Epidemiology of the Homebound Population in the United States.
Epidemiology of the Homebound Population in the United States.
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DOI：
10.1001/jamainternmed.2015.1849
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发表时间：
2015-07
影响因子：
39
通讯作者：
Szanton SL
中科院分区：
文献类型：
--
作者：
Ornstein KA;Leff B;Covinsky KE;Ritchie CS;Federman AD;Roberts L;Kelley AS;Siu AL;Szanton SL
越来越多住在社区的老年人有功能障碍，无法离开家。目前还不确定有多少住在美国的人是回家的。制定离家频率和离家能力的衡量标准，并使用这些衡量标准来估计美国人口中在家的人口。全国健康和老龄化趋势研究的横断面数据，收集于2011年。美国连续的非机构医疗保险受益人的全国代表性样本，年龄在65岁及以上（n=7609）我们将居家人士定义为那些在过去一个月内从不（完全居家）或很少（大部分居家）离开家的人。我们将半居家人士定义为只有在协助下才能离开家，或有困难或需要帮助才能离开家的人士。我们比较了不同居家状态类别的人口学、临床和医疗保健利用特征。2011年，宅在家的患病率为5.6% (95% CI= 5.09%-6.14%)，其中估计有395,422人完全宅在家，1,578,984人大部分宅在家。在半居家者中，没有个人帮助从未离开家的患病率为3.3% (95% CI= 2.82%-3.77%)，需要帮助和/或有困难的患病率为11.7% （95% CI= 10.89%-12.6%）。与非居家人群相比，完全居家人群更有可能是年龄较大、女性、非白人、受教育程度和收入较低（均p<0.05），更有可能患有更多慢性疾病（4.9比2.5,p<0.001），并且在过去12个月内曾住院（52.1%比16.2%,p<0.001）。只有11.9%的完全居家人士报告在家中接受初级保健服务。2011年，5.6%的社区医疗保险老年人（约200万人）完全或大部分在家。我们的研究结果可以为改善这些人的临床和社会服务提供信息。
An increasing number of older, community-dwelling adults have functional impairments that prevent them from leaving their homes. It is uncertain how many people who live in the United States (U.S.) are homebound. To develop measures of the frequency of and ability to leave the home, and to use these measures to estimate the homebound population in the U.S. population. Cross-sectional data from the National Health and Aging Trends Study, collected in 2011. Contiguous U.S. Nationally representative sample of non-institutionalized Medicare beneficiaries, ages 65 and older (n=7609) We defined homebound persons as those who never (completely homebound) or rarely (mostly homebound) left the home in the past month. We defined semi-homebound persons as those who only left the home with assistance, or had difficulty or needed help leaving the home. We compared demographic, clinical, and healthcare utilization characteristics across different homebound status categories. In 2011, the prevalence of the homebound was 5.6% (95% CI= 5.09%–6.14%), including an estimated 395,422 people who were completely homebound and 1,578,984 who were mostly homebound. Among the semi-homebound, the prevalence of those who never left home without personal assistance was 3.3% (95% CI=2.82%–3.77%) and the prevalence of those who required help and/or had difficulty was 11.7% (95% CI=10.89%–12.6%). Completely homebound individuals were more likely to be older, female, non-White and have less education and income than the non-homebound population (all p<0.05), to have more chronic conditions (4.9 vs. 2.5, p<0.001), and to have been hospitalized in the last 12 months (52.1% vs. 16.2%, p<0.001). Only 11.9 % of completely homebound individuals reported receiving primary care services at home. In 2011, 5.6% of the elderly, community-dwelling Medicare population, about 2 million people, were completely or mostly homebound. Our findings can inform improvements in clinical and social services for these individuals.