Researchers Examine Association of COVID-19 With Prevalence of Homebound Older Adults in U.S. 2011-2020

In the United States last year, researchers found that the proportion of community-dwelling homebound adults 70 or older increased, particularly among Black non-Hispanic and Hispanic/Latino individuals. Although the study couldn't establish the reasons for this first major increase in the homebound population in a decade, a likely explanation is compliance with social distancing and other public health recommendations to minimize the risk of infection with SARS-CoV-2.

As Ankuda, et al. (2021) explain, "Older adults who are homebound, defined as leaving home once a week or less, are often socially isolated, have unmet care needs, and have high mortality. In 2011, more older adults in the United States were homebound than living in nursing homes. The COVID-19 pandemic may have led to an increase in the number of homebound older adults who were at heightened risk for infection with SARS-CoV-2 Moreover, although Black non-Hispanic and Hispanic/Latino individuals have disproportionately died from COVID-19, it is unknown whether they were more likely to be homebound during the pandemic. We assessed the size and characteristics of the homebound population in the United States in 2020, including household size, important for disease transmission risks, and digital access, which is important for telemedicine and online vaccination registration."

The researchers used data collected between May 1, 2011, and Oct. 31, 2020, from the National Health and Aging Trends Study (NHATS), an annual cohort study of aging among community-dwelling older adults. The 2020 survey was conducted between May and October. Information about race, ethnicity, demographic characteristics, household size, Medicaid enrollment, self-reported health, comorbidities, and function was self-reported. In 2020, respondents 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.

After accounting for multiple observations of a single respondent, the researchers assessed the prevalence of homebound status among adults aged 70 years or older annually by race and ethnicity.

The researchers identified 10 785 individuals aged 70 years or older, observed a mean (SD) of 4.6 (3.0) times, for 49 267 total observations during the 10 years of the study, including 3861 in 2020. Between 2011 and 2020, the prevalence of homebound adults aged 70 years or older more than doubled, from approximately 5.0% from 2011-2019 to 13.0% in 2020. In 2020, an estimated 4.2 million adults aged 70 years or older were homebound compared with 1.6 million in 2019. The prevalence of being homebound in 2020 was greatest among Hispanic/Latino individuals (34.5% homebound compared with 12.6%-17.2% in prior years), followed by Black non-Hispanic individuals (22.6% homebound compared with 6.9%-9.9% in prior years) and White non-Hispanic individuals (10.1% homebound compared with 3.7%-6.0% in prior years). Among those homebound in 2020, 47.6% of Hispanic/Latino individuals were aged 70 to 75 years compared with 22.6% of the overall population. Black non-Hispanic and Hispanic/Latino homebound respondents were more likely to be receiving Medicaid than White non-Hispanic respondents and to report fair or poor health. Of homebound White non-Hispanic respondents, 43.7% lived alone compared with 28.9% of Black non-Hispanic respondents and 26.8% of Hispanic/Latino respondents. Compared with 18.8% of White non-Hispanic individuals, 47.6% of Hispanic/Latino individuals and 37.5% of Black non-Hispanic individuals lived with at least 2 others. Of the respondents, 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.

Reference: Ankuda CK, et al. Association of the COVID-19 Pandemic With the Prevalence of Homebound Older Adults in the United States, 2011-2020. JAMA Intern Med. Published online August 23, 2021. doi:10.1001/jamainternmed.2021.4456