The effect of homebound status on older persons

Objectives: To examine the effect of homebound status of older persons in Israel on mortality, mental health and function, future homebound status, and institutionalization. Design: Cross-sectional and longitudinal analysis using existing data sets of a national survey. Setting: A national survey. Participants: The analyzed sample was drawn from a representative cohort of 1,191 older persons in Israel (mean age 83.1 ± 5.3) in the first wave of the Cross-Sectional and Longitudinal Aging Study and 621 participants in the second wave of the study. Measurements: Homebound status, health, function, environment, mental health, distal events, mortality, activities daily living (ADLs), instrumental activities of daily living (IADLs), Orientation-Memory- Concentration Test, and Center for Epidemiologic Studies Depression Scale. Mortality data were recorded from the Israeli National Population Registry. Results: Homebound participants had a significantly higher risk of mortality than their non-homebound counterparts, even after controlling for background variables, health, and function (risk ratio=1.33, 95% confidence interval=1.08-1.63). In cross-sectional analysis, homebound status was related to depressed affect even after controlling for demographics, health, and function. In longitudinal analysis, homebound status predicted future depressed affect and ADL and IADL difficulties when controlling for demographics and health, but only IADL prediction was statistically significant when baseline levels of the outcome variable were entered into the regression. Conclusion: The results highlight the detrimental effects of homebound status, underscoring the importance of preventing this state, of interventions to assist those who are homebound, and of future research to examine the efficacy and coverage of services to this population.