TY - JOUR
T1 - Home, but Not Homebound
T2 - A Prospective Analysis of Persons Living With Dementia
AU - Reckrey, Jennifer M.
AU - Leff, Bruce
AU - Kumar, Raj G.
AU - Yee, Cynthia
AU - Garrido, Melissa M.
AU - Ornstein, Katherine A.
N1 - Funding Information:
Conflicts of Interest: Author Bruce Leff serves as an advisor to MedZed, Vessel Healthcare, Medically Home, Dispatch Health, and the Chartis Group. He serves as a volunteer member of the board of directors of the Alliance for Home Health Quality and Improvement and as a member of the Humana Multidisciplinary Advisory Board. He has grants from The John A. Hartford Foundation , The Centene Foundation , and a collaborative research agreement with Humana. The other authors declare no conflicts of interest.
Funding Information:
This work was supported by the National Institutes of Health (K23 AG066930 and R01 AG060967).Conflicts of Interest: Author Bruce Leff serves as an advisor to MedZed, Vessel Healthcare, Medically Home, Dispatch Health, and the Chartis Group. He serves as a volunteer member of the board of directors of the Alliance for Home Health Quality and Improvement and as a member of the Humana Multidisciplinary Advisory Board. He has grants from The John A. Hartford Foundation, The Centene Foundation, and a collaborative research agreement with Humana. The other authors declare no conflicts of interest.
Funding Information:
This work was supported by the National Institutes of Health ( K23 AG066930 and R01 AG060967 ).
Publisher Copyright:
© 2022 AMDA – The Society for Post-Acute and Long-Term Care Medicine
PY - 2022/10
Y1 - 2022/10
N2 - Objectives: Homebound persons living with dementia may have increased difficulty accessing needed care in the community. This study identifies factors associated with becoming homebound among a national sample of Medicare beneficiaries with newly identified dementia. Design: Prospective cohort analysis. Setting and Participants: We used the National Health and Aging Trends Study (NHATS) 2011-2018 to identify community-dwelling older adults at the time of a new dementia diagnosis (n = 939). Dementia status was determined based on cognitive testing and self and proxy reporting. Methods: We compared characteristics of homebound (ie, those who never or rarely left home) and non-homebound participants at the time of dementia identification. Among non-homebound participants, we used a Fine-Gray subdistribution hazard model to identify factors associated with becoming homebound over follow-up (median follow-up 4 years), accounting for competing risks of death and moving to a nursing home. Results: 20% of individuals with newly identified dementia were homebound and this group was more functionally impaired, medically complex, and socioeconomically disadvantaged as compared to the non-homebound. Over time, depression [subhazard ratio (SHR) 2.19, 95% CI 1.36, 3.54], living in an assisted living facility (SHR 2.60, 95% CI 1.35, 4.97), and Hispanic ethnicity (SHR 1.91, 95% CI 1.05, 3.47) were associated with becoming homebound. Conclusions and Implications: Most adults are not homebound at the time of dementia diagnosis. Identifying and addressing modifiable factors like depression may slow progression to homebound status and enable persons living with dementia to access needed care in the community. In order to accommodate diverse individual and family preferences for long-term care, robust systems of home-based clinical and long-term care are necessary for those who do become homebound.
AB - Objectives: Homebound persons living with dementia may have increased difficulty accessing needed care in the community. This study identifies factors associated with becoming homebound among a national sample of Medicare beneficiaries with newly identified dementia. Design: Prospective cohort analysis. Setting and Participants: We used the National Health and Aging Trends Study (NHATS) 2011-2018 to identify community-dwelling older adults at the time of a new dementia diagnosis (n = 939). Dementia status was determined based on cognitive testing and self and proxy reporting. Methods: We compared characteristics of homebound (ie, those who never or rarely left home) and non-homebound participants at the time of dementia identification. Among non-homebound participants, we used a Fine-Gray subdistribution hazard model to identify factors associated with becoming homebound over follow-up (median follow-up 4 years), accounting for competing risks of death and moving to a nursing home. Results: 20% of individuals with newly identified dementia were homebound and this group was more functionally impaired, medically complex, and socioeconomically disadvantaged as compared to the non-homebound. Over time, depression [subhazard ratio (SHR) 2.19, 95% CI 1.36, 3.54], living in an assisted living facility (SHR 2.60, 95% CI 1.35, 4.97), and Hispanic ethnicity (SHR 1.91, 95% CI 1.05, 3.47) were associated with becoming homebound. Conclusions and Implications: Most adults are not homebound at the time of dementia diagnosis. Identifying and addressing modifiable factors like depression may slow progression to homebound status and enable persons living with dementia to access needed care in the community. In order to accommodate diverse individual and family preferences for long-term care, robust systems of home-based clinical and long-term care are necessary for those who do become homebound.
KW - Homebound
KW - dementia
KW - home- and community-based long-term care
UR - http://www.scopus.com/inward/record.url?scp=85123852744&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2021.12.029
DO - 10.1016/j.jamda.2021.12.029
M3 - Article
C2 - 35063398
AN - SCOPUS:85123852744
SN - 1525-8610
VL - 23
SP - 1648-1652.e1
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 10
ER -