcome measure was limited social contact in 2020, operationalized as self-report of contact with family or friends during COVID-19<1/week through four communication mediums: (1) phone calls, (2) emails/texts/social media, (3) video calls, or (4)in-person visits.…”

The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012–2018

“…Since 2011, NHATS annually surveys respondents on health and disability, including homebound status. We identified incident homebound NHATS respondents in 2012 as follows: community‐dwelling and either independent or semi‐homebound (left the home at least twice per week but reported either difficulty or receiving help to do so) in 2011, but in 2012 were homebound (rarely or never left home) 1,25 . This incident homebound cohort was followed for up to 6 years (2013–2018).…”

Measuring older people’s socioeconomic position: a scoping review of studies of self-rated health, health service and social care use

“…Earlier concerns about missing financial data were also confirmed in a small number of studies 46–5455 56 there is less clarity about the patterning specifically at older ages.…”

“…Earlier concerns about missing financial data were also confirmed in a small number of studies. [46][47][48][49][50][51][52][53][54] While there is evidence that missing income data is socially patterned in studies not specific to older groups, 55 56 there is less clarity about the patterning specifically at older ages. Further research could explore whether it is the most or least advantaged older people who are most likely to be under-represented on these measures.…”