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

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Effect of a Telecare Case Management Program for Older Adults Who Are Homebound During the COVID-19 Pandemic: A Pilot Randomized Clinical Trial.

Importance: Older adults who are homebound can be difficult to reach owing to their functional limitations and social distancing during the COVID-19 pandemic, leaving their health needs unrecognized at an earlier stage. Objective: To determine the effectiveness of a telecare case management program for older adults who are homebound during the COVID-19 pandemic. Design, Setting, and Participants: This randomized clinical trial was conducted among 68 older adults in Hong Kong from May 21 to July 20, 2020, with a last follow-up date of October 20, 2020. Inclusion criteria were being 60 years or older, owning a smartphone, and going outside less than once a week in the previous 6 months. Interventions: Participants in the telecare group received weekly case management from a nurse supported by a social service team via telephone call and weekly video messages covering self-care topics delivered via smartphone for 3 months. Participants in the control group received monthly social telephone calls. Main Outcomes and Measures: The primary outcome was the change in general self-efficacy from before the intervention to after the intervention at 3 months. Self-efficacy was measured by the Chinese version of the 10-item, 4-point General Self-efficacy Scale, with higher scores representing higher self-efficacy levels. Analysis was performed on an intention-to-treat basis. Results: A total of 68 participants who fulfilled the criteria were enrolled (34 in the control group and 34 in the intervention group; 56 [82.4%] were women; and mean [SD] age, 71.8 [6.1] years). At 3 months, there was no statistical difference in self-efficacy between the telecare group and the control group. Scores for self-efficacy improved in both groups (ß = 1.68; 95% CI, -0.68 to 4.03; P = .16). No significant differences were found in basic and instrumental activities of daily living, depression, and use of health care services. However, the telecare group showed statistically significant interactions of group and time effects on medication adherence (ß = -8.30; 95% CI, -13.14 to -3.47; P = .001) and quality of life (physical component score: ß = 4.99; 95% CI, 0.29-9.69; P = .04). Conclusions and Relevance: In this randomized clinical trial, participants who received the telecare program were statistically no different from the control group with respect to changes in self-efficacy, although scores in both groups improved. After the intervention, the telecare group had better medication adherence and quality of life than the control group, although the small sample size may limit generalizability. A large-scale study is needed to confirm these results. Trial Registration: ClinicalTrials.gov Identifier: NCT04304989.

Barriers to telehealth access among homebound older adults.

BACKGROUND/OBJECTIVES: To identify major barriers to video-based telehealth use among homebound older adults. DESIGN: Cross-sectional survey. SETTING: A large home-based primary care (HBPC) program in New York City (NYC) serving 873 homebound patients living in the community. PARTICIPANTS: Sixteen primary care physicians. MEASUREMENTS: An 11-item assessment of provider perceptions of patients' experience with and barriers to telehealth. RESULTS: According to physicians in the HBPC program, more than one-third (35%) of homebound patients (mean age of 82.7; 46.6% with dementia; mean of 4 comorbidities/patient) engaged in first-time video-based telehealth encounters between April and June 2020 during the first COVID-19 surge in NYC. The majority (82%) required assistance from a family member and/or paid caregiver to complete the visit. Among patients who had not used telehealth, providers deemed 27% (n = 153) "unable to interact over video" for reasons including cognitive or sensory impairment and 14% lacked access to a caregiver to assist them with technology. Physicians were not knowledgeable of their patients' internet connectivity, ability to pay for cellular plans, or video-capable device access. CONCLUSION: The COVID-19 pandemic resulted in a large and dramatic shift to video-based telehealth use in home-based primary care. However, 4 months into the pandemic a majority of patients had not participated in a video-based telehealth encounter due to a number of barriers. Patients lacking caregiver support to assist with technology may benefit from novel approaches such as the deployment of community health workers to assist with device setup. Physicians may not be able to identify potentially modifiable barriers to telehealth use among their patients, highlighting the need for better systematic data collection before targeted interventions to increase video-based telehealth use.

The dynamics of being homebound over time: A prospective study of Medicare beneficiaries, 2012-2018.

BACKGROUND/OBJECTIVES: Approximately 2 million people, or 6% of older adults in the United States, are homebound. In cross-sectional studies, homebound older adults have high levels of morbidity and mortality, but there is little evidence of longitudinal outcomes after becoming homebound. The aim of this research is to prospectively assess over 6 years the dynamics of homebound status, ongoing community residence, and death in a population of community-dwelling older adults who are newly homebound. DESIGN/SETTING: Prospective cohort study using 2011-2018 data from the National Health and Aging Trends Study (NHATS), an annual, nationally-representative longitudinal study of aging in the United States. PARTICIPANTS: Two hundred and sixty seven newly homebound older adults in 2012. MEASUREMENTS: Homebound status was defined via self-report as living in the community but rarely/never leaving home in the prior month. Semi-homebound was defined as leaving the house only with difficulty or help. RESULTS: One year after becoming newly homebound, 33.1% remained homebound, 22.8% were completely independent, 23.8% were semi-homebound, 2.2% were in a nursing home, and 18.0% died. Homebound status is highly dynamic; 6 years after becoming homebound, 13.5% remained homebound and 65.0% had died. Recovering from being homebound at 1 year was associated with younger age and lower baseline rates of receiving help with activities of daily living, in particular, with bathing. CONCLUSION: Homebound status is a dynamic state. Even if transient, becoming homebound is strongly associated with functional decline and death. Identifying newly homebound older adults and developing interventions to mitigate associated negative consequences needs to be prioritized.

Implementing Health Care Quality Measures in Electronic Health Records: A Conceptual Model.

BACKGROUND/OBJECTIVES: There is significant literature on the development and validation of quality measures, but comparably less on their implementation into learning health systems. Electronic Health Records (EHRs) have made vast amounts of data available for quality improvement purposes. In this paper we describe a conceptual model for EHR implementation of quality measures. DESIGN: The model involves five steps: (1) select a measure; (2) define measure criteria; (3) validate criteria and measurement process; (4) improve recording of measure-related activity; and (5) engage quality improvement processes. The model was used to develop and implement a quality measure in the Home-Based Medical Care (HBMC) setting. SETTING: Harris Health House Call Program (HHHC) provides primary medical and palliative care for homebound patients in Houston. PARTICIPANTS: Four-hundred twenty-four primary care patients followed in the HHHC. MEASUREMENT: Completion rate of the 9-item Patient Health Questionnaire (PHQ-9) within the Electronic Health Record of newly enrolled HHHC patients. RESULTS: Use of the conceptual model to guide implementation of a quality measure of depression screening in a HMBC practice was successful. Additional components of early leadership and clinician buy-in were required, as well as strong relationships with IT to ease implementation and limit disruptions in clinicians' work-flow. CONCLUSION: This conceptual model was feasible for guiding implementation of a quality measure for depression care of HBMC patients, and it can guide broader implementation of EHR-based quality measures in the future.

Conceptualizing Food Insecurity Among Older Adults: Development of a Summary Indicator in the National Health and Aging Trends Study.

OBJECTIVES: Measurement of food insecurity in older adults is focused on financial barriers to food access. Given that older adults are particularly susceptible to additional access-related barriers including functional limitations and lack of social support, the objective of this study was to construct a summary indicator of food insecurity incorporating these domains. METHODS: We used nationally representative survey data from Round 5 of the National Health and Aging Trends Study (NHATS; n = 7,070). We constructed a summary indicator of food insecurity using factors within the following three domains: functional, social support, and financial limitations. First, we identified the prevalence of food insecurity among the sample as defined by the new summary indicator. Then, we estimated unadjusted and adjusted logistic regression models to assess the association between the expanded measure of food insecurity and biopsychosocial factors. RESULTS: In 2015, 4.3% (95% confidence interval [CI] 3.75-4.94) of community-dwelling older adults, approximately 1,673,775 million people, were characterized as having food insecurity. Multivariable-adjusted regression models identified that being homebound (odds ratio [OR] 3.49, 95% CI 2.03, 6.00), frail (OR 9.50, 95% CI 4.92-18.37), and experiencing community disability (OR 5.19, 95% CI 3.90-6.90) was associated with food insecurity. DISCUSSION: Food insecurity among older adults is broader than lacking adequate financial resources to obtain food; it is also associated with social and functional limitations. A more comprehensive conceptualization will aid future study on the impact of food insecurity on health status, utilization, and outcomes to inform senior nutrition program targeting and services.

Frequency of Social Isolation and Homeboundness and Their Relationships with High-Level Functional Capacity in Elderly Diabetic Patients.

PURPOSE: To determine the frequency of social isolation (hereinafter, isolation) and homeboundness in elderly diabetic patients and to investigate their relationships with high-level functional capacity. PATIENTS AND METHODS: Subjects were diabetic outpatients aged 65 years and older who were visiting the Japanese Red Cross Ise Hospital. Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was used to evaluate high-level functional capacity. Isolation was defined as having less than one interaction per week with someone other than co-habiting family members. Homeboundness was defined as leaving the house less than once a day. Multiple regression analysis was performed with the TMIG-IC score as the dependent variable and isolation and homeboundness as independent variables. RESULTS: Four hundred fifty-one patients were included in the analysis. The frequency of isolation and homeboundness affected 37% and 13.3% of men and 28.9% and 20.6% of women, respectively. The adjusted partial regression coefficient of the TMIG-IC scores of isolated, homebound, and isolated+homebound men was -0.94 [95% confidence interval (CI), -1.68 to -0.21; P = 0.012], -0.27 (95% CI, -1.93 to 1.39; P = 0.746), and -4.03 (95% CI, -5.37 to -2.68; P < 0.001) in relation to that of the non-isolated and non-homebound group as reference. In women, the respective coefficients to the reference were -1.33 (95% CI, -2.93 to 0.25; P = 0.099), -0.65 (95% CI, -2.56 to 1.26; P = 0.501), and -3.01 (95% CI, -4.92 to -1.1; P = 0.002), respectively. CONCLUSION: The frequency of isolation was high in both female and male elderly diabetic patients. In men, there was a significant relationship between isolation and decline in high-level functional capacity. In both men and women, there was a significant relationship between isolation+homeboundness and decline in high-level functional capacity.

The Association Between Income and Incident Homebound Status Among Older Medicare Beneficiaries.

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.

Factores relacionados con la sobrecarga que intervienen sobre la salud, las actividades económicas, laborales y sociales de los cuidadores principales de pacientes crónicos / Factors related to work overload that affect health, financial, occupational, and social activities of the primary caregiver

OBJETIVO: Conocer áreas de la vida de los cuidadores principales (CP) que pueden afectarse por cuidar en relación con variables del paciente y de CP: problemas de salud, laborales, económicos y sociales y el papel que la sobrecarga de los CP puede tener. MATERIAL Y MÉTODOS: Estudio transversal y descriptivo, 167 enfermos crónicos dependientes y sus CP. Se analizan impactos de cuidar sobre problemas de salud, laborales y económicos, mantener relaciones sociales en CP, variables demográficas, edad y sexo, cuidados, actividades y tiempo de cuidar. Pacientes dependientes, se estudia la tipología psicosocial de su enfermedad, cronología, dependencia, discapacidad e inmovilidad. Para el estudio de la sobrecarga de los CP se ha empleado la escala de Zarit reducida de ocho ítems. RESULTADOS: El 68,8% de los CP tenían problemas de salud, 20,9% económicos, 19,6% laborales y 50,9% para mantener relaciones familiares y sociales positivas. El impacto sobre la salud de los CP se relaciona con la tipología psicosocial A, mayor grado de dependencia e inmovilidad, género y mayor número de actividades de cuidar. El impacto sobre las actividades laborales se relaciona con la edad (< 66 años), género y convivencia en el hogar. El impacto sobre las relaciones sociales solo se relaciona con el parentesco. Los problemas económicos no tienen relación con variables del paciente. La sobrecarga de los CP se relaciona con problemas de salud, laborales, económicos y sociales. CONCLUSIONES: El impacto sobre la salud y las áreas económica, laboral y social de los CP se relacionan con variables de la persona enferma y de CP y especialmente con la sobrecarga percibida por los CP

OBJECTIVE: To determine the areas of the life of primary caregivers (CP) that may be affected by caring for a patient, as well as the CP variables: health, occupational, economic and social problems, as well as the role that CP overload can play. MATERIAL AND METHODS: A descriptive cross-sectional study was conducted on 167 dependent chronic patients and their CPs. It included and analysis on the impact of caring about health, occupational, and economic problems, as well as maintaining social relationships in CP. A record was made of, demographic variables, age and gender, care, activities, time to care. For the dependent patients, the psychosocial typology of their disease, chronology, dependence, disability, and immobility was studied. The Zarit scale reduced by 8 items has been used for the study of the overload of CPs. RESULTS: More than two-thirds (68.8%) of CPs had health problems, 20.9% economic, 19.6% occupational, and 50.9% for positive family and social relationships. The health impact of CPs is related to psychosocial A typology, an increased level of dependence and immobility, gender, and greater number of care activities. The impact on work activities is related to age (66 years) gender, and home coexistence. The impact on social relationships is only related to kinship. Economic problems have no relationship to patient variables. The overload of CPs is related to health, work, financial, and social problems. CONCLUSIONS: The health, financial, occupational, and social impact of CPs relate to variables of the sick person and CP, and especially to the overload perceived by the CPs

[Changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years].

Objective　This study aims to identify changes in homebound status and related factors in community-dwelling older adults participating in physical checkups over two years in order to help with prevention and recovery from being homebound.Methods　A survey on needs in the sphere of daily life was conducted in July 2011 among 6,696 independent older adults in 10 regions of Kameoka City (baseline survey). Of the 6,696 adults, 1,379 responded to the survey and participated in a physical checkup held between March and April 2012. These individuals were then invited to a similar checkup again in September 2013. Of these, 638 consenting individuals were administered a questionnaire survey (follow-up survey). In all, 522 subjects responded to both surveys (baseline and follow-up) regarding being homebound. The responses involved basic attributes, state of daily living, state of health, items of the Kihon Checklist, items concerning daily living activities in the baseline survey, and items concerning being homebound in the follow-up survey. The responses were analyzed, and an evaluation of homebound status was conducted based on whether or not one (or both) of the two items of the Kihon Checklist were applicable. The subjects were classified according to the following: 1) whether non-homebound individuals remained non-homebound (non-homebound group) or whether they became homebound (homebound transition group) and 2) whether individuals who became homebound recovered (recovery group) or remained the same (persisting group). After comparing the characteristics of each group, a logistic regression analysis was employed to analyze the factors related to changes in homebound status after two years.Results　Of the 375 non-homebound individuals in the baseline survey, 326 (86.9%) and 49 (13.1%) were classified into non-homebound and homebound transition groups, respectively. Of the 147 subjects who became homebound, 85 (57.8%) and 62 (42.2%) were classified into the recovery and persisting groups, respectively.　Among the factors related to change in homebound status after two years, a low score of social role (OR=0.675, CI=0.458-0.997) was an independent factor for being at risk of becoming homebound (P<0.05). Having no diseases under treatment (OR=14.340, CI=1.345-152.944) and a high intellectual activity score (OR=2.643, CI=1.378-5.069) were independent factors of recovery from being homebound (P<0.05).Conclusion　The results of the two year longitudinal study suggest the need for support for non-homebound older individuals devoid of social roles to prevent homebound status. Additionally, there is a need for support surrounding the reduction in obtaining a disease and maintaining intellectual activity in order to recover from being homebound.

Revisión sistemática: influencia de los Grupos de Ayuda Mutua sobre cuidadores familiares / Systematic review: influence of Self-Help Groups on family caregivers

INTRODUCCIÓN: Desde la incorporación de la mujer al mundo laboral, junto con el envejecimiento progresivo de la población y el aumento de las enfermedades crónicas, se produce una alteración en el rol del cuidador, debido a la carga física, laboral y familiar que soporta, generándose conflictos emocionales y con el resto de miembros de la familia. La ayuda mutua puede ser una alternativa eficaz para promover el bienestar de los cuidadores, así como el de sus familias y dependientes. OBJETIVO: Conocer las características de los grupos de ayuda mutua (GAM) para cuidadores familiares y su influencia sobre los cuidadores, la persona dependiente y la salud familiar. METODOLOGÍA: Revisión sistemática. La estrategia de búsqueda incluyó las bases de datos Pubmed, Scopus, Psycinfo, Eric, Cochrane plus y CSIC. Se buscaron artículos escritos en español, catalán, inglés, portugués o francés, publicados en los últimos 10 años. RESULTADOS: Se seleccionaron 12 artículos relacionados con el tema de estudio. Todos los estudios muestran que la participación en estos grupos puede mejorar el bienestar físico-psicológico, el estado de salud de los cuidadores y, al mismo tiempo, reforzar su sentimiento de apoyo social, aunque faltan estudios en nuestro medio, con un tamaño muestral superior y de mayor calidad. CONCLUSIONES: Los cuidadores se benefician de participar en grupos de ayuda mutua. Por lo tanto, deben convertirse en un componente de rutina del cuidador familiar

INTRODUCTION: Since the incorporation of women into the world of work, together with the progressive ageing of the population and the increase of chronic diseases, there is an alteration in the role of the caregiver, due to the physical, work and family burden it bears, emotional conflicts and with other family members. Mutual aid can be an effective alternative to promoting the well-being of caregivers, as well as their families and dependents. OBJECTIVE: To know the characteristics of self-help groups for family caregivers and their influence on caregivers, the dependent and family health. METHODOLOGY: Systematic review. The search strategy included the Pubmed, Scopus, Psycinfo, Eric, Cochrane plus and CSIC databases; selecting scientific articles in either Spanish, Catalan, English, Portuguese or French, for the last 10 years. RESULTS: 12 articles related to the study topic were selected. All studies show that participation in these groups can improve the physical-psychological well-being, the health of caregivers and, at the same time, reinforce their sense of social support, although there is a lack of studies in our environment, with a size higher quality sample. CONCLUSIONS: Caregivers benefit from participating in self-help groups. Therefore, they should become a routine component of the family caregiver

Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older.

BACKGROUND AND OBJECTIVES: The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories. RESEARCH DESIGN AND METHODS: The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1-Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories. RESULTS: Three trajectory groups were identified: the "never" group (65.5%) remained nonhomebound; the "chronic" group were largely persistently homebound (8.3%); and the "onset" group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the "onset" and "chronic" versus the "never" trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the "chronic" trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk. DISCUSSION AND IMPLICATIONS: The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.

The Bidirectional Relationship Between Depressive Symptoms and Homebound Status Among Older Adults.

OBJECTIVES: This study aimed to examine the bidirectional relationship between depressive symptoms and homebound status among older adults. METHOD: The study sample included 7,603 community-dwelling older adults from the National Health and Aging Trends Study. A bivariate latent state-trait model of depressive symptoms and homebound status was estimated via structural equation modeling. RESULTS: The model fit the data well (Root Mean Square Error of Approximation = .02, Comparative Fit Index = .97, Standardized Root Mean Square Residual = .06). The relationship between homebound status and depressive symptoms can be decomposed into three parts: a moderate correlation between the stable trait components (r = .56, p <.001); a contemporary association of the state components (b = .17, p <.001); and bidirectional lagged effects between the state components. Change in homebound status was as a stronger predictor of depressive symptoms (b = .19, p < .001) than change in depressive symptoms was of homebound status (b = .06, p < .001; test of difference: Δ scaled χ2(1) = 24.2, p < .001). DISCUSSION: Homebound status and depressive symptoms form a feedback loop to influence each other. Improving the outdoor mobility of older adults may have immediate benefits for reducing depressive symptoms.

Homebound Status and the Critical Role of Caregiving Support.

The homebound population relies on both paid and family caregivers to meet their complex care needs. In order to examine the association between intensity of caregiving support and leaving the home, we identified a population of community-dwelling, homebound Medicare beneficiaries age ≥65 (n = 1,852) enrolled in the 2015 National Health and Aging Trends Study and measured the support they received from paid and family caregivers. Those who had ≥20 h of caregiving support per week had 50% less odds of being "exclusively homebound" (rarely or never leave home) (OR 0.56, p < .01). Policies that facilitate increased support for family caregivers and better access to paid caregivers may allow homebound individuals who would otherwise be isolated at home to utilize existing community-based long-term care services and supports.

Eliminating the Surprise Question Leaves Home Care Providers With Few Options for Identifying Mortality Risk.

BACKGROUND: Precision health initiatives for end-of-life planning require robust methods for identifying patient risk for decline and mortality. The Outcome and Assessment Information Set (OASIS) surprise question (SQ; M1034 Overall Status) is the primary tool for evaluating risks in homebound older adults. However, the OASIS-D, Released in 2019, eliminates this question. This study examines the prognostic ability of 12- and 24-month mortality risk reflected in the OASIS-SQ and develops an alternative approach for classifying mortality risk to support decision-making in the absence of the OASIS-SQ. DESIGN: Retrospective secondary data analysis. SETTING/PARTICIPANTS: A nationally representative sample of 69 097 OASIS-C assessments (2012) linked to the Master Beneficiary Summary file (2012 and 2013). MEASUREMENTS: Survival analysis, k-means clustering, and Cohen κ coefficient with Z test. RESULTS: The OASIS-SQ predicts mortality (35% at 12 and 45% at 24 months; P < .001). Cluster analysis identified 2 risk groups: OASIS activity of daily living "ADL total scores" >15 = (lower risk) and ≤15 = (higher risk) for 24-month mortality. Model agreement is weak for both cluster 1 and cluster 2, the OASIS-SQ κ = 0.20, 95% confidence interval (CI) = .19 to .21, and "alive/not alive" κ = .17, 95% CI = .16 to .18. CONCLUSION: The OASIS-SQ and "ADL total score" are almost equally likely to predict 24-month mortality; therefore, it was reasonable to use the "ADL total score" as a substitute for the OASIS-SQ. Removal of the OASIS-SQ leaves home care providers with few clear options for risk screening resulting in missed opportunities to refer to palliative or hospice services.

Impacto do afastamento do trabalho por doenças inflamatórias intestinais no Brasil / Impact of work disability due to inflammatory bowel diseases in Brazil

As doenças inflamatórias intestinais (DII) podem ter impactos sociais e econômicos no Brasil, onde sua prevalência aumentou recentemente. Este estudo tem como objetivo principal avaliar a incapacidade por DII na população brasileira, descrevendo proporções com fatores demográficos e como objetivo secundário, a avaliação de possíveis fatores de risco de afastamento do trabalho por Doença de Crohn (DC) em um centro de referência em DII da Universidade do Estado do Rio de Janeiro (UERJ), cujo resultado pode refletir outras regiões do país. A análise foi realizada utilizando-se a plataforma do Sistema Único de Informações sobre Benefícios da Previdência Social, com um primeiro cruzamento de dados de auxílios doença e aposentadorias por invalidez com DC e Retocolite Ulcerativa (RCU) entre 2010-2014. Dados adicionais como valores médios de benefícios, duração do benefício, idade, sexo e região foram obtidos através da mesma plataforma. Um segundo cruzamento entre auxílios doença e aposentadorias por invalidez foi feito somente para DC entre 2010-2018 no estado do Rio de Janeiro e foram pesquisados os mesmos dados adicionais. Uma subanálise foi realizada nos casos de incapacidade em comum com os pacientes com DC da UERJ, para avaliação das características que teriam maior chance de atuar como fator de risco para afastamento do trabalho, se comparando com a população de DC desse ambulatório que não teve afastamento pelo Instituto Nacional do Seguro Social (INSS). No Brasil, a incapacidade temporária ocorreu com maior frequência na RCU enquanto a permanente na DC. A DC afastou pacientes mais jovens que a RCU e ambas mais mulheres que homens. As ausências temporárias do trabalho por DC e RCU foram maiores no Sul e as menores ausências por DC foram observadas no Norte e Nordeste. A média de dias de incapacidade foi longa, de quase um ano, sendo maiores na DC em comparação à RCU, porém ambos tenderam a diminuir de 2010 à 2014. O valor dos benefícios pagos pelas DII representou aproximadamente 1% de todos os benefícios da mesma natureza no país, sendo 51% dos gastos com DC. No RJ, a prevalência da DC foi de 26 por 100.000/habitantes, com custo indireto de 0,8% dos benefícios totais, apresentando taxa de 16,6% de incapacidade, similar a encontrada no grupo de pacientes da UERJ. Os fatores de risco de incapacidade por DC na UERJ foram idade menor que 40 anos a época do diagnóstico, tempo de duração da doença, cirurgia intestinal prévia e fístula anovaginal. Dos afastados, 19% apresentaram depressão ou ansiedade associados. A média de tempo entre o diagnóstico de DC e a incapacidade foi de 3 anos. No Brasil, as DII frequentemente causam incapacidade prolongada e podem gerar aposentadorias precoces, com programas de reabilitação profissional ainda pouco explorados. As tendências de redução das taxas de incapacidade no Brasil podem refletir melhorias no acesso a cuidados de saúde e a medicamentos. Os custos indiretos baseados apenas no absenteísmo em empregos foram significativos e a demonstração desse impacto socioeconômico e de fatores de risco de incapacidade podem auxiliar no planejamento de políticas públicas para o país.

Inflammatory bowel diseases (IBD) can lead to Brazil's social and economic impacts, where their prevalence has recently increased. This study's main objective is to evaluate the disability due to IBD in the Brazilian population describing proportions with demographic factors. Secondly, it assesses possible risk factors of absence from work due to Crohn's disease (CD) in a referral center of IBD of the State University of RJ (UERJ), which results may reflect other regions of the country. The analysis was performed using the Unified Social Security Benefits Information System platform, with the first crossing of data on sickness benefits and disability pensions with CD and Ulcerative Colitis (UC) between 2010- 2014. Additional data, such as average benefit values, benefit duration, age, sex, and region of the country, were obtained through the same platform. A second crossing between sickness benefits and disability pensions was made only for CD between 2010-2018 in the state of Rio de Janeiro (RJ) for the evaluation of the same additional data. A subanalysis was made in cases of CD disability in common with patients at UERJ, to assess the characteristics that would have a greater chance as a risk factor for absence from work, compared to the population of CD of this clinic that had no disability by the Institute National Social Security (INSS). In Brazil, temporary disability occurred more frequently in the UC while the permanent one in CD. Disability occurred in patients with CD younger than UC and both more in women than in men. Temporary absences from work due to CD and UC were more significant in the South, and the lowest absences due to CD were observed in the North and Northeast. The average number of days of disability was long, almost one year, being higher in CD than in UC, but both tended to decrease from 2010 to 2014. IBD's benefits represented approximately 1% of all the benefits of sickness in the country, with 51% of DC spending. In RJ, the prevalence of CD was 26 per 100,000 / inhabitants, with an indirect cost of 0.8% of total benefits, with a rate of 16.6% of disability, similar to that found in the group of patients at UERJ. The risk factors for CD disability in UERJ were age under 40 at the time of diagnosis, duration of the disease, previous intestinal surgery, and anovaginal fistula. Of those on absence from work 19% had associated depression or anxiety. The average time between the diagnosis of CD and disability was three years. In Brazil, IBDs often cause prolonged disability and can lead to early retirements, with professional rehabilitation programs still little explored. Trends in the reduction of disability rates in Brazil may reflect improvements in access to healthcare and medicines. The indirect costs with IBD in Brazil, based only in absenteeism, were significant, and demonstrating this socioeconomic impact and risk factors for disability can help plan public policies for the country.

Risk factors for falls in homebound community-dwelling older adults.

OBJECTIVE: To examine risk factors associated with falls among homebound community-dwelling older adults, a vulnerable population often possessing functional disabilities and chronic conditions. DESIGN AND SAMPLE: The study was a cross-sectional study utilizing round 6 data of the National Health and Aging Trend Study (NHATS). Descriptive statistics and multiple logistic regression analyses were conducted. A total of 1,356 homebound community-dwelling older adults aged 65 and above participated in the NHATS. MEASURES: The outcome variable was falls within the last month reported in NHATS. Independent variables were selected based on the NHATS disability conceptual model and literature review, including personal conditions, environmental conditions, and physical functioning limitations. RESULTS: In the sample population, 21.2% reported falls. Males were more likely to experience a fall than females. Hypertension or depression/anxiety increased risk for falls. Older adults with hearing impairment or balance problems limiting activities were also more likely to fall. CONCLUSIONS: Public health nurses need to conduct thorough fall risk assessment for homebound older adults, especially those with chronic health problems or functioning limitations. Studies are needed to examine the association between home environment and falls in homebound older adults.

Home and Community-based Services and Life Satisfaction among Homebound and Poor Older Adults.

Little evidence exists regarding the role of Home and Community-Based Services (HCBS) utilization on life satisfaction among older people who are both homebound and low-income. Guided by the personal-environment (P-E) fit perspective, this study aims to: (1) describe characteristics of older people with homebound and low-income status; (2) investigate how the combination of homebound and low-income status is associated with life satisfaction; and (3) examine whether HCBS utilization moderates the association between homebound and low-income status and life satisfaction. Data were drawn from the 2012 Health and Retirement Study, and the sample included respondents who were 51+ years who completed a questionnaire for HCBS utilization (n= 1,662). Results describe sociodemographic, health-related, and environmental characteristics of older adults. Combined homebound and low-income status was a significant predictor of lower life satisfaction (ß = -0.15, p< .05), but better life satisfaction when they used HCBS (ß = 0.33, p <.10). These findings suggest that promoting HCBS utilization is a promising strategy to enhance well-being among those homebound and poor. Further studies are needed to test the effectiveness of HCBS with longitudinal data and to investigate the details of effective HCBS utilization such as frequency of use and types of services.