Homebound status among middle-aged and older adults with disabilities in ADLs and its associations with clinical, functional, and environmental factors

Associations between Sarcopenia and trajectories of activities of daily living disability: a nationwide longitudinal study of middle-aged and older adults in China from 2011 to 2018

BACKGROUND

Sarcopenia is an age-related clinical syndrome, which is associated with numerous adverse outcomes among older adults. The relationship between sarcopenia and activities of daily living (ADL) disability has been studied in China, but these findings usually focused on a single time point. The patterns of ADL can change over time and vary among individuals. Therefore, it is necessary to explore the association between sarcopenia and trajectories of ADL disability.

METHODS

According to Asian Working Group for Sarcopenia (AWGS) 2019 criteria, muscle mass, muscle strength, and physical performance measurements were measured to diagnose sarcopenia. A six-item ADL score was used to measure ADL disability, and trajectories of ADL disability were identified by the latent class trajectory modelling (LCTM). Multiple logistic regression models were performed to examine the association between sarcopenia and trajectories of ADL disability.

RESULTS

Among 9113 middle-aged and older adults, three trajectories of ADL disability were determined according to changes in ADL score during follow-up, including a mild-high trajectory (n = 648, 7.11%), followed by the low-mild trajectory (n = 3120, 34.24%) and low-low trajectory (n = 5345, 58.65%). After adjustment for covariates, severe sarcopenia was significantly associated with higher risks of being in the mild-high trajectory group (OR = 3.31, 95%CI: 2.10-5.22) and the low-mild trajectory group (OR = 1.44, 95%CI: 1.05-1.98), compared with the low-low trajectory group. This association was still observed when stratified by age and gender. In addition, participants with sarcopenic obesity were associated with a higher risk of ADL disability (OR = 3.99; 95% CI: 2.50-6.09).

CONCLUSIONS

Among the middle-aged and older Chinese adults, sarcopenia and sarcopenic obesity were both associated with persistent higher trajectories of ADL disability. It suggested that early interventions to sarcopenia and sarcopenic obesity among the middle-aged and older adults may reduce the progression of ADL disability.

Effectiveness of non-pharmacological interventions delivered at home for urinary and faecal incontinence with homebound older people: systematic review of randomised controlled trials

INTRODUCTION

Incontinence is a common, distressing condition, most prevalent in older people. There is an unmet need for effective interventions to support continence. This review focuses on non-pharmacological interventions to reduce incontinence among homebound older people. Aim: to identify interventions with potential to be delivered by care workers, nurses or family members in a person's home.

METHODS

Multiple databases were searched until 15 September 2023 for randomised controlled trials reporting home-based interventions for incontinence for older people (≥65 years) living at home. Two reviewers independently screened titles, abstracts and papers against inclusion criteria, then assessed for the Risk of Bias (RoB2). A third reviewer resolved the discrepancies. Primary data were extracted and synthesised.

RESULTS

A full-text review of 81 papers identified seven eligible papers (1996-2022, all USA), including n = 636 participants (561 women and 75 men). Two studies focusing on multicomponent behavioural interventions showed benefit, as did one study of transcutaneous tibial nerve stimulation self-administered through electrode-embedded socks. Three, which included cognitively impaired people, reported improvement with toileting assistance programmes, but the effects were not all significant. Results were inconclusive from a study examining the effects of fluid intake adjustments. Interventions were delivered by nurses, three in collaboration with family caregivers. No faecal incontinence interventions met the criteria.

CONCLUSION

There is scant evidence for continence supporting interventions delivered in older people's own homes. With an ageing population often reliant on family or social care workers well-placed to support continence promotion and policy drives for services to support older people remaining at home, this evidence gap needs addressing.

HEPPI: a randomized controlled trial of the efficacy of a cognitive-emotional intervention for homebound older adults

OBJECTIVES

This randomized controlled trial aimed to assess the efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI), a home-delivered cognitive-emotional intervention, among the homebound older population presenting with mild cognitive impairment and depressive or anxiety symptoms.

METHODS

Participants were randomly assigned either to the intervention group or the treatment-as-usual group and completed baseline, post-intervention, and three-month follow-up assessments. Changes in episodic memory and symptoms of depression and anxiety were the primary outcomes. Secondary outcomes included changes in global cognition, attentional control, subjective memory complaints, functional status, and quality of life. Data were analyzed on an intention-to-treat basis employing a linear mixed models approach. ClinicalTrials.gov identifier: NCT05499767.

RESULTS

Compared with the treatment-as-usual group, the HEPPI group reported significant immediate improvement in cognition, mood, and daily functional performance. Positive effects of HEPPI were maintained over the follow-up phase only in depressive symptomatology, perceived incapacity to perform advanced instrumental activities of daily living, and self-reported emotional ability. A significant impact of the intervention on the subjective memory complaints level was observed only three months after the intervention.

CONCLUSIONS

This study suggests that HEPPI may be a promising home-delivered cognitive-emotional intervention to help homebound older adults improve their mental health.

Korean primary health care program for people with disabilities: do they really want home-based primary care?

BACKGROUND

Despite many studies on home-based primary care (HBPC)-related benefits and challenges, little is known about the perspectives of potential target groups of the care and their intention or preference for using it. This study aimed to explore the demand for HBPC from the perspective of people with disabilities (PWDs) and caregivers and identify relevant determinants for that demand.

METHODS

Data from the population-based survey conducted in the Gyeonggi Regional Health & Medical Center for People with Disabilities in South Korea were analyzed. Logistic regression analysis was performed to identify relevant determinants for the demand on HBPC.

RESULTS

Overall, 22% of respondents required HBPC, and 34.7% of persons aged ≥ 65 years demanded it. Older adults with disability, homebound status, and a need for assistance with daily living activities were associated with a demand for HBPC. Though having severe disability, only 19.49% of self-reported respondents demanded for HBPC, while 39.57% of proxy-reported respondents demanded for HBPC. Among self-reported group, only marital status was a predictor associated with a demand for HBPC. In contrast, among proxy-reported groups, PWDs with external physical disabilities, or with unmet medical needs due to availability barriers reported a higher demand for HBPC.

CONCLUSIONS

The demand for HBPC does not derive from the medical demands of the users themselves, but rather the care deficit by difficulty in getting out of the house or in outpatient care. Beyond an alternative to office-based care, HBPC needs to be considered to solve the care deficit and as well as to deal with PWDs' medical problems.

Bidirectional association between handgrip strength and ADLs disability: a prospective cohort study

Background

Decreased handgrip strength (HGS) and activities of daily living (ADL) disability are common in aging populations. No studies have evaluated the bidirectional associations between HGS and ADL disability. This study aimed to explore the bidirectional effects of HGS and ADL disability.

Methods

This study analyzed data from two waves (2011 and 2015) of China Health and Retirement Longitudinal Study (CHARLS). Low HGS is defined by the Asian Working Group for Sarcopenia criteria. Meanwhile, disability was assessed by ADLs scale. The prospective bidirectional association between HGS and ADL disability was examined using binary logistic regression. Subgroup analysis were performed according to age and gender.

Results

A total of 4,902 and 5,243 participants were included in the Stage I and Stage II analyses, respectively. On the one hand, low HGS was significantly associated with subsequent ADL disability. The odds ratio (OR) value of developing BADL disability and IADL disability were 1.60 (95% confidence interval (CI): 1.23-2.08) and 1.40 (95% CI: 1.15-1.70), respectively, in participants with low HGS. On the other hand, baseline ADL disability was associated with an increased risk of developing low HGS. The OR value of developing low HGS were 1.84 (95% CI: 1.34-2.51) and 1.46 (95% CI: 1.19-1.79) for participants with BADL disability and participants with IADL disability, respectively. Lastly, the strength of the bidirectional associations varied among subgroups.

Conclusions

A significant bidirectional associations were identified between HGS and ADL disability. Interventions should be developed to prevent the development or progression of both low HGS and ADL disability.

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

OBJECTIVE

Depressive 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.

DESIGN

A secondary analysis of cross-sectional data.

SETTINGS

Communities in the USA.

PARTICIPANTS

Community-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 MEASURES

Participants' 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.

RESULTS

Participants 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).

CONCLUSIONS

This 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.

Feasibility, Acceptability, and Preliminary Efficacy of A Cognitive-Emotional Intervention Program in Homebound Older Adults: A Pilot Randomized Controlled Trial

OBJECTIVES

To conduct a pilot randomized controlled trial to assess the feasibility, acceptability, and preliminary efficacy of the Homebound Elderly People Psychotherapeutic Intervention (HEPPI) among homebound older adults with mild cognitive impairment and depressive or anxious symptomatology.

METHODS

Fifty-one participants were randomly assigned to the intervention group or to the wait-list control group and completed baseline and post-intervention assessments. Feasibility and acceptability were the primary outcomes. Secondary outcomes included changes in cognitive function, depressive and anxiety symptoms, subjective memory complaints, functional status, and quality of life. Intervention effects were assessed both at a group level (two-way mixed ANOVA) and at an individual level (Reliable Change Index).

RESULTS

The HEPPI was a feasible and acceptable non-pharmacological intervention. Compared to the wait-list control group, the intervention group showed significant improvement in cognitive, emotional, and functional domains at post-intervention. Differences between groups in the distributions by clinical change categories were observed.

CONCLUSIONS

Results provide evidence of the HEPPI's feasibility, acceptability, and preliminary efficacy in increasing the cognitive and functional performance of homebound older adults and reducing their psychological symptomatology.

CLINICAL IMPLICATIONS

Home-delivered cognitive-emotional interventions may be a promising and acceptable mental health approach for homebound older adults, improving their cognitive and emotional functioning.

Service Demand for and Awareness of a Primary Healthcare Pilot Project for People With Disabilities

BACKGROUND

This study investigated the demand for and awareness of a primary healthcare pilot project for people with disabilities; it also sought to identify relevant determinants for demand and awareness using Andersen's behavioral model of health service use.

METHODS

This study is a secondary analysis of data from the population-based survey conducted in Gyeonggi Regional Health & Medical Center for People with Disabilities. The data was designed with quota random sampling based on the population with disabilities in each district (city [si] and county [gun]) across the Gyeonggi province (do) to evaluate the health and healthcare accessibility of the disabled people living in the Gyeonggi province. The data was collected through the mobile-based survey of 1,140 people with disabilities living in Gyeonggi-do between March 2021 and June 2021.

RESULTS

Awareness of the service (12.1%) was remarkably low, while the demand (80.5%) was high. The gap between respondents who needed the service but were unaware of it differed according to age, education, activities of daily living, health information sources, chronic disease, depression, subjective health status, and unmet healthcare needs. Chronic disease (odds ratio [OR], 1.86; P = 0.001) and an unmet need for medical care (OR, 2.30; P = 0.002) had significant influences on demand for the service. Furthermore, living alone (OR, 0.42; P = 0.023), medical aid program beneficiary status (OR, 2.10; P = 0.020), access to health information from health service centers (OR, 4.00; P = 0.002), chronic disease (OR, 1.68; P = 0.043), severity of disability (OR, 1.78; P = 0.025), and subjective health status (OR, 4.51; P < 0.001) significantly affected awareness of the program.

CONCLUSION

Chronic disease and an unmet need for medical care were key determinants of service demand, while the severity of disability was not. Thus, there is a need to review the initiative that defines service beneficiaries as people with severe disabilities. Policy makers should consider advertising programs to improve service awareness among people with disabilities.

Longitudinal association between personality traits and homebound status in older adults: results from the National Health and Aging Trends Study

Background

Personality is associated with predictors of homebound status like frailty, incident falls, mobility, and depression. However, the relationship between personality traits and homebound status is unclear. This study aims to examine the longitudinal association between personality traits and homebound status among older adults.

Methods

Using data of non-homebound community-dwelling adults aged 65 years and older in the 2013 and 2014 waves (baseline) of the National Health and Aging Trends Study (N = 1538), this study examined the association between personality traits and homebound status. Homebound status (non-homebound, semi-homebound, and homebound) was determined by the frequency of going outside, difficulty in going outside, and whether there was help when going outside. Personality traits, including conscientiousness, extraversion, neuroticism, openness, and agreeableness were assessed using the 10-item Midlife Development Inventory on a rating scale from 1 (not at all) to 4 (a lot). Ordered logistic regression models were used to examine whether personality traits predicted homebound status in later 3 years with and without adjusting covariates.

Results

The sample was on average 77.0 ± 6.70 years old, and 55% were female. The majority were non-Hispanic whites (76%), and received some college or vocational school education or higher (55%). Homebound participants tended to be less educated older females. Three years later, 42 of 1538 baseline-non-homebound participants (3%) became homebound, and 195 participants (13%) became semi-homebound. Among these five personality traits, high conscientiousness (adjusted odds ratio [OR] = 0.73, p < 0.01) was associated with a low likelihood of becoming homebound after adjusting demographic and health-related covariates.

Conclusions

These findings provided a basis for personality assessment to identify and prevent individuals from becoming homebound.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02771-8.

Multidimensional factors affecting homebound older adults: A systematic review

PURPOSE

To systematically identify the multidimensional factors affecting homebound older adults.

DESIGN

Systematic review.

METHODS

We searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies was used for quality assessment.

FINDINGS

Nineteen studies met the review criteria; the studies were either cross-sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health-related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%.

CONCLUSIONS

The prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses.

CLINICAL RELEVANCE

This research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults

BACKGROUND

Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status.

METHODS

Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression.

RESULTS

Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline.

CONCLUSION

Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.

A Scoping Review of Homebound Older People: Definition, Measurement and Determinants

Being homebound (HB) can affect people's physical and mental health by decreasing movement, which can itself be exacerbated by the deterioration of people's health. To break this vicious cycle of HB and being in poor health, it is necessary to identify and address the factors influencing HB status. Thus, we used a scoping review to identify an HB trend, focusing on the definition, measurements, and determinants of HB status. We analyzed 47 studies according to the five-stage methodological framework for scoping reviews. The common attribute of definitions of HB status was that the boundaries of daily life are limited to the home. However, this varied according to duration and causes of becoming HB; thus, the understanding of HB shifted from the presence or absence of being HB to the continuum of daily activity. Various definitions and measurements have been used to date. Many studies have focused on individual factors to analyze the effect of HB. In the future, it will be necessary to develop a standardized measurement that reflects the multidimensional HB state. In addition, it is necessary to utilize a theoretical framework to explore the social and environmental factors affecting HB.

Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older

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.

Factors associated with going outdoors frequently: a cross-sectional study among Swiss community-dwelling older adults

OBJECTIVE

This study examines potential risk and protective factors associated with going outdoors frequently among older persons, and whether these factors vary according to physical limitations.

DESIGN

Cross-sectional analysis.

SETTING AND PARTICIPANTS

Community-dwelling participants of the Lausanne cohort Lc65+ in 2016, aged 68-82 years (n=3419).

METHODS

Associations between going outdoors frequently and physical limitations, sociodemographic, health, psychological and social variables were examined using logistic regression models. Subgroup analyses were performed according to the severity of physical limitations.

MAIN OUTCOME MEASURES

'Going outdoors frequently' was defined as going out ≥5 days/week and not spending most of the time sitting or lying down.

RESULTS

Three in four (73.9%) participants reported going outdoors frequently. Limitations in climbing stairs (adjusted OR (AdjOR) 0.61, 95% CI 0.47 to 0.80) and walking (AdjOR 0.24, 95% CI 0.18 to 0.31), as well as depressive symptoms (AdjOR 0.58, 95% CI 0.47 to 0.70), dyspnoea (AdjOR 0.60, 95% CI 0.48 to 0.75), age (AdjORolder age group 0.73, 95% CI 0.59 to 0.92) and fear of falling (AdjOR 0.75, 95% CI 0.62 to 0.91) reduced the odds of going outdoors frequently. In contrast, living alone (AdjOR 1.30, 95% CI 1.08 to 1.56), reporting a dense (AdjOR 1.57, 95% CI 1.26 to 1.96) and a high-quality (AdjOR 1.28, 95% CI 1.06 to 1.53) social network increased the odds of going outdoors frequently. Among participants with severe limitations, 44.6% still went outdoors frequently. Among this subgroup, a new emotional relationship (AdjOR 2.52, 95% CI 1.18 to 5.38) was associated with going outdoors, whereas cognitive complaints (AdjOR 0.66, 95% CI 0.47 to 0.93), urinary incontinence (AdjOR 0.67, 95% CI 0.46 to 0.97), dyspnea (AdjOR:0.67, 95%CI:0.48-0.93), and depressive symptoms (AdjOR 0.67, 95% CI 0.48 to 0.93) lowered the odds of going outdoors.

CONCLUSION

Physical limitations are associated with decreased odds of going outdoors frequently. However, social characteristics appear to mitigate this association, even among older persons with severe limitations. Further studies are needed to determine causality and help guide interventions to promote going outdoors as an important component of active ageing.

Activities of Daily Living of Home Healthcare Patients

Activities of daily living (ADLs) is an important measure of the quality of care provided in home healthcare (HHC), but few studies describe the ADLs of HHC patients. The objectives of this study were to (1) describe the types and levels of ADL dependency among patients receiving home care, (2) identify the risk factors for severe ADL dependency at admission, and (3) identify the predictors of ADL improvement during an HHC stay. This was a secondary data analysis of a 5% random sample (n = 105,654) of the national Outcome and Assessment Information Set (OASIS-C) for the year 2013. The dependent variables were severe ADL dependency level at admission and ADL improvement from admission to discharge. About two thirds (65%) of the patients (n = 99,991) had severe ADL dependency (dependence in seven or more ADLs) at admission. Older age, female gender, and impaired decision-making were associated with severe ADL dependency on admission. Of the 105,654 patients, 58.1% (n = 89,997) experienced ADL improvement. ADL improvement was associated with increasing HHC length of stay, being female, and prior inpatient stay. Clinicians, policy makers, and agencies could focus on modifiable characteristics to achieve the goal of ADL improvement.

Determinants of ADL and IADL disability in older adults in southeastern Poland

Background

The extension of the life span has led to an increase in the number of older people and an increase in the prevalence of disability in people over 60 years of age. The aim of this study was to assess the prevalence of ADL and IADL disability and to analyze its determinants among people aged 60 and older living in southeastern Poland.

Methods

This cross-sectional study was carried out among a randomly selected, representative population of people aged 60 and older living in southeastern Poland. Disability was assessed using the Katz Index of Independence in Basic Activities of Daily Living and Instrumental Activities of Daily Living. Logistic regression models were used to identify the factors related to ADLs and IADLs. For the variables that were included in the above models, their clustered influence on the increase in the odds ratio for the occurrence of an ADL or IADL limitation was also examined.

Results

The research results show that 35.75% of the participants reported at least one problem with IADLs. At least one problem with ADLs was reported by 17.13% of the participants. The most significant modifiable factors influencing the occurrence of disability were the presence of barriers in the participant’s environment, poor relations with relatives, a lack of social contacts, multimorbidity and pain. A multiple increase in the odds ratio of disability was found with the presence of pairs of analyzed factors. The highest odds ratio of at least one ADL limitation was observed for the combination of barriers in the participant’s environment with multimorbidity (OR 74.07). With regard to IADL disability, the highest odds ratio was observed for the combination of pain on the VAS scale ≥3 points with older age (OR 19.47).

Conclusions

The study showed a high prevalence of ADL and IADL disability in older people living in southeastern Poland. It also indicated the extent to which modifiable factors influenced the occurrence of disability and the extent to which the risk of disability increased with the presence of pairs of factors, especially those that included environmental barriers in the participant’s environment.

Relationship between Perceived Indoor Temperature and Self-Reported Risk for Frailty among Community-Dwelling Older People

This study investigated the relationship between perceived indoor temperature in winter and frailty among community-dwelling older people. This cross-sectional study included 342 people 65 years and older in Japan. Participants answered questions about demographics, frailty, housing, and perceived indoor temperature in winter. Participants were grouped based on perceived indoor temperature (Cold or Warm) and economic satisfaction (Unsatisfied or Satisfied). Differences in the frailty index between perceived indoor temperature groups and economic satisfaction groups were tested by using ANCOVA and MANCOVA. An interaction effect showed that people in the Cold Group and unsatisfied with their economic status had significantly higher frailty index scores (F(1, 336) = 5.95, p = 0.015). Furthermore, the frailty index subscale of fall risk was the specific indicator of frailty that accounted for this significant relationship. While previous research has shown the risks related to cold indoor temperature in homes, interestingly among those who reported cold homes, only those who were not satisfied with their economic situation reported being at increased risk for frailty. This highlights the potential importance of preventing fuel poverty to prevent frailty.

[Prevalence of homebound older people in Spain]

OBJECTIVE

The number of older people with functional or other problems that prevent them from going out of doors is unknown. The objective of this study was to estimate the prevalence of homebound status in Spain and to determine their main characteristics.

MATERIAL AND METHODS

The Classification of Functioning, Disability and Health was used. Homebound status was defined according to the declared difficulty with regard to mobility outside the home: completely homebound (not able to leave home), semi-homebound (have serious difficulties but can leave with help), and the individuals without problems that were not homebound. Capacity and performance qualifiers were used to assess the final impact of technical or personal help. Prevalences were calculated, and sociodemographic and health characteristics were compared for the different groups.

RESULTS

Out of a total of 2,146,362 older people with disabilities, 8.1% (95% CI: 8.1-8.2) and 16.0% (95% CI: 15.9-16.0) were (complete) homebound, and semi-homebound, respectively. The homebound elderly were mostly women, had a higher mean age and low education level. They also declared they had more difficulty for the environmental barriers, had worse perceived health, a greater number of disabilities, chronic health conditions, and more functional problems.

CONCLUSIONS

The prevalence of older disabled people with a homebound status was 24.1%. The social, health, and functional characteristics suggest situations of vulnerability. The information on homebound individuals could contribute to enhance social and health plans, and to raise the visibility of this problem.