Homebound Older Adults Research Articles

Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences

BackgroundDepression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities.ObjectiveThis study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression.MethodsThe participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research.ResultsThree themes and various subthemes emerged related to participants’ experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants’ perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement.ConclusionsiCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence.Trial RegistrationClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289

A Technology Training Program to Alleviate Social Isolation and Loneliness Among Homebound Older Adults: A Community Case Study.

Despite substantial evidence of the negative health consequences of social isolation and loneliness and the outsized impact on older adults, evidence on which interventions are most effective in alleviating social isolation and loneliness is inconclusive. Further complicating the translation of evidence into practice is the lack of studies assessing implementation and scalability considerations for socialization programs delivered by community-based organizations (CBOs). Our primary objective was to describe the implementation barriers, facilitators, and lessons learned from an information and communication technology (ICT) training program aimed at reducing social isolation and loneliness for homebound older adults in a home-delivered meals program. Participants received in-home, one-on-one ICT training lessons delivered by volunteers over a 14-week period with the goal of increasing social technology use. To assess implementation facilitators and barriers, 23 interviews were conducted with program staff (n = 2), volunteers (n = 3), and participants (n = 18). Transcripts were analyzed using thematic analysis. Aspects that facilitated implementation included the organization's existing relationship with clientele, an established infrastructure to deliver community-based interventions, alignment of intervention goals with broader organizational aims, and funding to support dedicated program staff. Challenges to implementation included significant program staff time and resources, coordinating data sharing efforts across multiple project partners, participant and volunteer recruitment, and interruptions due to COVID-19. Implications of these facilitators and barriers for scalability of community-based ICT training interventions for older adults are described. Lessons learned include identifying successful participant and volunteer recruitment strategies based on organizational capacity and existing recruitment avenues; using a targeted approach to identify potential participants; incorporating flexibility into intervention design when working with the homebound older adult population; and monitoring the participant-volunteer relationship through volunteer-completed reports to mitigate issues. Findings from this formative evaluation provide insight on strategies CBOs can employ to overcome challenges associated with implementing technology training programs to reduce social isolation and loneliness for older adults, and thus improve overall well-being for homebound older adults. Recommendations can be integrated into program design to facilitate implementation of ICT programs in the community setting.

Multidimensional factors affecting homebound older adults: A systematic review.

PurposeTo systematically identify the multidimensional factors affecting homebound older adults.DesignSystematic review.MethodsWe searched PubMed, MEDLINE, Cochrane Library, CINAHL, EMBASE, and PsycINFO from inception to November 15, 2020. This systematic review followed the Preferred Reporting Items for Systematic Review and Meta‐analysis guidelines. The Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross‐Sectional Studies was used for quality assessment.FindingsNineteen studies met the review criteria; the studies were either cross‐sectional or longitudinal. Most studies have focused on personal factors affecting homebound older adults. The individual construct consisted of demographic, biological, psychological, functional, and health‐related factors. The structural construct included architectural, environmental, community, and social factors. Based on the different definitions of homebound used in the studies, the prevalence of homebound status ranged from 3.5% to 39.8%.ConclusionsThe prevalence of homebound status among older adults varied depending on how homebound was defined. Homebound status is the interaction between the individual and structural constructs. Variations in cultural, political, and economic conditions could influence homebound status across countries over time. Comprehensive assessment and interventions for homebound older adults based on multidisciplinary approaches are recommended for nurses.Clinical relevanceThis research will impact the development of nursing strategies to screen homebound older adults and provide targeted preventive interventions so that older adults with many risk factors do not become homebound.

Investigating predictors of self-care behavior among homebound older adults: The role of self-efficacy, eHealth literacy, and perceived social support.

This study aimed to investigate the predictors of self-care behavior among homebound older adults using the Health Empowerment theory as a framework. This was a cross-sectional, predictive correlational study. Sixty-eight participants were randomly selected from five Hong Kong community centers from May 21, 2020 through July 20, 2020. Self-care behaviors were assessed using the Chinese version of Partners in Health. Self-efficacy, eHealth literacy, and perceived social support were assessed as potential predictors of self-care behaviors. A multiple linear regression analysis was adopted to examine the predictive effects. The age of the sample ranged from 61 to 85years (mean=71.7, SD=6.0). Participants who reported having sufficient or more than sufficient financial resources had better self-care behaviors than those who claimed to have insufficient financial resources (F=5.08, p=0.009). Statistically significant correlations were found between the participants' eHealth literacy (r=0.54, p<0.001), perceived social support (r=0.60, p<0.001), and self-care behaviors. eHealth literacy (β=0.13, p=0.007) and perceived social support (β=0.13, p<0.001) were significant predictors of self-care behaviors. Collectively, the three variables accounted for 41% of the variances in self-care behaviors. The findings in this study suggest that eHealth literacy and perceived social support are two key factors that predicted the self-care behaviors of this vulnerable population. In this technological era, the use of eHealth, together with enhanced social support, can lead to better self-care among older adults, particularly those who are homebound.

Relationship between Psychological Status and Health Behaviors during the Coronavirus Disease Pandemic in Japanese Community-Dwelling Older Adults.

The coronavirus disease (COVID-19) continues to be a widespread pandemic. We investigated the relationship between anxiety/stress and health behaviors during the COVID-19 pandemic in homebound Japanese older adults during January and February 2021. We surveyed 1507 community-dwelling, older Japanese adults using a self-administered questionnaire on primary attributes, including family structure, evaluation of psychological anxiety/stress, and health behaviors. Participants were divided into four anxiety/stress groups based on the frequency of experiencing anxiety/stress, and their association with health behaviors was analyzed using bivariate and multivariate analyses. Responses were received from 469 (31.1%) respondents. In the bivariate analysis, age and family structure were significantly associated with anxiety/stress (p < 0.01). The health behaviors significantly associated with anxiety/stress were walking, balanced eating habits, limited snacking, regular lifestyle, and dental visits. Logistic regression analysis was performed using the variables in the bivariate analysis that showed a significant association with anxiety/stress status as independent variables. Finally, age and dietary habits were significantly associated with anxiety/stress status. No significant associations were found between any other variables. Among older adults living in the rural areas of Japan during the COVID-19 pandemic, anxiety/stress status was significantly associated with age and dietary habits but not with other health behaviors.

Usability-In-Place-Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review.

BackgroundTechnology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely.ObjectiveOur objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults.MethodsWe performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature.ResultsCritically, we identified a gap in the literature—a lack of remote usability testing methods, tools, and strategies for older adults, despite this population’s increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults.ConclusionsWe call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals.

Homebound status among older adult home care recipients in Ontario, Canada.

Homebound status is associated with an increased risk of morbidity and mortality in older adults, yet little is known about homebound older adults in Canada. Our objectives were to describe time trends in the prevalence of homebound status among community-dwelling long-term home care recipients and the characteristics associated with homebound status. This was a retrospective cross-sectional and cohort study using linked health administrative data in Canada's most populous province, Ontario. We included adults aged 65 years and older who received at least one long-term home care assessment from 2006 to 2017 (N= 666,514). Homebound individuals were those who exited the home an average of 0-1 days/week over the previous 30 days; not homebound comparators exited the home 2-7 days per week. We compared baseline characteristics between groups and estimated the association between these characteristics and homebound status at baseline and over time. From 2006 to 2017, the annual proportion of long-term home care recipients who were homebound increased from 48% to 65%. At first assessment, 50% of the cohort (331,836 of 666,514) were homebound. Among those with a 4-12 month repeat assessment, homebound status persisted over time for 80%, and developed anew in 24%. Dependency on others for locomotion, use of an assistive device, poor access to dwelling, older age, and female sex were most strongly associated with homebound status at baseline, as well as its development and persistence over time. We found that half of Ontario older adult long-stay home care clients were homebound at the time of their first assessment, and that the prevalence of homebound status among home care recipients rose steadily from 2006 to 2017. This informs further research and policy development to ensure the adequacy of supports for older homebound persons.

Caring callers: the impact of the telephone reassurance program on homebound older adults during COVID-19

ABSTRACT During the COVID-19 pandemic, older adults experienced great levels of social isolation and feelings of loneliness. We developed a telephone reassurance program, Caring Callers, to provide a weekly phone call to socially isolated older adults. Dyads were created which comprised of a Senior Companion volunteer and a homebound older adult. Using a mixed methods approach, we examined the program’s impact on homebound older adults. The participants were satisfied with the program and showed a significant increase in overall health. They discussed social and emotional benefits of the program and other benefits that they gained from community resources. Due to the vulnerability of the participants, this telephone-based intervention seemed feasible without technological barriers. It is critical that aging service providers recognize the resourcefulness and relatability of older adult volunteers and utilize them to continue to support socially isolated older adults during an unprecedented event affecting people’s isolation.

Pain in Homebound Older Adults with Heart Failure after Hospital Discharge.

Pain is not uncommon in older adult patients with heart failure (HF) and has been identified as a risk factor for rehospitalization of homebound patients with HF. Little is known about the pain experiences and management of older adults with HF after hospital discharge. We sought to describe pain and other symptoms among homebound older adults with HF using a qualitative and descriptive approach. We conducted semistructured interviews to obtain qualitative data and used the Brief Pain Instrument-Short Form and the Edmonton Symptom Assessment Scale to obtain descriptive data on symptom burden. We interviewed 18 participants within 10 days after hospital discharge. Participants' mean age was 75.8 ± 9.0 years; 78% were White. The mean pain score at its worst was 5.2 ± 3.1, and for pain interfering with sleep was 4.3 ± 3.41. Most participants managed pain with medications. Using thematic analysis of qualitative data, we identified three distinct categories: (1) the diversity of patients' pain experiences, (2) the diversity of pain management routines, and (3) patients' experiences with healthcare providers' pain assessment and management practices. Our findings show that homebound older adults with HF experience various pain symptoms and receive inconsistent education about how to manage pain from healthcare providers. This study supports the need for better pain assessment and education about the appropriate use of pain medications and nonpharmacologic approaches to pain control for homebound older adults with HF.

Nutrition‐Related Policy Fundamentals for Supporting Older Adults in the Community during a Pandemic: Lessons from COVID‐19

AbstractNutrition is a key factor supporting healthy aging. Yet during the global COVID‐19 pandemic, issuances of shelter‐in‐place orders, closures of senior centers and other congregate dining locations, losses of income, increases in grocery prices, and other changes have left many older adults struggling to maintain good nutrition. However, there are available solutions to improve the nutrition of millions of older adults who may be challenged to put food on the table. This commentary outlines the problems of older adult malnutrition and food insecurity and their strong correlation with COVID‐19. It summarizes existing federal nutrition programs for older adults, including the U.S. Department of Health and Human Services' Older Americans Act (OAA) nutrition programs and the U.S. Department of Agriculture's means‐tested nutrition programs such as the Supplemental Nutrition Assistance Program (SNAP). The commentary also contains lessons from community‐based OAA nutrition programs that refocused some of their nutrition services and other supportive services during the COVID‐19 pandemic to better serve socially distancing, newly homebound older adults. It explores pre‐ and post‐COVID‐19 policy actions and opportunities for improving the nutrition, health, and well‐being of community‐dwelling older Americans during the current pandemic and beyond, including the need for more federal funding and flexibility for older adult nutrition programs, the need for improvements to older adult access to these programs, and the need for more older adult nutrition screening and intervention.

A Qualitative Study of the Social and Lived Experiences of Homebound Older Adults.

The number of homebound older adults is increasing in the United States. We aimed to examine their social and lived experiences and to understand their perspectives on their situation, feelings, and coping mechanisms. We conducted a cross-sectional qualitative study using semi-structured interviews with 18 older homebound individuals in Central Virginia. Homebound older adults experienced both physical and mental health challenges that restricted their ability to participate in activities of daily living, recreation, and social interactions. Participants often felt dependent, helpless, lonely, and socially isolated. Those who communicated regularly with friends, family, and health care providers reported positive benefits from these interactions. Participants faced challenges to their physical, emotional, and mental well-being. Our findings might help clinicians, policymakers, and community organizations understand how to better support homebound older adults. We should provide educational opportunities, respect their autonomy, and implement initiatives to address their isolation and loneliness.

Impact of the COVID-19 pandemic on community services for homebound older adults in New York City.

The ongoing COVID‐19 pandemic has affected multiple aspects of society. Based on data from a community program, this study examined how the pandemic influenced community services for homebound older adults and whether those services could be delivered via internet‐based information and communications technology. Using mixed methods, we collected quantitative data from client profiles and service documents and qualitative data from phone interviews with program staff members and clients. The quantitative results show that during the pandemic, more services were provided for the physical well‐being of homebound older adults than for their psychological and home environment needs. Service duration during the pandemic was significantly longer than prior to the pandemic. The qualitative data indicate that the pandemic has influenced inputs, activities and outcomes of the program. The program staff members and clients expressed concerns about delivering services online. Based on the findings, we provide suggestions for future practice and policy.

Association of the COVID-19 Pandemic With the Prevalence of Homebound Older Adults in the United States, 2011-2020

This cohort study evaluates the prevalence of homebound older adults in the US from 2011 to 2020 and assesses whether the COVID-19 pandemic was associated with a change in prevalence.

Loneliness and Activity Engagement Among Rural Homebound Older Adults With and Without Self-Reported Depression.

Rural homebound older adults are a vulnerable population at risk for depression, loneliness, and limited participation, but studies that examine these factors in this population are scarce. To describe the degree of depression, loneliness, and activity engagement among rural homebound older adults and determine differences in loneliness and activity engagement between those with and those without self-reported depression. Cross-sectional survey. Two rural counties in south central Indiana. Homebound adults ages 60 yr and older who received nutritional or companionship services from a local Area Agency on Aging. Outcomes and Measures: Depression was measured with an item on the self-report questionnaire and the Geriatric Depression Scale-15. Loneliness was measured with an item on the self-report questionnaire and the UCLA Loneliness Scale. Activity engagement was measured with the Engagement in Meaningful Activities Survey and the Meaningful Activity Participation Assessment. Ninety-one participants returned surveys, of which 78 were analyzed. Regarding depression, 40% of participants reported having it, but results for the Geriatric Depression Scale-15 showed that 63% were in the indicative or suggestive range for depression. Participants in general reported moderate loneliness and low to moderate engagement in meaningful activities. Those with self-reported depression had significantly higher loneliness and lower activity engagement, particularly in self-care, leisure, and socializing activities. A high proportion of this sample of rural homebound older adults had depression. Those who did tended to have a higher degree of loneliness and lower engagement in meaningful activities. What This Article Adds: Depression was associated with greater loneliness and lower activity engagement in rural homebound older adults. Occupational therapy practitioners serving rural homebound older adults with depression should consider providing interventions to address loneliness and facilitate activity engagement.

Monitoring Cognitive Health Status in Homebound Older Adults: Insights from a Nationwide Request for Information

ABSTRACT The COVID-19 pandemic has fueled growing concerns about the long-term impacts on outcomes in older adults including social isolation and declines in cognitive health. Prior to the pandemic, the Administration for Community Living (ACL) released a nationwide request for information to understand how community-based organizations monitor changes in cognitive status for homebound older adults. This Perspective describes strategies reported by community-based organizations to monitor cognitive status in homebound older adults and notes the potential for technology to mitigate the risk of social isolation and delays in observing cognitive decline, considerations that are especially relevant during COVID-19 amid social distancing requirements.

Loneliness in Homebound Older Adults: Integrative Literature Review.

Loneliness affects people of all ages at one point or another in their lives; however, older adults aged ≥65 years are disproportionally affected due to age-related losses. Most research on loneliness has focused on older adults in general. Older adults who are homebound tend to have more disabilities and associated complications than older adults in the general population and face unique challenges. The current review examined and synthesized knowledge about loneliness among older adults who are homebound using Whittemore and Knafl's analysis process. Fourteen studies published from 1999 to 2020 met the inclusion criteria. The analysis resulted in four themes: characteristics of loneliness in older adults who are homebound, risks for homebound in older adults, location of older adults who are homebound, and coping strategies and methods to reduce loneliness in this population. Implications for nursing practice and recommendations for future research are discussed. [Journal of Gerontological Nursing, 47(8), 13-20.].

Meals on Wheels Central Texas: addressing loneliness and isolation through client-volunteer interaction

PurposeMeals on Wheel Central Texas (MOWCTX) provides meals to more than 5,000 home-bound older adults in the Austin area every weekday. The purpose of this paper is to examine the impact of client-volunteer interactions to assess the social benefits clients receive and ascertain if and how loneliness and social isolation are addressed.Design/methodology/approachObservations of volunteer-client interactions, interviews with clients and surveys of clients were conducted to gain insight into clients’ experiences with MOWCTX services.FindingsQualitative analysis of observation and interview data revealed four non-tangible benefits clients received from MOWCTX: reduced physical risks when mobility issues are present, a daily safety check, opportunities for social contact and increased ability to maintain independence. Survey results supported these conclusions.Originality/valueThis research examines the impact of volunteer-client relationships on the experience of loneliness and social isolation.

Disruptions in Care and Support for Homebound Adults in Home-Based Primary Care in New York City During the COVID-19 Pandemic.

Homebound older adults are a highly vulnerable population, yet little is known about their experiences with healthcare during the COVID-19 pandemic. We interviewed patients in home-based primary care (HBPC) in New York City by telephone in May and June of 2020. Interviews covered social supports, household activities, self-care, and medical care, and asked participants to compare current with prepandemic experiences. Among 70 participants, 37% were Black and 32% were Hispanic. Disruptions in the home included greater difficulty accessing paid caregivers (13.9%) and food (35.3%) than before the pandemic, and unaddressed household chores (laundry, 81.4%; food preparation, 11.4%). Black study participants were more likely than White and Hispanic participants to report disruptions in accessing medical care (13 [50.0%] vs. 3 [14.3%] vs. 6 [27.3%], respectively, p = 0.02), as well as food preparation and medication taking. Black patients in HBPC are at risk of disparities in healthcare and social support during the COVID-19 pandemic.

“Stuck at Home”: Empowering Homebound Older Adults

Homebound older adults are a highly vulnerable and isolated population that social workers serve. The objective of this study is to understand the daily needs and challenges of this group to understand how social workers can empower this population to enhance well-being and help meet basic human needs. Existing data was accessed from assessment forms at a local senior center to understand more about 502 home-delivered meal recipients. Quantitative and qualitative data were analyzed to see common characteristics and prevalent needs in the sample. Logistic regression analysis reveals that those who are living alone are 2.1 times more live-in poverty than those who live with someone. Likewise, those who are living alone are 8.4 times more at high nutritional risk than those who live with someone. Qualitative data revealed the importance of agency services and strong social supports to help older adults meet basic human needs on a daily basis. This article discusses what further can be done to support homebound older adults by identifying problem areas relating to living and eating alone.

Innovative educational approaches to house calls in the time of COVID-19.

Innovative educational approaches to house calls in the time of COVID-19.