Homebound status in a community-dwelling elderly population in Japan

Preference for primary care in Chinese homebound patients

OBJECTIVE

This study aims to describe the preference for primary healthcare (PHC) and investigate associated factors among homebound residents in both rural and urban areas of China. It provides valuable insights to facilitate the rational allocation of healthcare resources and promote the utilization of PHC.

METHODS

In this nationally representative cross-sectional study, we utilized the most recent data (2020) from the China Family Panel Studies (CFPS). Participants were recruited from 25 provincial-level administrative regions in both rural and urban areas of China. Homebound patients were asked to provide details about their individual characteristics, variables related to family caregiving, and preferences for PHC. Multivariable logistic models were used to analyze potential factors associated with preference for PHC. Estimates of association were reported as odds ratios (OR) and their 95% confidence intervals (CI).

RESULTS

The study found that 58.43% of rural patients reported a preference for PHC, while 42.78% of urban patients favored PHC. Compared to rural participants who did not received inpatient care in the past year, those who received inpatient care in the past year had 67% lower odds of choosing PHC (OR:0.33, 95% CI:0.19-0.59); Compared to rural participants who did not received family caregiving when ill, those who received family caregiving when ill had 59% lower odds of choosing PHC (OR: 0.41, 95% CI:0.21-0.77). Correspondingly, Compared to urban participants who did not received inpatient care in the past year, those who had received inpatient care in the past year had 75% lower odds of choosing PHC (OR: 0.25, 95% CI: 0.10-0.56); Compared to urban participants who did not received family caregiving when ill, those who received family caregiving when ill had 73% lower odds of choosing PHC (OR: 0.27, 95% CI: 0.11-0.63); Compared to urban participants who with agricultural Hukou, those with Non-agricultural Hukou had 61% lower odds of choosing PHC (OR: 0.39, 95% CI:0.18-0.83); Compared to urban participants living in the eastern part of mainland China, those living in the central part of China had 188% higher odds of choosing PHC (OR: 2.88, 95% CI: 1.14-7.29).

CONCLUSION

Policymakers should focus on tailoring PHC to vulnerable populations and prioritizing family-based public health strategies for enhancing homebound patients' perceptions of PHC. Furthermore, further study is needed on whether the Hukou registration system affects the barriers that homebound patients experience in choosing healthcare providers.

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.

The burden of boundedness and the implication for nursing: A scoping review

Background

In the COVID‐19 pandemic, many people experienced temporal boundedness in different ways (e.g., home, country, persons, and rules). However, being bound is also a permanent experience for chronically ill or handicapped people with sometimes serious consequences. To be able to recognize the phenomenon, a clear definition is necessary. In the literature, though, boundedness shows up as a very multifaceted phenomenon.

Objectives

Exploring and conceptualizing the phenomenon of boundedness taking into account the various forms and the consequences for nursing.

Methods

A scoping review using the framework of Arksey and O'Malley and the PRISMA statement (PRISMA‐ScR) to verify the fullness of the review.

Data Sources

Online dictionaries and theoretical and empirical publications in CINAHL, Medline via PubMed, PsycINFO, PsycArticles, Scopus, WISO. A total of 34 sources were included.

Results

Boundedness as a contextual concept is ambiguous. There are three basic causes: an acquired condition, personal obligations, arranged conditions, two principal courses: enduring and temporary, and seven types of being bound: to one or more person(s), to a place/position, to/in an object, to thoughts/opinions, to activities, to/in substances and to time. Examples of types are bedbound, culture‐bound, homebound, time‐bound, wheelchair‐bound and are particularly relevant for care. The consequences are manifold, physically, as well as mentally, and socially.

Conclusion

To reduce or avoid the burdens caused by boundedness, the concept must be implemented in nursing education and nursing practice. To this end, nursing research must further specify the types of boundedness in concept analyses and develop suitable interventions.

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.

Relationship between the occurrence of falls by season and physical functions of community-dwelling old-old people living in cold, snowy areas

AIM

To investigate the functional characteristics of older adults who experienced a fall in the winter season and other seasons.

METHODS

Participants were 403 older adults enrolled in the project "Population-Based and Inspiring Potential Activity for Old-old Inhabitants," and were living in cold, snowy regions in Japan. They were aged ≥75 years, and 41.9% (n = 169) were men. Sociodemographic characteristics, and physical, psycho-cognitive and social factors were surveyed. By experiences of falls, they were divided into three groups: the non-fall group, the fall in non-winter group and the fall in winter group. Each factor was compared with a χ² -test, Student's t-test and Mann-Whitney U-test. Logistic regression analysis was carried out. spss version 25 was used for the statistical analysis. The level of significance was set at 5%.

RESULTS

No differences were confirmed between the non-fall and fall in winter groups. In contrast, the maximum walking speed in the fall in non-winter group was significantly slower than the non-fall group, even with adjustment by variables, such as age, sex and self-efficacy.

CONCLUSIONS

When considering intervention methods for health promotion, it is necessary to consider not only the presence or absence of falls, but also the seasons of falls. Geriatr Gerontol Int 2019; 19: 124-129.

[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.

Improved Health Status and Life Satisfaction among Older People following Self-Help Group Intervention in Jakarta

Although self-help group for older people gains the effectiveness, the effect of a nursing intervention using a self-help group model as a guideline for self-monitoring and intervention on the health status and life satisfaction among older people still remains. To determine the effectiveness of this nursing intervention, an experimental design using multistage sampling method was used for this study. The self-help intervention included a single 50-70-minute session once a week for 12 weeks done, using the Life Satisfaction Inventory-A (LSI-A) questionnaire, and SF-36 shows a significant difference. Self-help intervention could be implemented by nurses for older people in the community to improve health and well-being.

Self-care agency, lifestyle, and physical condition predict future frailty in community-dwelling older people

The purpose of this 2 year longitudinal study was to identify the relationship between self-care agency, lifestyle, physical condition, and frailty among community-dwelling older people in a rural area of Japan. The participants were 133 older individuals aged 65 years or above. Data collection was conducted via face-to-face interviews using self-administered questionnaires. Background information, such as age, sex, current employment status, family structure, medication use, comorbidities, and knee and lower back pain, were assessed. The definition of frailty was based on the Frailty Checklist. Self-care agency, lifestyle habits, and locomotive syndrome were assessed using specific assessment scores. Logistic regression analysis showed that locomotive syndrome, knee and lower back pain, and stroke are risk factors for frailty. Among the factors associated with frailty, current employment, regular exercise, and self-care agency were recognized as preventive factors of depression, decreased cognitive function, and being housebound. Our findings suggest that enhancing self-care agency, regular exercise, and self-management skills for chronic illness and disability may decrease the progression of frailty among older people.

Prevalence of and factors associated with homebound status among adults in urban and rural Spanish populations

Background

There is a marked growth in the number of homebound older adults, due mainly to increased life expectancy. Although this group has special characteristics and needs, it has not been properly studied. This study thus aimed to measure the prevalence of homebound status in a community-dwelling population, and its association with both socio-demographic, medical and functional characteristics and the use of health care and social services.

Methods

We used instruments coming under the WHO International Classification of Functioning (ICF) framework to carry out a cross-sectional study on populations aged 50 years and over in the province of Zaragoza (Spain), covering a total of 1622 participants. Persons who reported severe or extreme difficulty in getting out of the house in the last 30 days were deemed to be homebound. We studied associations between homebound status and several relevant variables in a group of 790 subjects who tested positive to the WHODAS-12 disability screening tool.

Results

Prevalence of homebound status was 9.8 % (95 % CI: 8.4 to 11.3 %). Homebound participants tended to be older, female and display a lower educational level, a higher number of diseases, poorer cognition and a higher degree of disability. In fully adjusted models including disability as measured with the ICF-Checklist, the associated variables (odds ratios and [95 % confidence intervals]) were: female gender (3.75 [2.10–6.68]); urban population (2.36 [1.30–4.29]); WHODAS-12 disability (6.27 [2.56–15.40]); depressive symptoms (2.95 [1.86–4.68]); moderate pain (2.37 [1.30–4.31] and severe pain (3.03 [1.31–7.01]), as compared to the group with no/mild pain; hospital admissions in the previous 3 months (2.98 [1.25–7.11]); and diabetes (1.87 [1.03–3.41]). Adjustment for ICF-Checklist disability had a notable impact on most associations.

Conclusions

The study shows that homebound status is a common problem in our setting, and that being disabled is its main determinant. Socio-demographic characteristics, barriers and chronic diseases can also be assumed to be playing a role in the onset of this condition, indicating the need for further research, including longitudinal studies on its incidence and associated factors.

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

BACKGROUND

Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown.

OBJECTIVES

The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants.

METHODS

This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week.

MEASURES

Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status.

RESULTS

The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status.

CONCLUSIONS

Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status.

[Homebound status and related factors according to age in female elders in the community]

PURPOSE

The purpose of this study was to investigate homebound status and significant related factors for community-dwelling female elders according to age.

METHODS

The participants were female elders over 65 years of age registered in public health centers. Data were collected by interviewing the elders, who voluntarily completed the entire survey. For data analysis, descriptive statistics and multiple logistic regression were performed using SPSS version 18.0.

RESULTS

There were statistically significant differences in homeboundness and related factors between the young-old (65 to 74 years of age) and the old-old (75 years of age or older). The level of homeboundness of the old-old was higher than that of the young-old. Multiple logistic regression showed, timed "up and go", depression, and fear of falling as significantly associated with homebound status of the young-old, while hand grip strength (right), timed "up and go", static balance ability, severity of urinary incontinence, and fear of falling as significant for the old-old.

CONCLUSION

The findings of this study indicate that homebound status and related factors for elders are different according to age, and therefore, interventions to prevent and help homebound elders get over being homebound should be developed according to age.

Homebound older persons: prevalence, characteristics, and longitudinal predictors

The current study examines the prevalence and correlates of homebound status aiming to elucidate the predictors and implications of being homebound. Analyzed sample was drawn from two representative cohorts of older persons in Israel, including 1191 participants (mean age=83.10 ± 5.3 years) of the first wave of the Cross-Sectional and Longitudinal Aging Study (CALAS) and 418 participants (mean age=83.13 ± 5.2 years) of the Israeli Multidisciplinary Aging Study (IMAS). Cross-sectional and longitudinal analyses were conducted. Homebound prevalence rates of 17.7-19.5% were found. Homebound participants tended to be older, female, have obese or underweight body mass index (BMI), poorer health, lower functional status, less income, higher depressed affect, were significantly lonelier (in CALAS), and more likely to have stairs and no elevators, than their counterparts. Predictors of becoming homebound include low functional IADL status, having stairs and no elevator (in both cohorts), old age, female gender, and being obese or underweight (in CALAS). The study shows that homebound status is a prevalent problem in old-old Israelis. Economic and socio-demographic resources, environment, and function play a role in determining the older person's homebound status. Implications for preventing homebound status and mitigating its impact with regards to the Israeli context are discussed.

The effect of homebound status on older persons

OBJECTIVES

To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization.

DESIGN

Cross-sectional and longitudinal analysis using existing data sets of a national survey.

SETTING

A national survey.

PARTICIPANTS

The analyzed sample was drawn from a representative cohort of 1,191 older persons in Israel (mean age 83.1±5.3) in the first wave of the Cross-Sectional and Longitudinal Aging Study and 621 participants in the second wave of the study.

MEASUREMENTS

Homebound status, health, function, environment, mental health, distal events, mortality, activities daily living (ADLs), instrumental activities of daily living (IADLs), Orientation-Memory-Concentration Test, and Center for Epidemiologic Studies Depression Scale. Mortality data were recorded from the Israeli National Population Registry.

RESULTS

Homebound participants had a significantly higher risk of mortality than their non-homebound counterparts, even after controlling for background variables, health, and function (risk ratio=1.33, 95% confidence interval=1.08-1.63). In cross-sectional analysis, homebound status was related to depressed affect even after controlling for demographics, health, and function. In longitudinal analysis, homebound status predicted future depressed affect and ADL and IADL difficulties when controlling for demographics and health, but only IADL prediction was statistically significant when baseline levels of the outcome variable were entered into the regression.

CONCLUSION

The results highlight the detrimental effects of homebound status, underscoring the importance of preventing this state, of interventions to assist those who are homebound, and of future research to examine the efficacy and coverage of services to this population.

Absence of outdoor activity and mortality risk in older adults living at home

The primary objective of this study was to determine whether the absence of outdoor activities is associated with an increased risk of mortality among elderly people living at home. In January 1995, the authors enrolled 863 household residents, 65 years old and older, who were able to fully understand and complete a baseline interview unassisted. Participant demographics, functional capabilities, activities of daily living, and three dimensions of outdoor activities (initiative, transport, and frequency) were examined. Cohort mortality was assessed through December 1999. Of the 863 participants, 139 (16.1%) died within the study observation period. After adjusting for gender and age, three dimensions of functional impairment (vision, hearing, and speech), impairment in activities of daily living, and all three dimensions of outdoor activities were predictive of 5-year mortality. In multivariate analysis, these three dimensions remained as explanatory variables for mortality at 5 years. Assessment of outdoor-activity levels can help identify elderly individuals with greater mortality risk.

Predictors of Institutionalization in Elderly People Living at Home: The Impact of Incontinence and Commode Use in Rural Japan

A 5-year cohort study was conducted to determine factors that predict the institutionalization of elderly people who reside at home in a geographically-defined rural community in southern Japan. Among 766 (321 men and 445 women) residents living at home, 742 (97%) were followed-up for 5 years. During that period, 55 (25 men and 30 women) subjects were institutionalized. In univariate analysis, institutionalization of men was significantly associated with incontinence (either urinary or fecal), speech impairment, impairment in activities of daily living (ADLs: transferring, eating, dressing, bathing), being housebound, and the use of a commode. In women, it was associated with incontinence, visual impairment, ADLs impairment, being housebound, and the use of a commode. Using Cox regression hazard model analysis, incontinence was identified as a predictor for institutionalization in men, but not in women. In women, visual impairment was a predictor for institutionalization. The use of a commode and the other variables had no association with institutionalization in either sex. In conclusion, incontinence is a predictor for institutionalization in elderly men. Use of a commode, however, does not appear to have a preventive effect with respect to institutionalization in elderly men.

Disability and its effects on quality of life among older people living in Antalya city center, Turkey

The problems of older people become more prevalent with aging of the population. Occurrence of disability and its effects on living conditions are two of the major factors that determine the quality of life of elderly people. The aim of this study is to find out the frequency and severity level of disability for people aged 65 and older living in Antalya city center. We also aim to determine the effects of disability over living conditions and to detect the variables associated with disability. World Health Organization-Disability Assessment Schedule (WHO-DAS-II) was implemented to 840 people who were selected from the research population with cluster sampling method. Disability status of these 840 people was measured for six different fields of life (domains). The domains that disability was the most frequent were; "participation in society (86.7%)", "getting around (70.2%)" and "life activities (68.8%)". The fields that were found to contain the most severe disabilities were "life activities" (50.5 +/- 32.5 points), "getting around" (40.6 +/- 27.0 points) and "self care" (34.2 +/- 23.4 points). It was found that disability frequency was positively associated with age, number of chronic diseases and number of acute complaints (odds ratios are 1.05, 1.31 and 1.43, respectively). Disability was also found to be 1.71 times more frequent for women, 2.54 times more frequent for people who live in separate houses and 4.50 times more frequent for illiterates. Disability affects the fields of lives of elderly people with rates of 90.4% for "self care", 88.6% for "getting around" and 85.2% for "life activities". For the elderly population participating in our study, disability is most frequently seen in "participation in society", the most severe disability is seen in "life activities" and the most effected field is found to be "self care". These findings must to be incorporated into planning procedures as expenditure is allocated in order to decrease disability.