As more Americans cross into older age, the risk of dementia increases and so, too, does the risk of becoming homebound.
This presents an access to care problem not only for aging adults and their families, but also for our health care system to successfully serve those patients. While there are home-based primary care and community programs that reach homebound individuals with dementia, the demand for them far outstrips supply.
There’s incentive, then, to better understand what factors contribute to becoming homebound for people living with dementia beyond well-established contributors like age or socioeconomic status.
Recent Study
Collaborators from the Icahn School of Medicine at Mount Sinai, Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, and Boston University School of Public Health published a study investigating factors that contribute to someone newly diagnosed with dementia becoming homebound.
Authors followed a cohort of 939 individuals aged 65 or older newly diagnosed with dementia in the National Health and Aging Trends Study (NHATS) from 2011 to 2018. Participants were classified as either homebound (never or rarely leaving home) or nonhomebound based on self and proxy reporting.
Investigators performed two different analyses to examine factors contributing to becoming homebound in individuals with dementia. First, they used chi-square and Student t tests to investigate differences between those who were homebound and nonhomebound when initially diagnosed with dementia. Those participants were followed for a median of four years after initial participation to identify changes in homebound status over time.
Authors also used a Fine-Gray subdistribution hazard model to identify factors contributing to becoming homebound over time among those who were nonhomebound when they initially received their dementia diagnosis.
Findings
Authors found that about 20 percent of this nationally representative sample were homebound at the time of dementia diagnosis. Additionally, these homebound individuals were more likely to be Hispanic, have Medicaid and lower income, and have more chronic conditions and depression than nonhomebound individuals.
Those who were homebound from the start were also more likely to need more assistance with activities of daily living (e.g., eating, dressing) and receive more hours of care from a caregiver per week. This group was more likely than nonhomebound individuals to receive paid help, live in an assisted living facility, and live in a metropolitan area.
When looking at the individuals who were nonhomebound at the time of dementia diagnosis, between eight to 11 percent became homebound in any given year of follow-up between 2011 to 2018. Authors found that individuals living in an assisted living facility and Hispanic ethnicity were more likely to become homebound.
Conclusion
Investigators acknowledged several limitations of this study. First, homebound status can be fluid, and annual, brief assessments may fail to capture that fluidity. Additionally, the National Health and Aging Trends Study definition of dementia is not equivalent to a clinical assessment, so some cohort participants may instead have had more transient cognitive impairment.
The study’s findings demonstrate that most individuals newly diagnosed with dementia are nonhomebound but may become homebound over time, and this risk is elevated among those residing in an assisted living facility or being of Hispanic descent. These findings underscore the need to examine if and how assisted living facilities meet the needs of those who are newly diagnosed with dementia. Additionally, further research is needed to identify the preferences of different groups and their options for culturally sensitive care.
In general, identifying contributing factors to becoming homebound for individuals newly diagnosed with dementia is an important first step for preventing or reducing this phenomenon.
