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

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.

Mental Health and Handgrip Strength Among Older Adults: A Nationwide Study

Handgrip strength is used as an important indicator of health in older adults. We aimed to explore the association between stress, depression, and suicidal ideation and handgrip strength among older adults. We conducted this cross-sectional study involving 1254 individuals (aged ≥65 years), using data from the 2015 Korean National Health and Nutrition Examination Survey VI. We used logistic regression analysis to examine associations between handgrip strength and mental health. Among mental health factors, a significant difference was noted between stress and handgrip strength among the older adults. After adjusting for confounding factors, the odd ratio (OR) of stress among older adults with low handgrip strength was statistically significant in Models 1 (1.61 (95% CI: 1.01–2.57)) and 2 (1.59 (95% CI: 1.01–2.52)) but not in Model 3 (1.52 (95% CI: .96–2.43)). No significant association was found between depression or suicidal ideation and handgrip strength. The risk of stress was 1.59-1.61 times higher in older adults with low handgrip strength, compared to that in older adults with normal handgrip strength. It is necessary to develop strategies aimed at managing stress among older adults with low handgrip strength and educating them about the importance of handgrip strength and exercises that increase handgrip strength.

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.

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.

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.

Sex-Based Differences in the Association between Nutrition Label Awareness and the Prevalence of Atopic Dermatitis: A Cross-Sectional Survey

Atopic dermatitis is a chronic allergic disease with multifactorial causation. Although its association with diet has been demonstrated, it remains unclear whether the prevalence of atopic dermatitis among adults is associated with nutrition label awareness. Nutrition label awareness indicates knowledge of the existence of nutrition labels on processed food, and the use of them for food selection. In this cross-sectional study, we analyzed the relationship between nutrition label awareness and the prevalence of atopic dermatitis among men and women using data from the Korean National Health and Nutrition Examination Survey VI (2013–2015), including a nationally representative sample of 13,505 Korean adults (aged > 19 years). The relationship between the prevalence of atopic dermatitis and nutrition label awareness was evaluated using t-tests, χ² tests and multivariate adjusted logistic regression analysis. Although univariate analysis showed that atopic dermatitis was associated with nutrition label awareness in both men and women, after adjustment for covariates, there was no significant association among men. The significant association between the prevalence of atopic dermatitis and nutrition label awareness among women reveals a sex-based difference in this relationship in adults, and atopic dermatitis may be managed and prevented among women by targeted education regarding nutrition labels and diet.

Quality of life and subjective health status according to handgrip strength in the elderly: a cross-sectional study

OBJECTIVES

The purpose of this cross-sectional study was to examine potential associations between handgrip strength and health-related quality of life, or subjective health status, in the elderly.

METHOD

We performed secondary data analysis on 2377 elderly individuals aged >65 years. Raw data from the Korea National Health and Nutrition Examination Survey VI (2014-2015), were drawn from a representative national sample.

RESULTS

Of those aged ≥65 years or older, 25.4% had low handgrip strength. After adjusting for confounding variables, the odds ratios of elderly individuals with low handgrip strength were 1.30 (95% confidence interval [CI]: 1.00-1.69) for mobility, 2.18 (95% CI: 1.47-3.22) for self-care, 1.70 (95% CI: 1.30-2.23) for usual activities, 1.30 (95% CI: 1.01-1.67) for pain/discomfort, 1.03 (95% CI: 0.74-1.44) for anxiety/depression, 1.44 (95% CI: 1.10-1.87) for the EQ-5D index, and 1.37 (95% CI: 1.08-1.73) for subjective health status.

CONCLUSION

Health-related quality of life and subjective health status differ according to handgrip strength. Therefore, handgrip strength should be addressed to improve quality of life in elderly individuals. Elderly individuals require exercise education and adequate nutritional intake to increase handgrip strength.

Home-Based Primary Care for Homebound Older Adults: Literature Review

Home-based primary care (HBPC) refers to the type of home care services which provide interdisciplinary primary care services with a comprehensive and continuous manner. Currently, it is getting much attention due to possess potential of converting primary care services from outpatient clinic to home, especially for those who are medically isolated including homebound older adults. This study examined a number of HBPCs introduced in the literature since 1990s, and summarizes the key factors with the analytic framework of 5Ps: purpose, patients, people, process, patterns. The results of this study emphasize that contents of primary care for older population should be different from those of the general population. This paper may be interpreted as the practice guideline of the following policy questions: “How can we design the HBPC if it is introduced in the nearest future?” In the future, it is necessary to have a heated debate concerning what is the most desirable primary care system for older adults.

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

Studies on the occurrence of homebound and the factors influencing it are available. However, the study of community homebound in China is still in its preliminary stage. No previous studies about this issue are available. This study aims to assess the occurrence of and factors influencing homebound elderly in Chinese communities and to provide a basis for effective intervention and prevention of homebound elderly people.One sample community from three provinces was randomly selected. Investigations were performed on the selected communities and 2180 elderly people were chosen as the research subjects. Unified survey scales were used. Home visit and face-to-face interviews were performed to ensure that no single qualified survey respondent was missed.The rate of morbidity in homebound elderly Chinese community was found to be 15.49% and it gradually increased with age, and also with a lower education or poorer Activities of Daily Living (ADL). Single factor analysis showed that general situation, living habits, physical condition, mental condition, society, social support, and other factors affected the occurrence of community homebound elderly. Women were more likely to be homebound than men (P < .05). Having a spouse or high income reduced the rate of morbidity in the homebound elderly (P < .05). Multifactor regression analysis revealed that poor ADL, depression, hearing impairment, being old, no exercise, and low social support are the main influencing factors.Appropriate measures should be taken based on the specific influencing factor to prevent the occurrence of homebound.

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.

Urinary incontinence in women in relation to occupational status

Through this cross-sectional study the authors explore urinary incontinence in women in relation to occupational status and environment. Data from the fourth Korea National Health and Nutrition Examination Survey (2008-2009) were used (n = 5,928) excluding those aged under 19 or over 65 years, male, with renal disease, and with missing data. Urinary incontinence was prevalent in working women. Compared to unemployed women, the adjusted odds ratio (95% confidence intervals) for women working in services/sales was 1.62 (1.21-2.19); for paid workers was 1.81 (1.20-2.73); and for self-employed workers was 1.46 (1.05-2.03). Compared to unemployed women, the adjusted odds ratio for working women with a daytime work schedule was 2.14 (1.18-3.87), while for those with evening work schedules, it was 1.35 (1.05-1.74). Urinary incontinence was significantly associated with various occupational environments: an unclean and uncomfortable workplace, dangerous job and probability of accidents, feeling pressed for time, awkward position for long periods, and carrying heavy weights. These findings suggest that urinary incontinence was prevalent in working women and was associated with occupational status and working environment. Therefore, improving occupational status and environment for working women-such as modifying the working schedule, posture, and workplace atmosphere-are needed to prevent urinary incontinence.