Occurrence of and factors influencing elderly homebound in Chinese urban community: A cross-sectional study

Mapping of technological strategies for reducing social isolation in homebound older adults: A scoping review

BACKGROUND

Homebound older adults (HOAs) are particularly vulnerable to social isolation and loneliness, which engender a poorer physical and mental health, and greater cognitive decline. The purpose of this review is to map the literature to identify potential technological strategies that reduce social isolation in HOAs, and to understand facilitators and barriers for adoption and implementation.

METHODS

Six databases including PubMed (MEDLINE), Google Scholar, Cochrane Database, EBSCOHost, National Library ProQuest, Web of Science, and the Journal of Medical Internet Research were searched for relevant articles. Peer-reviewed literature published in English from Jan 2014 to Feb 2024 that employed technological strategies applicable to HOAs and assessed social isolation or connectedness as an outcome measure were included.

RESULTS

107 studies were reviewed and classified into different technological categories based on their functions and features. A social technology framework encompassing delivery, hardware, software, content, training, and support was conceptualized with core characteristics identified from the reviewed technological strategies. Cost and complexity of technology, and resource commitment were identified as barriers while user-friendliness, content curation and a supportive ecosystem may facilitate the adoption of a technological strategy to address social isolation in HOAs.

CONCLUSION

There is a need for early and concerted effort to identify HOAs, provide technology training, and empower them to tap on the digital world to complement and/or supplement social interactions. Development of cost-effective and rapid-to-implement technology is vital for HOAs who are at highest risk to social isolation.

Homebound older adults who live independently in rural Japan: Prevalence and contributing factors during the COVID-19 pandemic

Being homebound is a phenomenon of confining older adults to their homes owing to health, social, and psychological factors. During the COVID-19 pandemic, people were requested to refrain from going out to prevent infection. Consequently, the homebound status of older adults was influenced by social and environmental factors, resulting in an increase in the number of homebound older adults during the pandemic. This study aimed to determine the homebound prevalence and related factors among homebound older adults during the COVID-19 pandemic. In 2021, a cross-sectional study conducted in rural Saitama, Japan, included 1,020 participants aged 65 years and above who did not have long-term care insurance certification and were independent in instrumental activities of daily living. Herein, homebound individuals were defined as those who went out once a week or less. The relationships of homebound status with demographic, health, social, and psychological factors in older adults were examined. The prevalence of homebound independent older adults was estimated as 10.4 % (6.6 % males, 13.8 % females). Homebound status was significantly associated with one or more medical histories (odds ratio [OR] = 1.98, 95 % confidence interval [CI] = 1.00-3.90), no social or family roles (OR = 1.95, 95 % CI = 1.09-3.48), and no hobbies (OR = 1.84, 95 % CI = 1.02-3.34). Establishing social or family roles and promoting participation in hobbies may prevent older adults from being homebound. The social environment, which changed during the pandemic, should be improved to encourage older adults to go out.

Social participation and health in middle-aged and older empty nesters: A study on gender differences

Background

The growing population of middle-aged and older empty nesters is characterized by poorer health, and social participation (SP) has been shown to improve this situation. However, few studies have investigated specific performance and gender differences between SP and health. The present study aims to address these issues.

Methods

A total of 1207 middle-aged and older empty nesters over 45 years old were selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). Random-effects analyses were used to explore the association between changes in SP (diversity, frequency, type) and changes in health status. Health status include physical health, mental health, self-reported health (SRH).

Results

Female middle-aged and olderly empty nesters have significantly poorer health and participate in SP more frequently. The higher the diversity of SP, the better the health of middle-aged and olderly empty nesters, while higher frequency is beneficial to SRH. Female's participation in sports and Internet had better mental health and SRH, and mahjong helped female's mental health. Clubs are helpful for male's SRH.

Conclusions

This study reveals the specifics of the association between SP and health status of middle-aged and older empty nesters. Therefore, all aspects of SP and gender differences should be taken into account when predicting and improving the health status. Help the government to better formulate policies to better cope with the increasing empty nest phenomenon and build a harmonious and stable society.

Retrospective Observational Study on the Characteristics of Pain and Associated Factors of Breakthrough Pain in Advanced Cancer Patients

Objective

This study aimed to conduct a retrospective observational study to understand the status of characteristics of pain and identify potential variables influencing the clinical presentation of breakthrough cancer pain (BTP) in advanced cancer patients.

Methods

Advanced cancer patients over 18 years of age; diagnosed with cancer of any type and stage III or IV in the palliative care ward with available data were enrolled between 2018 and 2020. Demographic data and pain-related information were collected by using structured electronic extraction form from Hospital Information System (HIS). Patients who had well-controlled background pain with an intensity ≤4 on a 0–10 numerical scale for >12 hours/day, the presence of transient exacerbations of pain with moderate-severe intensity (≧5), and clearly distinguish from background pain were regarded to have suffered BTP. Spearman correlation was conducted to explore the relationship between pain score and demographics characteristics. Factors significant in univariate analysis were included in the multiple regression model to explore independent predictive factors associated with the BTP.

Results

Of 798 advanced cancer patients, the mean age was 56.7 (SD = 11.84) years. Lung cancer (29.95%) was the most common cancer, and pain (93%) was the most common symptom. More than half (n = 428, 53.6%) of the patients experienced BTP. The median number of BTP episodes was 4 (IQR = 2, 7, range: 1–42). The median intensity of BTP was 6 (IQR = 6, 7, range 5–10). Patients with severe background pain or BTP had longer hospital stay and more symptoms. Besides, more severe background pain was related to higher activity of daily living. Intramuscular injection of hydromorphone hydrochloride was the main medication for BTP onset. Younger age, background pain, anorexia, and constipation were independently associated with the presentation of BTP. BTP pain intensity was independently associated with bloating. Symptom numbers were an independent factor and positively associated with BTP episodes.

Conclusions

BTP resulted in poor prognosis, which has a variable presentation depending on interdependent relationships among different characteristics. Good controlling of background pain and assessment of pain-related symptoms are essential for BTP management. BTP should be managed individually, especially the invisible pain among aged patients. Furthermore, BTP-related education and training were still needed.

Effects of Social Interaction and Depression on Homeboundness in Community-Dwelling Older Adults Living Alone

This study examines the levels of social interaction, depression, and homeboundness, and the effects of social interaction and depression on homeboundness in community-dwelling older adults living alone. Survey data were collected from 6444 older adults aged 65 and over, living alone, who registered for individualized home care services at 42 public health centers in Gyeonggi Province. A total of 5996 participants with complete questionnaire data were included in the analysis. The mean social interaction score was 2.90 out of 6, and the mean depression score was 6.21 out of 15. The mean homeboundness score was 0.42 out of 2. A hierarchical multiple regression analysis was performed with general characteristics, health factors, social interaction, and depression to identify their effects on homeboundness. In general characteristics and health factors, homeboundness is associated with decreasing social interaction (β = 0.17, p < 0.001) and increasing depression (β = 0.25, p < 0.001) in older adults living alone. Homeboundness was severe among participants aged 80 and over (β = 0.04, p = 0.015) and those with several chronic diseases (β = 0.04, p < 0.001), falling history (β = 0.14, p < 0.001), and lack of exercise (β = −0.20, p < 0.001). Thus, interventions that target social interaction, depression, and health functions are important for this demographic.

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.

Mental health of homebound older adults in China

The mental health status of the homebound population in China is relatively overlooked. A sample of 1,301 older adults from Shandong Province was used to compare the mental health status among homebound, semi-homebound, and non-homebound older adults in China, and examine the moderation effects of loneliness and gender. This study found that, controlling for demographic and physical health status, the homebound population was more likely to have worse mental health status than non-homebound older adults. Experiencing loneliness intensified the adverse effects of being homebound on older adults' mental health. The negative effects of being semi-homebound on mental health were more pronounced among older males than females. Findings from this study suggested that homebound older adults in China experienced psychological challenges. Social programs and interventions may be designed to improve this population's mental health.

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.

Homebound status among older adult home care recipients in Ontario, Canada

BACKGROUND

Homebound status is associated with an increased risk of morbidity and mortality in older adults, yet little is known about homebound older adults in Canada. Our objectives were to describe time trends in the prevalence of homebound status among community-dwelling long-term home care recipients and the characteristics associated with homebound status.

METHODS

This was a retrospective cross-sectional and cohort study using linked health administrative data in Canada's most populous province, Ontario. We included adults aged 65 years and older who received at least one long-term home care assessment from 2006 to 2017 (N = 666,514). Homebound individuals were those who exited the home an average of 0-1 days/week over the previous 30 days; not homebound comparators exited the home 2-7 days per week. We compared baseline characteristics between groups and estimated the association between these characteristics and homebound status at baseline and over time.

RESULTS

From 2006 to 2017, the annual proportion of long-term home care recipients who were homebound increased from 48% to 65%. At first assessment, 50% of the cohort (331,836 of 666,514) were homebound. Among those with a 4-12 month repeat assessment, homebound status persisted over time for 80%, and developed anew in 24%. Dependency on others for locomotion, use of an assistive device, poor access to dwelling, older age, and female sex were most strongly associated with homebound status at baseline, as well as its development and persistence over time.

CONCLUSIONS

We found that half of Ontario older adult long-stay home care clients were homebound at the time of their first assessment, and that the prevalence of homebound status among home care recipients rose steadily from 2006 to 2017. This informs further research and policy development to ensure the adequacy of supports for older homebound persons.

Prevalence of and factors related to homebound and semi-homebound older adults in a rural area in Japan

AIM

The homebound status is associated with unhealthy factors and physical disability. However, the prevalence of those who may be at an earlier stage of the homebound status ("semi-homebound") is unclear. This study thus examines the prevalence of semi-homebound individuals and identifies the associated physical, psychological, and social factors.

METHODS

A cross-sectional study invited 1,157 participants aged 65 years and more in rural Japan. The mean age was 74.7 ± 6.8. The survey questionnaire accounted for different parameters, such as age, sex, homebound status, morbidity, instrumental activities of daily living (IADL), and mental health. Ordinal regression analysis examined participants' homebound status; socio-demographic characteristics; and physical, psychological, and social variables.

RESULTS

The prevalence of the homebound status was 0.11 (95%CI = 0.99-0.13), and the semi-homebound status was 0.30 (95%CI = 0.28-0.33). In the multivariable analysis, the homebound status was negatively associated with IADL (p < .001), mobility (p < .001), being alone during the day (p < .001), depression and anxiety (p < .05), and self-efficacy for going out (p < .001).

DISCUSSION

The prevalence of semi-homebound individuals was approximately 30%. Homebound and semi-homebound individuals were associated with older, female, IADL, functional fitness, being alone during the day, depression and anxiety, and self-efficacy for going out. In the case of psychical, psychological, and social factors, the semi-homebound individuals revealed that these indicators fluctuated between homebound and non-homebound. Our findings further focused on semi-homebound individuals at elevated risks of disability, thereby emphasizing the need for customized intervention. Geriatr Gerontol Int 2021; 21: 1033-1039.

Loneliness in Homebound Older Adults: Integrative Literature Review

Loneliness affects people of all ages at one point or another in their lives; however, older adults aged ≥65 years are disproportionally affected due to age-related losses. Most research on loneliness has focused on older adults in general. Older adults who are homebound tend to have more disabilities and associated complications than older adults in the general population and face unique challenges. The current review examined and synthesized knowledge about loneliness among older adults who are homebound using Whittemore and Knafl's analysis process. Fourteen studies published from 1999 to 2020 met the inclusion criteria. The analysis resulted in four themes: characteristics of loneliness in older adults who are homebound, risks for homebound in older adults, location of older adults who are homebound, and coping strategies and methods to reduce loneliness in this population. Implications for nursing practice and recommendations for future research are discussed. [Journal of Gerontological Nursing, 47(8), 13-20.].

Homebound: A concept analysis

AIM

Analysis of the concept and development of a conceptual definition of homebound.

BACKGROUND

Homebound persons have a significantly higher mortality risk as well as physical and psychosocial burden. A clarification of the term is necessary to develop preventive measures.

DESIGN

Concept analysis.

DATA SOURCES

Scientific literature from electronic databases (CINAHL, Medline via PubMed, PsycINFO, PsycArticles, and Scopus) and definitions from online dictionaries.

REVIEW METHODS

Walker and Avant's method was applied to guide the concept analysis. To prevent arbitrary and empty results in determining the attributes, antecedents, and consequences a thematic analysis was carried out.

RESULTS

Homebound is defined as an enduring condition in which the life-space is reduced to the home, but moving around in the home is possible (by walking short distances alone or by holding on to furniture, or with the help of a stick, walker, or another person). Homebound has six attributes: in need of help in ADL/IADL and in leaving the life-space, powerlessness, life-space confinement, mobility limitation, endurance, and weakness. Physiological instability and physical immobility are antecedents with wide-ranging influencing factors as illness, complexity, burden, and endogenous/exogenous booster. Homebound has also wide-ranging consequences such as the progression of inactivity, physical, psychosocial, and/or spiritual problems.

CONCLUSIONS

The multidimensional concept of homebound modifies the concepts of mobility and immobility. Given the extensive consequences of homebound nurses play a central role in the prevention.

A qualitative study of home health care experiences among Chinese homebound adults

BACKGROUND

Home health care services (HHC) are emerging in China to meet increased healthcare needs among the homebound population, but there is a lack of research examining the efficiency and effectiveness of this new care model. This study aimed to investigate care recipients' experiences with HHC and areas for improvement in China.

METHODS

This research was a qualitative study based on semi-structured interviews. Qualitative data were collected from homebound adults living in Jinan, Zhangqiu, and Shanghai, China. A sample of 17 homebound participants aged 45 or older (mean age = 76) who have received home-based health care were recruited. Conceptual content analysis and Colaizzi's method was used to generate qualitative codes and identify themes.

RESULTS

The evaluations of participants' experiences with HHC yielded both positive and negative aspects. Positive experiences included: 1) the healthcare delivery method was convenient for homebound older adults; 2) health problems could be detected in a timely manner because clinicians visited regularly; 3) home care providers had better bedside manners and technical skills than did hospital-based providers; 4) medical insurance typically covered the cost of home care services. Areas that could potentially be improved included: 1) the scope of HHC services was too limited to meet all the needs of homebound older adults; 2) the visit time was too short; 3) healthcare providers' technical skills varied greatly.

CONCLUSIONS

Findings from this study suggested that the HHC model benefited Chinese older adults-primarily homebound adults-in terms of convenience and affordability. There are opportunities to expand the scope of home health care services and improve the quality of care. Policymakers should consider providing more resources and incentives to enhance HHC in China. Educational programs may be created to train more HHC providers and improve their technical skills.

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.

Cross-sectional study of individual and environmental factors associated with life-space mobility among community-dwelling independent older people

BACKGROUND

Life-space mobility is reflected in comprehensive longevity and health outcomes and is also an important indicator for preventing mortality and decline in well-being among older people. However, a comprehensive framework of life-space mobility and modifiable individual and environmental factors has not been well validated among community-dwelling independent older people, for primary prevention. We examined individual and environmental factors affecting life-space mobility among community-dwelling independent older people.

METHODS

This cross-sectional study included 3500 community-dwelling independent older people randomly selected using the National Basic Resident Registration System in Japan. Life-space mobility was measured using the Japanese version of the Life-Space Assessment (LSA) instrument, which is used to assess an individual's pattern of mobility. Negative multivariate binomial regression analysis was performed in a final sample of 1258 people. Individual factors (including physical, mental, and social characteristics) and environmental factors (including the social and material environment) were measured and analyzed as potential factors.

RESULTS

Negative multivariable binomial regression analysis, adjusted for demographics, showed that LSA score was associated with locomotive syndrome (β = - 0.48, 95% confidence interval [CI] = - 0.24 to - 0.73), depression (β = - 0.29, 95% CI = - 0.03 to - 0.55), health literacy (β = 0.20, 95% CI = 0.39-0.01), and participation in community activities (β = 0.23, 95% CI = 0.03-0.43) among individual factors, and receipt of social support (β = - 0.19, 95% CI = 0.00 to - 0.38) and social network (β = 0.29, 95% CI = 0.48-0.10) among environmental factors.

CONCLUSIONS

Our findings suggest that modifiable individual factors and environmental factors are related to life-space mobility among community-dwelling older people.

Environmental predictors of objectively measured out-of-home time among older adults with cognitive decline

BACKGROUND

Older adults with cognitive decline are vulnerable to various health problems. Going out of home for longer time could be beneficial for their health. Identifying modifiable predictors is essential for developing effective strategies that would increase time spent out-of-home by older adults. This study examined social and physical environmental predictors of objectively measured out-of-home time spent among older adults with cognitive decline.

METHODS

This study was a secondary analysis of a randomized controlled trial (n = 147). Out-of-home time per day was measured by a Global Positioning System at baseline and 1-year follow-up. Baseline data of social environment (living alone, social network [Japanese version of the Lubben Social Network Scale]), objective physical environment (road network distance from each home address to nearest supermarket store, convenience store, and public transportation), and demographic factors (gender, age, education, driving status, fear of falling) were examined as potential predictors.

RESULTS

After adjusting main effects of allocation group, time of measures, and their interactive effect, a mixed model showed that younger age (p = 0.044), current driving status (p = 0.039), and stronger social network (p = 0.003) were predictors of out-of-home time. However, none of the physical environmental factors significantly predicted outdoor time.

CONCLUSIONS

The present study found that social network was a predictor of objectively measured out-of-home time among older adults with global cognitive decline. A sufficient social network might help increase out-of-home time among them. However, the influence of physical environment on out-of-home time might be small.

Health promoting lifestyles and influencing factors among empty nesters and non-empty nesters in Taiyuan, China: a cross-sectional study

Background

In China, the problems of population aging and empty nesting have become important issues which will affect the social stability and economic development. The aim of this study was to explore the health promoting lifestyles and influencing factors among empty nesters and compare with non-empty nesters to find out their differences, so as to provide a scientific evidence for people to formulate health management strategies for elderly.

Methods

A cross-sectional survey which used a stratified random cluster sampling method, was conducted among 500 elders in six districts of Taiyuan, China, there were 288 empty nesters and 212 non-empty nesters. The general information and health- promoting lifestyles were investigated by using the self-made General Information Questionnaire and Health Promoting Lifestyle Scale(HPLP). Two-sample t-test and Chi-square test were used to compare the sociodemographic factors, HPLP scores of empty nesters to non-empty nesters; Multiple stepwise linear regression was performed to estimate influencing factors related to the HPLP of empty nesters and non-empty nesters.

Results

The current findings showed that there were differences between the empty nesters and non-empty nesters in gender, resident, marital status, education and income, self-care ability, source of income, relationship with spouse and social activities (P < 0.05). Empty nesters were mostly male, married, had a higher education level, self-care ability and income and lived in urban compared with non-empty nesters. The health promoting lifestyles of the elderly in this survey were in the medium level, the highest score for all dimensions in both groups was in nutrition, whereas health responsibility was executed worst. The HPLP and six subscales scores of the empty nesters were higher than non-empty nesters, there were significant differences in total score of HPLP, self-realization and health responsibility (P < 0.01). Multiple regression analysis showed that the main predictive factors for the empty nesters were education, self-care ability and resident, whereas the main predictive factors for the non-empty nesters were parents-child relationship, source of income and age; social activity was the common factor for two group.

Conclusion

The health promoting lifestyles of the empty nesters was better than that of the non-empty nesters. Health responsibility, interpersonal relations and stress management were key dimensions to be improved. Except social activity, education, self-care ability and resident were the unique influencing factors of health-promoting lifestyles for empty nesters, while the parents-child relationship, income and age were unique factors for non-empty nesters. The main target of Intervention strategy for elderly health promoting lifestyles should be the enhance of health responsibility, interpersonal relations and stress management by improving social activities, parent-child relationship, education and income of elderly.