OBJECTIVE: To determine the frequency and characteristics
of homebound older adults in a rural community.
DESIGN: An
epidemiological survey of an age-stratified random community
sample.
SETTING: The rural mid-Monongahela Valley in
Southwestern Pennsylvania.
PARTICIPANTS: A total of 878
noninstitutionalized persons aged 68 years and older, fluent in
English, and with at least grade 6 education.
MEASUREMENTS:
The frequency with which subjects left their homes, the
Mini-Mental State Examination (MMSE) score, and additional
information on demographics, self-reported health problems, health
services utilization, IADLs, depression, and social support were
measured.
RESULTS: 10.3% of the sample was classified as
homebound. In univariate analyses, being homebound was found to be
associated significantly (P < .001) with being older, female, and
widowed and with MMSE and IADL impairment, with more depressive
symptoms and worse social supports, fair to poor self-rated
general health, weight loss, and histories of stroke, angina,
arthritis of the spine, and falls. In a multiple regression model,
variables associated independently with homebound status were
gender (odds ratio = 9.4, 95% confidence interval = 3.6 - 24.9),
weight loss (OR = 3.7, CI = 1.7 - 8.2), IADL impairment (OR = 2.6,
CI = 2.1 - 3.1), and depressive symptoms (OR = 2.1, CI = 1.3 -
3.2). Being homebound was also associated with recent acute
hospitalization and use of home health and social services.
CONCLUSIONS: These data provide evidence that homebound older
adults have a disproportionate share of morbidity and disability
and suggest a sociodemographic and clinical profile to help
identify those older people at risk of being or becoming
homebound. They also point to the need for home-based health
services for the older adults, particularly in medically
underserved communities such as rural areas.