Evidence map›Paper›PMID 42394468›Full record

Observational studyJournal of the American Geriatrics Society2026

Utilization Patterns Among Heterogeneous Subgroups of Homebound Older Adults: A Latent Class Analysis.

J Lee Young, Mary L Pomeroy, Hanna Charankevich, Katherine A Ornstein, Bruce P Kinosian

Abstract readObservational Study
In one paragraph

Observational study in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

J Lee YoungDepartment of Medicine, Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.ORCID 0009-0006-6425-1855
Mary L PomeroyCenter for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.ORCID 0000-0001-7715-1964
Hanna CharankevichCenter for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
Katherine A OrnsteinCenter for Equity in Aging, School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA.
Bruce P KinosianDepartment of Medicine, Division of Geriatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Funding

Technological Assessment and Solutions Core - RC4P30AG021334 · NIA · JOHNS HOPKINS UNIVERSITY · PI Jeremy D Walston · 2003 to 2026
$33.2M
EPIDEMIOLOGY AND BIOSTATISTICS OF AGINGT32AG000247 · NIA · JOHNS HOPKINS UNIVERSITY · PI Karen J. Bandeen-Roche · 1996 to 2026
$13.2M
Home, but homebound: The impact of caregiving, financial, and community resources on the lives of individuals with dementiaR01AG060967 · NIA · JOHNS HOPKINS UNIVERSITY · PI ORNSTEIN, KATHERINE A · 2019 to 2023
$2.5M
NIA NIH HHS P30 AG021334NIA NIH HHS P30AG021334NIA NIH HHS R01 AG060967NIA NIH HHS R01AG060967NIA NIH HHS T32 AG000247NIA NIH HHS T32AG000247
6 · The paper itself

Abstract

backgroundHomebound older adults represent a high-risk, high-needs population characterized by significant clinical and sociodemographic heterogeneity. Little is known about how such heterogeneity shapes care needs and utilization patterns. We characterized utilization patterns among distinct subgroups of homebound older adults and examined associations between levels of outpatient care and emergency department (ED) utilization. PARTICIPANTS AND

settingWe used nationally representative data from the National Health and Aging Trends Study (NHATS) linked to Medicare Fee-For-Service (FFS) claims from 2011 to 2019 and 2021-2023 to examine trends among homebound older adults ages 70 or older.

methodsIn this retrospective observational study, we characterized utilization patterns among distinct subgroups of homebound older adults identified using latent class analysis (LCA). We then used multivariable regression to examine associations between level of outpatient utilization and probability of both any ED visit and any potentially avoidable ED visit identified using Ambulatory Care Sensitive Conditions (ACSC). We adjusted for other indicators of ED use and access to care (i.e., self-reported health, rurality, and disease burden).

resultsThere was a total of 2202 person-year observations across 1343 unique homebound individuals. The LCA identified four subgroups of homebound older adults: functional independence; dementia; multimorbidity; and dementia plus multimorbidity. There were significant differences in levels of ambulatory and acute care utilization between subgroups. Regression analyses did not show evidence to support the conventional wisdom that inability to access ambulatory care leads to more avoidable ED visits among the homebound older adult population.

conclusionsHeterogeneity among the homebound older adult population shapes care needs that in turn influence utilization patterns. Understanding these dynamics is crucial to targeting interventions like home-based primary care to the highest risk groups while tailoring care to individual needs.

Indexed as

Ambulatory CareEmergency Service, HospitalHomebound PersonsPatient Acceptance of Health CareAgedAged, 80 and overEmergency Room VisitsFemaleHumansLatent Class AnalysisMaleMedicareRetrospective StudiesUnited Statesfrailtyhealthcare utilizationhome‐based carelatent class analysis

Identifiers

PMID42394468
PMCPMC13426286

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.