The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012–2018

Ankuda, Claire K.; Husain, Mohammad; Bollens‐Lund, Evan; Leff, Bruce; Ritchie, Christine S.; Liu, Shelley H.; Ornstein, Katherine

doi:10.1111/jgs.17086

Cited by 18 publications

(33 citation statements)

References 30 publications

(59 reference statements)

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“…This is the case for community dwelling older adults with and without dementia. Consistent with other research, 18 these results suggest that homebound status does not necessarily follow a clear declining gradient over time and reengagement with the community may be possible. Thus, we need to better understand who improves over time and why, especially if factors may be modifiable.…”

Section: Discussionsupporting

confidence: 90%

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Ornstein

Liu

Husain

et al. 2021

J American Geriatrics Society

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Background: One in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions. Methods: Using 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries.Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model. Results: Less than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. Discussion: Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.

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Section: Discussionsupporting

confidence: 90%

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Ornstein

Liu

Husain

et al. 2021

J American Geriatrics Society

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“…This framework allowed us to increase our number of observations and account for the fact that an individual's homebound status can change from year to year. 29 We examined demographic and clinical characteristics of our observations by homebound status using bivariate linear or logistic regression. We used logistic and zero-inflated negative binomial regressions to compare adjusted and unadjusted differences in utilization.…”

Section: Discussionmentioning

confidence: 99%

“…This framework allowed us to increase our number of observations and account for the fact that an individual’s homebound status can change from year to year. 29 …”

Section: Methodsmentioning

confidence: 99%

Patterns of Healthcare Utilization and Spending Among Homebound Older Adults in the USA: an Observational Study

et al. 2022

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Background Homebound older adults have complex social, medical, and financial needs, but little is known about their healthcare utilization and spending. Objective To characterize healthcare utilization and spending among homebound older adults. Design Cohort study using National Health and Aging Trends Study data linked to Medicare Fee-for-Service (FFS) claims data. Participants Adults aged 70 years and older with Medicare FFS coverage ( n = 6468). Main Measures In a person-year analysis, survey-weighted rates and adjusted marginal differences in inpatient, outpatient, and emergency department utilization and spending 12 months post-interview were calculated by homebound status, defined as reporting never or rarely (no more than 1 day/week) leaving home in the last month. Key Results Compared to the non-homebound, homebound observations had lower annual unadjusted rates of accessing primary care (60.9% vs 71.9%, p < 0.001) and specialist care (61.0% vs 74.9%, p < 0.001) and higher annual rates of emergency department use (54.0% vs 32.6%, p < 0.001) and hospitalization (39.8% vs 19.8%, p < 0.001). Total annual Medicare spending was $11,346 higher among the homebound compared to the non-homebound ( p < 0.001). In a single year analysis (2015), homebound older adults accounted for 11.0% of Medicare spending among those over 70 despite making up only 5.7% of this population. 13.6% of the homebound were in the 95 th percentile or above of Medicare spending in 2015. In models adjusting for demographic, clinical, and geographic characteristics, homebound status was associated with a decreased likelihood of having an annual primary care or specialist visit and $2226 additional total annual Medicare spending. Conclusions Homebound older adults use more hospital-based care and less outpatient care than the non-homebound, contributing to higher levels of overall Medicare spending. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07742-8.

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“…Older people with walking difficulty may have been and may continue to be at heightened risk of becoming homebound during the COVID-19 restrictions especially if the restrictions on outdoor mobility are prolonged and effective interventions are not offered. Being homebound is a serious situation, as it is associated with a high mortality rate [ 32 ] and dependency in self-care [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Use of walking modifications, perceived walking difficulty and changes in outdoor mobility among community-dwelling older people during COVID-19 restrictions

et al. 2021

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Background Outdoor mobility enables participation in essential out-of-home activities in old age. Aim To compare changes in different aspects of outdoor mobility during COVID-19 restrictions versus two years before according to self-reported walking. Methods Community-dwelling participants of AGNES study (2017–2018, initial age 75–85) responded to AGNES-COVID-19 postal survey in spring 2020 (N = 809). Life-space mobility, autonomy in participation outdoors, and self-reported physical activity were assessed at both time points and differences according to self-reported walking modifications and difficulty vs. intact walking at baseline were analyzed. Results Life-space mobility and autonomy in participation outdoors had declined (mean changes -11.4, SD 21.3; and 6.7, SD 5.3, respectively), whereas physical activity had increased (5.5 min/day, SD 25.1) at follow-up. Participants perceiving walking difficulty reported the poorest baseline outdoor mobility, a steeper decline in life-space mobility (p = 0.001), a smaller increase in physical activity (p < 0.001), and a smaller decline in autonomy in participation outdoors (p = 0.017) than those with intact walking. Those with walking modifications also reported lower baseline life-space mobility and physical activity, a steeper decline in life-space mobility and a smaller increase in physical activity those with intact walking (p < 0.001 for both). Discussion Participants reporting walking modifications remained the intermediate group in outdoor mobility over time, whereas those with walking difficulty showed the steepest decline in outdoor mobility and hence potential risk for accelerated further functional decline. Conclusion Interventions should target older people perceiving walking difficulty, as they may be at the risk for becoming homebound when environmental facilitators for outdoor mobility are removed.

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The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012–2018

Cited by 18 publications

References 30 publications

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Prospective assessment of dementia on transitions in homeboundness using multistate Markov models

Patterns of Healthcare Utilization and Spending Among Homebound Older Adults in the USA: an Observational Study

Use of walking modifications, perceived walking difficulty and changes in outdoor mobility among community-dwelling older people during COVID-19 restrictions

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