Homebound older persons: Prevalence, characteristics, and longitudinal predictors
Introduction
Prevalence rates from early studies of homebound older persons fluctuate widely, ranging from 2.7% to 61.0%, possibly due to variance in the populations studied and various definitions used for homebound status (Ganguli et al., 1996). These included being confined to a bed or chair and not being able to get about outdoors. Alternatively, the capacity to move purposefully in one's environment had been otherwise referred to as life space (Allman et al., 2006). Recent studies, defining homebound as going outdoors once or less than once a week or as receiving medical services at home, have narrowed the range of prevalence rates for the homebound older population to 10.3–18.6% (Ganguli et al., 1996, Fujita et al., 2006, Zeltzer and Kohn, 2006).
Community-based studies found that being homebound is significantly associated with being older, female gender, and being widowed. Also, being homebound was significantly associated with more depressive symptoms, higher prevalence of cognitive disorders, and greater functional limitations, compared with persons who went outdoors more often (Ganguli et al., 1996, Fujita et al., 2006, Zeltzer and Kohn, 2006). Additionally, environmental factors were found predictive of homebound status (Lindesay and Thompson, 1993). Particularly, being homebound was significantly associated with living on a higher floor and not having car access, compared with non-homebound persons of similar age.
In Israel, 38.9% of older persons over 80 are frail (Iecovich, 2009), with those homebound placing a significant additional load on available medical service (Vinker et al., 2000). Indeed, a study of the homebound in Israel revealed that about half of physicians’ home visits are made to persons aged 65 or older, resulting most commonly in diagnoses of hypertension (24.1%) and diabetes mellitus (19.9%) (Vinker et al., 2000).
Considering the marked health care needs of homebound older persons in Israel, the current study seeks to improve the understanding of this population, which in turn may assist in improving services for the homebound older persons. Accordingly, this study examines the prevalence and correlates of homebound status in two representative cohorts of older persons in Israel, aiming to elucidate the predictors and implications of being homebound through a longitudinal study.
The specific questions are: (1) what is the prevalence of being homebound in the older Israeli population and has this prevalence changed between the two cohorts? (2) What are the characteristics of homebound older persons? How do they compare to those who are not homebound? (3) What factors predict homebound status in both cross-sectional and longitudinal analyses?
Section snippets
Participants and procedure
The first sample included participants from the CALAS (Benyamini et al., 2003, Walter-Ginzburg et al., 2005, Ben-Ezra and Shmotkin, 2006, Blumstein et al., 2008). The CALAS is a multidimensional survey of a random sample of the older Jewish population in Israel, stratified by age group (75–79, 80–84, 85–89, 90–94), gender, and place of birth (Asia/Africa, Europe/America, Israel). This study examines two waves of data collection, the first collected during 1989–1992 and the second during
The prevalence of older homebound persons in each cohort and a comparison of the two cohorts
In the first cohort 19.5% of participants were homebound, defined as going out of the house once a week or less, whereas in the more recent cohort the percentage was 17.7%. The difference between the cohorts was not significant.
The characteristics of homebound older persons and a comparison to their non-homebound counterparts
The comparison of homebound participants to non-homebound participants on background, health, and functional variables is presented in Table 1 for both cohorts. Homebound participants were significantly older, more likely to be female, unmarried (in CALAS), had more
Discussion
Previous surveys in many countries estimate housebound rates among persons over 65 range from 10% to 30% (Ganguli et al., 1996, Fujita et al., 2006, Zeltzer and Kohn, 2006). In order to determine the prevalence in Israel we defined homebound as going out of the house once a week or less and pooled data from two population surveys. We found that a substantial proportion of the old-old, between 17.7% and 19.5% of self-respondent participants aged 75–94, are homebound. This finding is worrisome
Conclusions
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. The results portray a similar profile of the homebound older person in terms of characteristics, functional capacity, and health to that emerging from studies of homebound elders in United States (Ganguli et al., 1996), UK (Lindesay and Thompson, 1993), and Japan (Inoue and Matsumoto,
Conflict of interest statement
None.
Acknowledgements
The data collection for this work was supported by the U.S. National Institute on Aging [grant numbers R01-5885-03, R01-5885-06 to the Department of Clinical Epidemiology at the Chaim Sheba Medical Center]; and the Israel National Institute for Health Policy [grant number A/2/1998]. Funding sources had no role in study design; in subject recruitment; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.
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