CHARACTERISTICS OF RURAL HOMEBOUND CIDER ADULTS - A COMMUNITY-BASED STUDY

OBJECTIVE: To determine the frequency and characteristics of homebound older adults in a rural community. DESIGN: An epidemiological survey of an age-stratified random community sample. SETTING: The rural mid-M onongahela Valley in Southwestern Pennsylvania. PARTICIPANTS: A total of 878 noninstitutionalized persons aged 68 years and older, fluent in English, and with at least grade 6 education. MEASUREMENTS: The frequ ency with which subjects left their homes, the Mini-Mental State Exami nation (MMSE) score, and additional information on demographics, self- reported health problems, health services utilization, IADLs, depressi on, and social support were measured. RESULTS: 10.3% of the sample was classified as homebound. In univariate analyses, being homebound was found to be associated significantly (P < .001) with being older, fema le, and widowed and with MMSE and IADL impairment, with more depressiv e symptoms and worse social supports, fair to poor self-rated general health, weight loss, and histories of stroke, angina, arthritis of the spine, and falls. In a multiple regression model, variables associate d independently with homebound status were gender (odds ratio = 9.4, 9 5% confidence interval = 3.6 - 24.9), weight loss (OR = 3.7, CI = 1.7 - 8.2), IADL impairment (OR = 2.6, CI = 2.1 - 3.1), and depressive sym ptoms (OR = 2.1, CI = 1.3 - 3.2). Being homebound was also associated with recent acute hospitalization and use of home health and social se rvices. CONCLUSIONS: These data provide evidence that homebound older adults have a disproportionate share of morbidity and disability and s uggest a sociodemographic and clinical profile to help identify those older people at risk of being or becoming homebound. They also point t o the need for home-based health services for the older adults, partic ularly in medically underserved communities such as rural areas.