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The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries
Author(s) -
Ornstein Katherine A.,
Garrido Melissa M.,
BollensLund Evan,
Reckrey Jennifer M.,
Husain Mohammed,
Ferreira Katelyn B.,
Liu Shelley H.,
Ankuda Claire K.,
Kelley Amy S.,
Siu Albert L.
Publication year - 2020
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.16715
Subject(s) - quartile , medicine , socioeconomic status , gerontology , household income , population , confidence interval , cohort study , observational study , demography , cohort , health and retirement study , activities of daily living , environmental health , physical therapy , archaeology , pathology , sociology , history
IMPORTANCE A large and growing population of older adults with multimorbidity, cognitive impairment, and functional disability live in the community, but many never or rarely leave their homes. Being homebound is associated with decreased access to medical services, poor health outcomes, and increased mortality. Yet, it is unknown what factors, in particular socioeconomic factors, are associated with new onset of homebound status. OBJECTIVE To evaluate the association between income and risk of becoming homebound. DESIGN Observational cohort study using 2011 to 2018 data from the National Health and Aging Trends Study, a nationally representative sample of Medicare beneficiaries aged 65 years and older. SETTING Population‐based study in the United States. PARTICIPANTS A total of 7,042 initially nonhomebound community‐dwelling older adults. EXPOSURE Total annual household income at baseline (in 2011) measured via self‐report. OUTCOME Annual measure of homebound status, defined as leaving home an average of 1 d/wk or less. RESULTS Over 7 years, 15.81% of older adults in the lowest income quartile (≤$15,003) became homebound, compared with only 4.64% of those in the highest income quartile (>$60,000). In a competing risks analysis accounting for risks of death and nursing home admission, and adjusted for clinical and demographic characteristics, those in the lowest income quartile had a substantially higher subhazard of becoming homebound than those in the highest income quartile (1.65; 95% confidence interval = 1.20–2.29). Moreover, we see evidence of a gradient in risk of homebound status by income quartile. CONCLUSION AND RELEVANCE Our work demonstrates that financial resources shape the risk of becoming homebound, which is associated with negative health consequences. In the context of existing income disparities, more support is needed to assist older adults with limited financial resources who wish to remain in the community.