Katherine A Ornstein1, Shelley H Liu2, Mohammed Husain1, Claire K Ankuda1, Evan Bollens-Lund1, Amy S Kelley1,3, Melissa M Garrido4,5. 1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. James J Peters Veterans Affairs Medical Center, Bronx, New York, USA. 4. Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA. 5. Boston VA Healthcare System, Boston, Massachusetts, USA.
Abstract
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.
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.
Authors: Jennifer M Reckrey; Theresa A Soriano; Cameron R Hernandez; Linda V DeCherrie; Silvia Chavez; Meng Zhang; Katherine Ornstein Journal: J Am Geriatr Soc Date: 2015-01-30 Impact factor: 5.562
Authors: Sarah L Szanton; Qian-Li Xue; Bruce Leff; Jack Guralnik; Jennifer L Wolff; Elizabeth K Tanner; Cynthia Boyd; Roland J Thorpe; David Bishai; Laura N Gitlin Journal: JAMA Intern Med Date: 2019-02-01 Impact factor: 21.873
Authors: Katherine A Ornstein; Melissa M Garrido; Evan Bollens-Lund; Jennifer M Reckrey; Mohammed Husain; Katelyn B Ferreira; Shelley H Liu; Claire K Ankuda; Amy S Kelley; Albert L Siu Journal: J Am Geriatr Soc Date: 2020-08-10 Impact factor: 5.562
Authors: Meredith L Kilgore; David C Grabowski; Michael A Morrisey; Christine S Ritchie; Huifeng Yun; Julie L Locher Journal: Med Care Date: 2009-03 Impact factor: 2.983
Authors: Laureano Negrón-Blanco; Jesús de Pedro-Cuesta; Javier Almazán; Carmen Rodríguez-Blázquez; Esther Franco; Javier Damián Journal: BMC Public Health Date: 2016-07-15 Impact factor: 3.295