Prevalence of Homebound Older Adults in US Rose Dramatically With Pandemic

By Linda Carroll

August 24, 2021

(Reuters Health) - The number of homebound seniors nearly tripled between 2019 and 2020 with the biggest increases seen among Hispanic and Black Americans, a U.S. study finds.

In an analysis of data from the National Health and Aging Trends Study (NHATS), researchers estimate that in 2019 there were 1.6 million seniors aged 70 or older who left home once a week or less often, as compared to 4.2 million in 2020, according to the report published in JAMA Internal Medicine.

More than a third (34.5%) of Hispanic/Latino seniors, one in five (22.6%) non-Hispanic Black seniors, and one in 10 (10.1%) non-Hispanic white seniors met the definition of homebound in 2020, the study found.

"The proportion of older adults rarely or never leaving home skyrocketed in 2020, and Hispanic/Latino and Black older adults were impacted the most," said the study's first author, Dr. Claire Ankuda, an assistant professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai in New York City. "Furthermore, among those homebound in 2020, Hispanic older adults reported much greater rates of depression, anxiety, and dementia, while also lacking strong digital tools and connections," Dr. Ankuda noted.

"Our results indicate low rates of digital access - including use of cell phones, computers, or the internet - as well as poor mental and physical health among those homebound in 2020," Dr. Ankuda said in an email. "While it is certainly likely that those in poor health are more likely to stay at home, it is also likely that staying home, especially without strong social connections, caregiving, and medical support could worsen mental and physical health."

It's not yet clear what the impact will be, Dr. Ankuda said.

"As a clinician, I have heard many stories over the past months of how the social isolation of the pandemic has resulted in my patients experiencing severe declines in their mood, cognition, and physical health," she added.

To take a closer look at the pandemic's impact on the number of homebound seniors, the researchers analyzed data collected between May 1, 2011 and October 31, 2020 by NHATS, an annual cohort study of aging among older adults not living in institutional settings. Information about race, ethnicity, demographic characteristics, household size, Medicaid enrollment, self-reported health, comorbidities and function were self-reported.

In 2020, participants were asked whether they owned a cell phone or computer and whether in the last month they had used email or text, used the internet or gone online.

The analysis focused on 10,785 seniors aged 70 or older, for whom there were 49,267 total observations during the 10 years of the study, including 3,861 in 2020. Between 2011 and 2020, the overall prevalence of being homebound nearly tripled from approximately 5.0% during 2011-2019 to 13.0% in 2020.

Among Hispanic/Latino individuals, homebound prevalence ranged between 12.6% and 17.2% during 2011-2019, and jumped to 34.5% in 2020. Black non-Hispanic individuals had 6.9%-9.9% homebound prevalence, rising to 22.6% in 2020, while prevalence among non-Hispanic white individuals rose from 3.7%-6.0% in prior years to 10.1% in 2020.

Among the seniors homebound in 2020, Black non-Hispanic and Hispanic/Latino participants were more likely to be receiving Medicaid than non-Hispanic white respondents and to report fair or poor health. Among the homebound white non-Hispanic respondents, 43.7% lived alone as compared with 28.9% of Black non-Hispanic respondents and 26.8% of Hispanic/Latino respondents.

Many of the participants did not have digital access: 27.8% did not have a cell phone, 50.8% did not have a computer, and more than half had not used email or texted (52.0%) or gone online (55.2%) in the last month. These proportions were highest among Hispanic/Latino homebound older adults, of whom 67.8% had not used email or texted in the last month, and 74.7% had not gone online.

"Hispanic/Latino and Black older adults may be living in communities with greater rates of COVID, and so are wisely staying home," Dr. Ankuda said. "They may not have access to safe transportation or safe grocery stores to leave their homes without risk of infection. However, due to racial inequities, they also have lower access to digital technologies and report both worse physical and mental health compared to white homebound older adults."

The finding that the number of homebound seniors increased dramatically was not surprising, said Dr. John Rowe, a professor at the Mailman School of Public Health at Columbia University in New York City. "Part of that is related to the hesitancy of people to go out in the interest in maintaining social distancing," he said. "And part is that there were fewer options for people to go somewhere."

"The importance of this is to underline the fact that isolation is toxic for older persons," Dr. Rowe said. "There is a very strong body of evidence that social connectedness is a critical part of wellbeing late in life. I tell my medical students that if they have only one question to ask of an 80-year-old man to assess how he's going to do going forward, they are better off asking him how many times he has been in contact with friends and family than asking him if he smokes cigarettes."

The lesson here is we need to develop approaches to increase seniors' contacts with people, particularly using telemedicine and Zoom meetings with family members and friends or groups to mitigate the adverse effects of isolation, Dr. Rowe said.

The study doesn't tell us why people stayed home, said Dr. David Nace, chief medical officer, UPMC Senior Communities and assistant professor of medicine in the division of geriatric medicine at the University of Pittsburgh School of Medicine.

"Perhaps the most salient finding from this study is the number of homebound older adults who do not use the internet, email, or even cell phones on a regular basis," Dr. Nace said. "Telehealth serves a key role in ensuring access to care during this pandemic. For homebound individuals, regardless of reason for homebound status, telehealth may not be able to reach those most in need of care."

SOURCE: JAMA Internal Medicine, online August 23, 2021.