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PubMed1998

Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36.

The purpose of this report is to examine health-related quality of life (HRQoL) as measured by the Medical Outcomes Study Short Form-36, across patient populations with chronic disorders and to compare quality of life (QoL) in these subjects with normative data on healthy persons. Six studies, within the Center for Research in Chronic Disorders at the University of Pittsburgh School of Nursing, in patients with urinary incontinence, prostate cancer, chronic obstructive pulmonary disease (COPD), acquired immune deficiency syndrome (AIDS), fibromyalgia and hyperlipidaemia provided the data for analysis. The results demonstrated that not only did the prostate cancer and hyperlipidaemia patients have the highest QoL across the chronic disorders, but their QoL was comparable to normative data on healthy persons. Homebound, elderly, incontinent patients had the lowest QoL for physical functioning, whereas patients hospitalized with AIDS had the lowest QoL in general health and social functioning. Patients with COPD had the lowest QoL in role-physical, role-emotional and mental health. Patients with fibromyalgia had the lowest QoL in bodily pain and vitality. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia generally had lower QoL. Prostate cancer and hyperlipidaemia patients had QoL comparable to normative data. Compared to normative data, patients with urinary incontinence, COPD, AIDS and fibromyalgia had more variability for role-emotional. AIDS patients had more variability on physical functioning, bodily pain and social functioning compared to the normative data. These data suggest that patients with various chronic disorders may have QoL that is lower in most domains compared to a healthy population. However, there may be differences in the domains affected as well as the extent of variation across specific chronic disorders.

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PubMedDate not supplied

A comparison of two mobile treatment programs for the homebound and nursing home patient.

Two mobile treatment programs using portable equipment transported in vans to serve homebound persons in Denver and Chicago are compared for types of patients treated, use by local dentists, types of services provided, fees generated, and costs involved in operation during the 2-year period (1985-86). Both programs treated a similar, largely nursing home-based white female population that was predominantly older. Volunteer dentist participation varied greatly, with more than twice the number of dentists using the service in Chicago. Both programs accomplished essentially the same number of visits for the biennium studied, with 1,324 for Chicago and 1,320 for Denver. The Denver program was more efficient, generating more visits each time a dentist used the program. The services provided in total were about the same for both programs, with Denver generating 4,887 procedures and Chicago 4,602 for the biennium, but Denver had a more favorable ratio of diagnostic to treatment services. The costs of both programs were close, averaging about $60,000 per year. Denver was able to generate far more in equivalent fees than Chicago for the biennium, but Chicago dentists donated a greater percentage of services (67) than did Denver dentists (62).

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PubMed1998

[Homebound elderly in a Japanese community: related factors and change of mobility].

The aim of this study was to identify the prevalence of homebound elderly (defined as people whose daily activities were limited to their home) and factors related to it among 300 community elderly residents aged 60 and over in Yamagata city. In 1995, the baseline survey was performed and the follow-up survey was conducted one year later. Subjects were divided into two groups according to the extent of their daily activities: the non-homebound group (defined as people whose daily activities extended into their community) and the homebound group. The main results were as follows; 1. The prevalence of homebound elderly was 7.7% in 1995. 2. Chi-square test or t test was performed to examine the relationship between homebound and various factors. Significant factors were age, history of hypertension, history of mental disease, incompetence of ADLs (walking, eating, toileting, bathing, dressing), interpersonal dependency, subjective health, 'ikigai' (meaningfulness of life), life style (cooking, cleaning, reading newspaper or magazine, watching TV, exercise, associate with friend) and TMIG (Tokyo Metropolitan Institute of Gerontology) index of competence. The present study reveals that daily activities in community elderly residents is related to not only physical factors but also psychosocial factors. Using the significant variables in univariate analysis, multiple logistic regression analysis controlling for age was performed. Significant factors for homebound were incompetence of ADLs (walking, toileting), subjective health and TMIG index of competence. 3. Three out of 214 non-homebound elderly persons in 1995 changed to homebound in 1996.

Activities of Daily Living↗
PubMed1987

Dietary characteristics and nutrient intake in an urban homebound population.

The food and nutrient intake of 53 homebound older persons (mean age = 82 years) who receive home medical care in metropolitan Boston was examined, using the 24-hour recall and food frequency methodologies. Demographic data were collected in personal interviews, and systematic analyses were conducted of subjects' medical records. Mean intake of energy, folic acid, and calcium was below the RDAs for both men and women, and intake of thiamin was below the RDA for men. Nutrient intake failed to meet the RDAs for nine leader nutrients in 40% to 80% of the sample. Fewer than 20% of the subjects were able to name the Basic Food Groups or any of their food components. The subjects' age, income, gender, marital and health status, living situation, and educational level did not predict nutrient intake. Poor dietary intake among older, homebound persons, coupled with diverse medical problems, places them at major risk of nutrition problems. The nutrition needs and problems of the homebound elderly should be considered in the delivery of home health care services.

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PubMed2002

The interrelationship of nutritional risk factors, indicators of nutritional risk, and severity of disability among home-delivered meal participants.

PURPOSE: This study examines the direct and indirect relationships between individual components of nutritional risk and increased severity of disability among a large and diverse sample of homebound older adults. DESIGN AND METHODS: Using routinely collected nutrition and function data, structural equation modeling of recursive and nonrecursive models examined the interrelationships of nutritional risk factors, indicators of nutritional risk, and disability severity among 1,010 home-delivered meals program participants in Wake County, NC. RESULTS: The equally good fit for both the recursive and nonrecursive structural models revealed that specific nutritional risk factors were directly and indirectly associated with indicators of nutritional risk and increased severity of disability. The nonrecursive model also revealed significant reciprocal associations of increased disability with unintended weight change and medication use. IMPLICATIONS: The findings from this study acknowledge aspects of the complex direct and indirect relationships between nutrition and function among homebound older persons. This knowledge will help service providers with the development of effective elderly nutrition programs with nutritional and functional status outcomes.

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PubMedDate not supplied

Sociodemographics of homebound people in Kentucky.

In this report, selected results are presented from the 1987 Kentucky Oral Health Survey, which acquired statewide data on the oral health status and practices of the noninstitutionalized population of Kentucky. In the 1987 epidemiological survey, information about persons who were homebound was also gathered through telephone and in-person interviews. The results of that survey provided a relatively accurate estimate of the number of persons homebound in the state of Kentucky. Although the majority of this population was older than age 60, almost 21% were between the ages of 35 and 59. Household income for persons who are homebound and the amount of money spent on dental care is significantly less than in households not reporting the presence of a person who is homebound. These findings provide baseline data for dentists and health planners interested in serving this population. Also, this data is pertinent to the formation of health policies to create accessible, affordable care for this growing segment of the population.

Adult↗
PubMed2003

Summary measure of dietary musculoskeletal nutrient (calcium, vitamin D, magnesium, and phosphorus) intakes is associated with lower-extremity physical performance in homebound elderly men and women.

BACKGROUND: Nutritional intake has been overlooked as a possible contributing factor to lower-extremity physical performance, especially in homebound elderly persons. OBJECTIVES: Our objectives were to examine the association of a summary measure of calcium, vitamin D, magnesium, and phosphorus intakes with 1) the inability to perform lower-extremity physical performance tests and 2) declining levels of summary lower-extremity physical performance. DESIGN: Baseline data from the Nutrition and Function Study were used to calculate a summary musculoskeletal nutrient (SMN) score as a measure of nutrient intake (factor analysis) and to examine the association of SMN intake with physical performance (multivariable regression models) among recipients of home-delivered meals who completed an in-home assessment (anthropometric measures and performance-based physical tests) and three 24-h dietary recalls. RESULTS: Among the 321 participants, elderly age, black race, body mass index (in kg/m2) > or = 35, arthritis, frequent fear of falling, and lowest SMN intake were independently associated with being unable to perform functional tests. The lowest SMN intake and the highest BMI were both significantly associated with increasingly worse levels of lower-extremity physical performance, after adjustment for health and demographic characteristics. CONCLUSIONS: Considering the importance of identifying short- and long-term outcomes that help elderly persons maintain adequate nutritional status and remain functionally independent at home, the results of this study suggest the need to identify intervention strategies that target the improvement of dietary intake and physical performance. Further investigation is indicated to identify the manner in which nutritional status contributes to the preservation or deterioration of physical performance in homebound elderly persons.

Activities of Daily Living↗
PubMed2005

[Prevalence and characteristics of different types of homeboundness among community-living older adults].

BACKGROUND: Little is known about the epidemiologic features of different types of homeboundness among the elderly. PURPOSE: This cross-sectional study examined prevalence and characteristics of "type 1" and "type 2" homeboundness (see definitions below) among community-living older adults. METHODS: The subjects comprised all residents aged 65 years and over living in Yoita, Niigata Prefecture, and Hatoyama, Saitama Prefecture. Subject data on sociodemographics, and physical, mental and social functioning were collected through in-person interview. Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into "type 1" or "type 2", based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3, 4, or 5). "Type 1" homebound persons included those who could not get out into the neighborhood without assistance (i.e, levels 3, 4, or 5). "Type 2" included those who were homebound, though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We focused on characteristics of "type 1" and "type 2" homeboundness as compared with those of respective controls, ie., non-homebound persons within the same mobility categories. RESULTS: Out of the eligible subjects (1588 in Yoita, and 1135 in Hatoyama), 1544 and 1002 persons participated in the survey (response rates of 97.2% and 88.3%, respectively). Among the participants, "type 1" and "type 2" homeboundness was found for 4.1% and 5.4%, respectively, in Yoita, and 3.3% and 6.8% in Hatoyama. After adjustment for potential confounders such as age, gender and mobility level, we found a significant regional difference in the prevalence of "type 2" but not of "type 1" (OR of "type 2" for Hatoyama/Yoita 1.44; 95% CI 1.02-2.03). Both types of homeboundness increased with advancing age; "type 1" and "type 2" featured in over 10% of persons aged at least 85 years and 80 years, respectively. Even after controlling for potential confounders, "type 2" showed a higher prevalence with walking disability and incontinence, and reported lower self-rated health, more depressed mood, lower functional capacity and lower social functioning. "Type 1" showed a higher prevalence with fear of falls, but a lower prevalence with basic ADL disability and a high score for Intellectual Activity, indicating reduced self-efficacy. CONCLUSIONS: Prevalence of "type 1" and "type 2" homeboundness among community-living older adults differs depending on the residential area and age of the subjects. A substantial proportion of "type 2" homebound persons are at high risk of functional decline, indicating that "type 2" as well as "type 1" homebound persons need care-preventive programs.

Activities of Daily Living↗
PubMed1988

Managing diabetes in the home: a model approach.

The Diabetes Home Care Program has been an effective means of providing diabetes management and education to homebound, usually elderly, persons with diabetes. The program appears to be cost effective, the average cost per patient is less than one day of hospitalization. Reimbursement of the program has been good as patients have qualified for reimbursement under Medicare guidelines. Improved diabetes control has been demonstrated following the home care intervention. Since elderly persons with diabetes are frequently referred for home care, it would be appropriate for home care agencies to provide specialized care for persons with diabetes. The Diabetes Home Care Program can serve as a model of diabetes management and education for homebound persons with diabetes.

Diabetes Mellitus↗
PubMed2006

Obesity is a risk factor for reporting homebound status among community-dwelling older persons.

OBJECTIVE: To test the a priori hypothesis that obesity is a predictor of risk for reporting homebound status. RESEARCH METHODS AND PROCEDURES: A longitudinal cohort study was conducted with 21,645 community-dwelling men and women 65 to 97 years old. A nutrition risk screen was administered baseline between 1994 and 1999 and again 3 to 4 years later. Univariate analyses identified baseline variables associated with subsequent reporting of homebound status. Multivariable logistic regression models were created to identify baseline variables that were significant independent predictors of reporting homebound status. RESULTS: At baseline, 24% of the cohort had BMI > or = 30. There were 12,834 (45% men) respondents at follow-up (68% response). Non-responders at follow-up differed little from responders except for greater baseline age (72.2 +/- 6.2 vs. 71.4 +/- 5.6 years, p < 0.001) and reporting of any functional limitations (9.2% vs. 4.9%, p < 0.001). At follow-up, those who reported homebound status (n = 169) were significantly (p < 0.001) older (80.3 +/- 7.3 vs. 75.1 +/- 5.5 years) and more likely to report functional limitations (83.4% vs. 10.8%). Univariate analyses identified 16 baseline variables that were eliminated stepwise until five significant independent predictors remained: age > or = 75 years (2.21, 1.55 to 3.15/odds ratio, 95% confidence interval), BMI > or = 35 (1.75, 1.04 to 2.96), poor appetite (2.50, 1.29 to 4.86), low income (1.59, 1.00 to 2.56), and any functional limitation (10.67, 7.36 to 15.46). DISCUSSION: Obesity remained a significant independent predictor for reporting homebound status and should be considered in screening of older populations and in the planning, implementation, and evaluation of services for homebound older persons.

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PubMed1998

Factors affecting QOL of the home-bound elderly disabled.

The purpose of this study was to clarify the factors affecting the quality of life (QOL) of the elderly home-bound patients. Data were collected from 56 chronically disabled elderly persons (mean age of 76.7 years) who needed a long-term home-based care. They were assessed on QOL, range of activity, functional capacity, and capacity of family care functioning as well as socio-economic condition. The QOL was evaluated by using Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The activities of daily living (ADL) and handicaps were evaluated by the Barthel index and the ESCROW profile, respectively. The capacity of family care functioning was also recorded according to the "Family Care Scale" developed by Hamamura. As a result, there was a significant difference between PGC Morale Scale score and Barthel index score (P < 0.05), and we found a negative correlation between PGC Morale Scale score and ESCROW score (P < 0.05). It was also revealed that the factors affecting the QOL of the home-bound elderly disabled were determined by the motivation, functional capacity, and capacity of family care functioning (P < 0.05). These results suggest that in order to improve their QOL, ADL must be improved, therefore, rehabilitation should be continued to maintain their function after discharging from hospitals and that we should take these factors into consideration, such as living environments and social conditions of the family care. The results also indicate how the patient's independence in the daily life influences social and economic status, and consequently it affects the quality of life.

Activities of Daily Living↗
PubMed1996

Characteristics of urinary incontinence in homebound older adults.

OBJECTIVE: To describe the characteristics of urinary incontinence and related factors in incontinent homebound older adults. DESIGN: A descriptive study of 90 cognitively intact incontinent homebound older persons referred to a clinical trial to examine the effectiveness of behavioral therapies in the treatment of urinary incontinence (UI) in homebound patients. SETTING AND PARTICIPANTS: Incontinent patients more than 60 years of age who met the Health Care Financing Administration's definition of homebound were referred to a clinical trial by home care nurses from a Medicare-approved home care agency in a large metropolitan country in Pennsylvania. MEASURES: Structured continence and medical history, basic and instrumental activities of daily living, Folstein MMSE, Geriatric Depression Scale, mobility-toileting skills, bladder diaries, and physical examination. RESULTS: Four hundred eighty-four persons were referred to the clinical trial, and 90 cognitively intact persons were found eligible to participate in this study (80 women and 10 men). Subjects had a mean age of 75.8 years, reported a mean of 8.4 medical problems, and most, 80%, had functional limitations in ambulation. Subjects recorded a mean of 3.8 urinary accidents/day-1.4 large and 2.4 small accidents/ day-in baseline bladder diaries. The majority, 73.3%, had more than 10 accidents per week, and most patients reported mixed urge, stress (57.1%), or pure urge (37.7%) UI. Half (54.4%) reported that UI further restricted their activities, and 52.2% reported that this problem was extremely disturbing. However, 90.5% believed that UI could be treated. CONCLUSIONS: Urinary incontinence tends to be severe among cognitively intact homebound older adults in both frequency and volume of accidents. Although subjects were homebound with many health and functional disabilities, they perceived UI as a very disturbing problem that further restricted their activities. Participants in this study were optimistic about the potential benefits of treatment.

Activities of Daily Living↗
PubMedDate not supplied

Social work in a dental program for the developmentally disabled.

This article discusses the role of a social worker in a dental school based program for the developmentally disabled. Developmentally disabled people constitute a heterogeneous population with problems that often prevent them from receiving appropriate dental services. A social worker in the dental care setting can help this population access dental services. Data gathered during a 2-year period support the hypothesis that patients living at home present more obstacles to dental care and require more social work intervention in obtaining dental care than patients living in residential settings.

Dental Care for Persons with Disabilities↗
PubMed2005

[Prognosis of different types of homeboundness among community-living older adults: two-year prospective study].

PURPOSE: This 2-year prospective study was conducted to determine prognosis of two different types of homeboundness among community-living older adults and explore whether those types of homeboundness exert independent effects even after controlling for potential confounders. METHODS: Out of all residents aged 65 years and over who lived in Yoita, Niigata, Japan (n = 1,673), 1,544 persons participated in the baseline survey which was conducted in November, 2000 (response rate, 92.2%). They were followed for the subsequent 2 years in terms of mortality, institutionalization and functional status (mobility, IADL, BADL, and cognition). Persons were defined as being homebound if he/she went outdoors only once a week or less often. Homeboundness was further classified into types 1 or 2, based on the hierarchical mobility level classification (levels 1 or 2 vs. levels 3 or over). Type 1 homebound persons included those who could not get out into the neighborhood without assistance (i.e., levels 3 or over). Type 2 included those who were homebound though they could get out at least into the neighborhood unassisted (i.e., levels 1 or 2). We compared two-year prognosis between the type 2 homebound cases and controls (the non-homebound individuals in levels 1 or 2), or the type 1 homebound and controls (the non-homebound in levels 3 or over). Multiple regression analysis or multiple logistic regression models were used to analyze independent effects of the homebound status on the prognosis, controlling for potential confounders such as age, gender, chronic conditions, functional status, and psychosocial variables at baseline. RESULTS: At baseline there were 1,322 non-homebound in levels 1 or 2 (87.0%), 81 type 2 homebound (5.3%), 39 non-homebound in levels 3 or over (2.6%), and 78 type 1 homebound older persons (5.1%) . As compared to controls, type 2 homebound elderly showed increased risks of functional decline even after controlling for potential confounders. Relative risks of type 2 homeboundness for developing mobility loss, IADL and ADL disability, and cognitive impairment (MMSE < 20) were 3.20(95% CI, 1.60-6.38), 2.85(1.20-6.82), 1.52(0.61-3.75), and 3.05(1.06-8.78) in the partially adjusted model, and 2.49(1.20-5.17), 2.25(0.90-5.63), 1.46(0.54-3.94) and 2.41(0.71-8.17) in the fully adjusted model. Type 1 homebound elderly showed an increased risk for mortality (33.3% vs. 5.1%), but a lower risk for institutionalization (9.0% vs. 25.6%). The independent effect of type 1 was not significant when mortality and institutionalization were combined (relative risk, 2.05[0.54-7.75] in the fully adjusted model). CONCLUSIONS: Type 2 homeboundness is an independent risk factor for functional decline among competent older persons, while the prognosis of older persons with a low functional state is poor, regardless of type 1 homeboundness or not.

Activities of Daily Living↗
PubMed2005

[Incidence of disability in housebound elderly people living in a rural community].

This study aimed to explore whether being housebound is a risk factor for disabilities and whether low social communication increases incidence of disability in elderly people. A self-reported questionnaire regarding demographic characteristics was administered to 2,046 community-dwelling elderly people (aged 65 and older) in October 2000, and subjects were followed up until March 2003. All subjects were independent in activities of daily living. In this study, being housebound was defined on frequency of going out, with those who left the house once or less per week being classified as housebound. We further classified the housebound into four groups: I, going out alone is difficult but social communication occurs; II going out alone is difficult and no social communication occurs; III, going out alone is possible but not undertaken often, and some social communication occurs; and IV, going out alone is possible but seldom undertaken and no social communication occurs. In this population, overall prevalence of being housebound was 8.5%, and about half of those who were housebound fit the third classification. At the end of the follow-up period, 12.7% of subjects reported disabilities. The incidence of disability was higher in the housebound compared with the non-housebound. The incidence of disability by age was higher in housebound groups than in the non-housebound in elderly individuals aged under 85, but no significant differences were recognized in those aged over 85. In terms of housebound status, all housebound groups had higher levels of disability than the non-housebound. However, the groups without social communication (H and IV) exhibited higher incidence of disability than those with social communication (I and II). From the results obtained, we conclude that being housebound is a risk factor for disability in elderly individuals aged 65 to 85 years who are living independently, and that lower social communication also represents a risk factor for disability. This study appears to indicate that a frequency of going out of once or less a week is a valid guide for determination of housebound status.

Activities of Daily Living↗
PubMed1988

Nutrition in the elderly.

Nutritional modulation is one approach to successful aging. In animals, dietary restriction increases life span. Alterations in the macronutrient and micronutrient constituent of the diet can modulate gene expression. Anorexia is common in elderly persons. The results of studies in animals suggest that aging is associated with a decrease in the opioid feeding drive and an increase in the satiating effect of cholecystokinin. Unrecognized depression is a common, treatable cause of anorexia and weight loss in elderly persons. Protein synthesis decreases in elderly persons; nevertheless, nitrogen balance can be maintained in patients with fairly low intakes of protein. Carbohydrate intolerance is common and may be modulated by nutritional intervention and physical activity. The role of cholesterol in the development of heart disease in very old persons is controversial. Homebound and institutionalized elderly persons often do not expose their skin to sunlight; because the skin of older persons has a decreased ability to form vitamin D, the vitamin D status in these persons is precarious and they are at risk for osteopenia. Vitamins are often abused by elderly persons. Drug administration alters the vitamin requirements of persons. Borderline zinc state has been associated with deteriorating immune function, especially in persons who have diabetes mellitus or who abuse alcohol. Zinc administration appears to protect against the deteriorating vision associated with age-related macular degeneration. Selenium deficiency seems to be associated with an increased prevalence of cancer.

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PubMed2005

Patterns of therapeutic prescription medication category use among community-dwelling homebound older adults.

PURPOSE: The measurement of prescription medication use is usually through a simple count of medications, which tends to ignore therapeutic categories. This research investigated prescription medication use among homebound older adults, by documenting the therapeutic prescription medication categories used by these individuals and identifying the factors associated with use of multiple therapeutic categories. METHODS: Baseline Nutrition and Function Study (2000-2001) data from 326 homebound older persons who completed the medication review component (visual inspection of medications) of the baseline in-home interview and used > or =1 prescribed medication were included in this analysis. RESULTS: More than 40% (n = 133) regularly took medications from three to four different therapeutic categories and 31.6% (n = 103) used > or =5 different therapeutic categories. The use of respiratory medications declined with increasing age, and more women than men used diuretic and thyroid replacement medications. Independent of other factors, increased use of multiple therapeutic categories was associated with sociodemographic characteristics (gender, age, living arrangement, marital status and medication coverage), medical conditions (diabetes, heart problems and lung disease) and inability to self-manage medications. CONCLUSIONS: Our findings suggest that individual characteristics and medical conditions may help identify homebound elders at high risk for using prescription medications from an increased number of different therapeutic categories. This observation may help clinicians and community-based providers of services to older persons to be aware of differences in therapeutic medication use within an older population, and how patterns of use may alter service needs.

Age Factors↗
PubMed1993

Alcohol use and abuse in the frail, homebound elderly: a clinical analysis of 103 persons.

We studied alcohol use and abuse in 103 frail, homebound elderly individuals cared for in a long-term home health care program from July 1991 to February 1992. Their average age was 80.63 years. Eighty-four percent were abstinent at the time of the study, including 25 (25%) past heavy drinkers. Two persons were current heavy drinkers and 14 continued to drink socially. Previous alcohol use or abuse was associated with a history of smoking, cardiovascular morbidity, social isolation, and anxiety or agitation. Current social drinking was associated with sedative-hypnotic use as well as smoking. Twenty-three of 25 past heavy drinkers remained sober on our programs without the use of formal alcohol treatment. Abstinence is known to increase with age, appears to be fostered by the homebound setting, is feasible for homebound elderly persons and is often accepted.

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