Homebound Older Adults and Transportation Barriers to Social and Community Activities.

Introduction: Although a homebound state in late life is often a result of cognitive and/or physical/functional health problems, transportation barriers may also be an important contributor. In this study, we examined the associations of homebound states with driving status and self-reported transportation barriers to social/community activities. Methods: We used the 2023 National Health and Aging Trends Study (N=7,543), and homebound older adults were defined as those who rarely (≤1 a week) or never went outside the home in the past month. We used generalized linear models to examine the associations. Results: Homebound older adults comprised 5.2% of Medicare beneficiaries age 65 and older. Only 27% reported driving in the past month, and 54.2% and 32.1% reported health-related and transportation barriers to participating in social/community activities, respectively. Multivariable analysis results showed that homebound older adults were more likely to have stopped driving in the past year than their peers who went out 2-4 days a week (IRR=2.28, 95% CI=1.52-3.43) and those who went out 5+ days a week (IRR=7.20, 95% CI=4.34-11.97). Homebound older adults were also more likely to report transportation barriers than those who went out 2-4 days a week (IRR=1.30, 95% CI=1.06-1.58) and those who went out 5+ days a week (IRR=1.99, 95% CI=1.50-2.65). Less than 10% of homebound older adults used taxi/ride-hailing services and public transportation. Conclusion: The study suggests that older adults' homebound state significantly correlates with transportation barriers. Reliable transportation services appropriate to older adults' capabilities are needed to facilitate their participation in social/community activities.