Modifiable risk factors for homebound progression among those with and without dementia in a longitudinal survey of community-dwelling older adults

Mia Yang, Nicholas Pajewski, Mark Espeland, Douglas Easterling, Jeff D Williamson, Mia Yang, Nicholas Pajewski, Mark Espeland, Douglas Easterling, Jeff D Williamson

Abstract

Background: Being homebound is independently associated with increased mortality but the homebound population is heterogeneous. In order to improve precision medicine, we analyzed potentially modifiable factors that contribute to homebound progression (from independent to needing assistance, to homebound), stratified by dementia status.

Methods: Using National Aging and Trends Survey (NHATS), a nationally-representative, longitudinal annual survey from 2011 to 2017 (n = 11,528), we categorized homebound progression if one transitioned from independent or needing assistance to homebound, including competing risks of institutionalization or death between 2011 and last year of data available for each unique respondent. Using proportional hazards regression, we calculated hazard ratios of potentially modifiable risk factors on homebound progression.

Results: Depressive symptoms, mobility impairment, and pain increased risk of homebound progression regardless of dementia status. Social isolation increased risk of homebound progression only among those without dementia at baseline.

Conclusion: Future clinical care and research should focus on the treatment of depressive symptoms, mobility, and pain to potentially delay progression to homebound status.

Keywords: Dementia; Depression; Homebound progression; Mobility; Pain; Risk factors.

Conflict of interest statement

All the authors have declared no competing interests.

© 2021. The Author(s).

References

    1. Ornstein KA, Leff B, Covinsky KE, Ritchie CS, Federman AD, Roberts L, Kelley AS, Siu AL, Szanton SL. Epidemiology of the homebound population in the United States. JAMA Intern Med. 2015;175(7):1180–1186. doi: 10.1001/jamainternmed.2015.1849.
    1. Inc for OSORA CMS H. Medicare Benefit Policy Manual. Cited 2018 Aug 21. Available from: . Accessed 28 Jan 2021.
    1. Soones T, Federman AD, Leff B, Siu AL, Ornstein KA. Two-year mortality among homebound, older adults: an analysis of the National Health and aging trends study. J Am Geriatr Soc. 2017;65(1):123–129. doi: 10.1111/jgs.14467.
    1. Xiang X, Chen J, Kim M. Trajectories of homebound status in medicare beneficiaries aged 65 and older. Gerontologist. 2019; Cited 2019 Apr 4. Available from: .
    1. Katsumata Y, Arai A, Tamashiro H. Contribution of falling and being homebound status to subsequent functional changes among the Japanese elderly living in a community. Arch Gerontol Geriatr. 2007;45(1):9–18. doi: 10.1016/j.archger.2006.07.005.
    1. Xiang X, Brooks J, Xiang X, Brooks J. Correlates of depressive symptoms among homebound and semi-homebound older adults. J Gerontol Soc Work. 2017;60(3):201–214. doi: 10.1080/01634372.2017.1286625.
    1. Smith AR, Chen C, Clarke P, Gallagher NA. Trajectories of outdoor mobility in vulnerable community-dwelling elderly: the role of individual and environmental factors. J Aging Health. 2016;28(5):796–811. doi: 10.1177/0898264315611665.
    1. Cohen-Mansfield J, Shmotkin D, Hazan H. The effect of homebound status on older persons. J Am Geriatr Soc. 2010;58(12):2358–2362. doi: 10.1111/j.1532-5415.2010.03172.x.
    1. Wang J, Kearney JA, Jia H, Shang J. Mental health disorders in elderly people receiving home care: prevalence and correlates in the National U.S. population. Nurs Res. 2016;65(2):107–116. doi: 10.1097/NNR.0000000000000147.
    1. Patel KV, Guralnik JM, Phelan EA, Gell NM, Wallace RB, Sullivan MD, Turk DC. Symptom burden among community-dwelling older adults in the United States. J Am Geriatr Soc. 2019;67(2):223–231. doi: 10.1111/jgs.15673.
    1. Wajnberg A, Ornstein K, Zhang M, Smith KL, Soriano T. Symptom burden in chronically ill homebound individuals HHS public access. J Am Geriatr Soc. 2013;61(1):126–131. doi: 10.1111/jgs.12038.
    1. Ornstein KA, Garrido MM, Bollens-Lund E, Reckrey JM, Husain M, Ferreira KB, et al. The association between income and incident homebound status among older Medicare beneficiaries. J Am Geriatr Soc. 2020;68(11):2594–2601. doi: 10.1111/jgs.16715.
    1. De-Rosende Celeiro I, Santos-del-Riego S, Muñiz García J, De-Rosende Celeriro I. Homebound status among middle-aged and older adults with disabilities in ADLs and its associations with clinical, functional, and environmental factors. Disabil Health J. 2017;10(1):145–151. doi: 10.1016/j.dhjo.2016.06.006.
    1. Zhao Y, Alderden J, Lind B, Stibrany J. Risk factors for falls in homebound community-dwelling older adults. Public Health Nurs. 2019;36(6):772–778. doi: 10.1111/phn.12651.
    1. Freedman VA, Kasper JD. Cohort profile: the National Health and Aging Trends Study (NHATS) Int J Epidemiol. 2019;48(4):1044–1045G. doi: 10.1093/ije/dyz109.
    1. Montaquila J, Freedman VA, Edwards B, Kasper, JD. National Health and Aging Trends Study round 1 sample design and selection. NHATS technical paper #1. 2012. Cited 2021 May 10. Available from: . We acknowledge the valuable contributions of Graham Kalt on of West at who led the NHATS sample design. We also thank David Ferraro and Rui Jiao for their many contributions to the design and selection of the NHATS sample. This technical paper was prepared with funding from the National Institute on Aging (U01AG032947).
    1. Freedman VA, Hu M, Dematteis J, Kasper J. Accounting for sample design in NHATS and NSOC analyses: Frequently asked questions. Cited 2021 May 10. Available from: . Accessed 28 Jan 2021.
    1. Kasper JD, Freedman VA, Spillman B. Classification of persons by dementia status in the National Health and Aging Trends Study. 2013;14 Available from: .
    1. Groff AC, Colla CH, Lee TH. Days spent at home-a patient-centered goal and outcome HHS public access. N Engl J Med. 2016;375(17):1610–1612. doi: 10.1056/NEJMp1607206.
    1. Robbins R, Quan SF, Weaver MD, Bormes G, Barger LK, Czeisler CA. Examining sleep deficiency and disturbance and their risk for incident dementia and all-cause mortality in older adults across 5 years in the United States. Aging (Albany NY). 2021;13(3):3254–68 Available from: . Cited 2021 May 10.
    1. Cudjoe TKM, Roth DL, Szanton SL, Wolff JL, Boyd CM, Thorpe RJ. Epidemiology of social isolation: National health and aging trends study. J Gerontol Ser B Psychol Sci Soc Sci. 2018;00(00):1–7.
    1. Kotwal AA, Cenzer IS, Waite LJ, Covinsky KE, Perissinotto CM, Boscardin WJ, et al. The epidemiology of social isolation and loneliness among older adults during the last years of life. J Am Geriatr Soc. 2021; Cited 2021 Sep 3. Available from: .
    1. Nicholson NR. A review of social isolation: an important but underassessed condition in older adults. J Primary Prevent. 2012;33:137–52. 10.1007/s10935-012-0271-2.
    1. Lyketsos CG, Lopez O, Jones B, Fitzpatrick AL, Breitner J, DeKosky S. Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. JAMA. 2002;288(12):1475. doi: 10.1001/jama.288.12.1475.
    1. Tareque MI, Chan A, Saito Y, Ma S, Malhotra R. The impact of self-reported vision and hearing impairment on health expectancy. J Am Geriatr Soc. 2019;67(12):2528–2536. doi: 10.1111/jgs.16086.
    1. Penninkilampi R, Casey AN, Singh MF, Brodaty H. The association between social engagement, loneliness, and risk of dementia: a systematic review and Meta-analysis. J Alzheimers Dis. 2018;66(4):1619–1633. doi: 10.3233/JAD-180439.

Source: PubMed

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