Many older adults in America suffer behind closed doors largely because they aren’t strong or well enough to leave their homes, even to get medical care, according to the findings of a study recently published in JAMA Internal Medicine.
“The homebound population of older adults is 50% larger than the nursing home population in this country but almost completely invisible,” senior author Sarah Szanton, PhD, ANP, FAAN, associate professor and PhD program director at the Johns Hopkins School of Nursing in Baltimore, said in a news release. “Only 11% receive homebound medical care, and the others may receive no care or intermittent care.”
In the study “The Epidemiology of the Homebound in the United States,” Szanton, Katherine A. Ornstein, PhD, MPH, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues looked at the community-dwelling Medicare population, which they estimate to be about 2 million people. They explain that most older adults want to age at home, but with the ability to come and go as they wish. Being homebound means being trapped and unable to leave their homes without considerable help.
“In 2011, the prevalence of the homebound was 5.6%, including an estimated 395,422 people who were completely homebound and 1,578,984 who were mostly homebound,” Szanton said in the release. “Completely homebound individuals were more likely to be older, female, non-white and have less education and income than the nonhomebound population, to have more chronic conditions, and to have been hospitalized in the last 12 months. Only 11.9% of completely homebound individuals reported receiving primary care services at home.”
Szanton said the challenges facing homebound adults “may be partially or fully remediated by the availability of personal assistance.” Szanton is the driving force behind an intervention called CAPABLE — for Community Aging in Place, Advancing Better Living for Elders — which involves home visits with an occupational therapist, a registered nurse and a handyman who work together with older adults to identify mobility and self-care issues in their homes and inexpensively fix or modify them.
Co-authors of the study include Bruce Leff, MD, of the Johns Hopkins Schools of Nursing, Medicine and Public Health; Kenneth Covinsky, MD, and Christine Ritchie, MD, MSPH, of the University of California San Francisco; Alex D. Federman, MD, MPH, of the Icahn School of Medicine at Mount Sinai; Laken Roberts of the Hopkins School of Nursing; and Amy S. Kelley, MD, MSHS, and Albert L. Siu, MD, MSPH, of Mount Sinai and the James J. Peters Veterans Affairs Medical Center.
The authors point to evidence of success and cost-savings through the Patient Protection and Affordable Care Act, which has spurred the development of new health service delivery models to serve the homebound, including the Independence at Home demonstration program and multidisciplinary home-based primary care programs that deliver medical and social services.
“Our findings can inform improvements in clinical and social services for these individuals,” the authors concluded in the study.