ArticleJournal of the American Geriatrics Society2022
Prospective assessment of dementia on transitions in homeboundness using multistate Markov models.
Article in Journal of the American Geriatrics Society, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Losses to Follow-Up in a Nationally Representative Study of Community-Living Older Americans: Two Approaches to Censoring and Implications for Mortality Outcomes.Journal of the American Geriatrics Society · 2026Article
- Undocumented Dementia Diagnosis During Skilled Home Health Care: Prevalence and Associated Factors.Journal of the American Geriatrics Society · 2025Article
- Incomplete Ascertainment of Mortality in a Nationally Representative Longitudinal Study of Community-Living Older Americans.The journals of gerontology. Series A, Biological sciences and medical sciences · 2025Article
- Prospective transitions in hemoglobin A1c following gestational diabetes using multistate Markov models.American journal of epidemiology · 2025Article
- The heterogeneity of the homebound: A latent class analysis of a national sample of homebound older adults.Journal of the American Geriatrics Society · 2023Article
- Study on Dynamic Progression and Risk Assessment of Metabolic Syndrome Based on Multi-State Markov Model.Diabetes, metabolic syndrome and obesity : targets and therapy · 2022Article
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Authors and funding
7 authors.
Funding
Abstract
backgroundOne in 20 older adults in the United States is homebound and rarely/never leaves home. Although being homebound decreases the quality of the lived experience of individuals with serious illnesses, little is known about the frequency or likelihood of transitions in or out of homebound status. The objective of this study was to characterize the probability of transitions to and from homebound status among older adults and examine the relationship between dementia status and homebound transitions.
methodsUsing 2011-2018 data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging in the United States, we identified 6375 community-dwelling Medicare beneficiaries. Homebound status (independent, semi-homebound (leaving home but with difficulty or help), homebound (rarely or never leaving home), nursing home resident, dead) was assessed annually via self-report. Transition probabilities across states were assessed using a multistate Markov model.
resultsLess than half of homebound individuals remain homebound (probability = 41.5% [95% CI: 39.2%, 43.5%]) after 1 year. One out of four dies (24% [22.3%, 26.0%]) and there is a low probability (3.2% [2.5%, 4.1%]) of transition to a nursing home. Dementia status was associated with increased risk of progression from independence to homebound status (HR: 1.83 [1.01, 3.34]). Dementia was consistently associated with increased probabilities of transitions to death including a two-fold increased hazards of progression from homebound to death (HR: 2.18 [1.69, 2.81]). Homebound individuals with dementia have a 34.2% [25.8%, 48.1%] probability of death in 5 years, compared with 17.4% [13.7%, 24.3%] among those without dementia. DISCUSSION: Dementia is associated with greater risk of transitioning across homebound states. There is a greater need to support home-based care for patients with dementia, especially as the ongoing COVID pandemic has raised concerns about the need to invest in alternative models to nursing home care.
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