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

Abstract

Background/objectives: Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross-sectional studies, homebound older adults have high levels of morbidity and mortality, but there is little evidence of longitudinal outcomes after becoming homebound. The aim of this research is to prospectively assess over 6 years the dynamics of homebound status, ongoing community residence, and death in a population of community-dwelling older adults who are newly homebound.

Design/setting: Prospective cohort study using 2011-2018 data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of aging in the United States.

Participants: Two hundred and sixty seven newly homebound older adults in 2012.

Measurements: Homebound status was defined via self-report as living in the community but rarely/never leaving home in the prior month. Semi-homebound was defined as leaving the house only with difficulty or help.

Results: One year after becoming newly homebound, 33.1% remained homebound, 22.8% were completely independent, 23.8% were semi-homebound, 2.2% were in a nursing home, and 18.0% died. Homebound status is highly dynamic; 6 years after becoming homebound, 13.5% remained homebound and 65.0% had died. Recovering from being homebound at 1 year was associated with younger age and lower baseline rates of receiving help with activities of daily living, in particular, with bathing.

Conclusion: Homebound status is a dynamic state. Even if transient, becoming homebound is strongly associated with functional decline and death. Identifying newly homebound older adults and developing interventions to mitigate associated negative consequences needs to be prioritized.

Keywords: NHATS; disability; epidemiology; geriatrics; homebound; longitudinal.

FIGURE 1

Homebound status 6 years after first report of homebound status (2013–2018). Source: National Health and Aging Trends Study, 2012–2018, N = 267. Independent: leaves home >1×/week without difficulty or receiving help; semi-HB (Homebound): community dwelling and leaves home >×/week but reports either difficulty and/or receiving help with leaving home; HB (homebound): community dwelling and leaves home never or rarely (1×/week); NH (nursing home): resides in a nursing home. All proportions adjusted to account for complex survey design and sampling approach