The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2020 Aug 11

PMID 32776512

Citations 8

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

Affiliations

Soon will be listed here.

Abstract

Importance: A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status.

Objective: To evaluate the association between income and risk of becoming homebound.

Design: Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older.

Setting: Population-based study in the United States.

Participants: A total of 7,042 initially nonhomebound community-dwelling older adults.

Exposure: Total annual household income at baseline (in 2011) measured via self-report.

Outcome: Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less.

Results: Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20-2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile.

Conclusion And Relevance: Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.

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Social isolation, homebound status, and race among older adults: Findings from the National Health and Aging Trends Study (2011-2019).

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Home, but Not Homebound: A Prospective Analysis of Persons Living With Dementia.

Reckrey J, Leff B, Kumar R, Yee C, Garrido M, Ornstein K J Am Med Dir Assoc. 2022; 23(10):1648-1652.e1.

PMID: 35063398 PMC: 9294063. DOI: 10.1016/j.jamda.2021.12.029.

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