Association of the COVID-19 pandemic with the prevalence of homebound older adults in the United States, 2011-2020

JAMAAnkuda CK, Leff B, Ritchie CS, et al. | December 08, 2021


Because of the COVID-19 pandemic, there may be an increase in the number of homebound older adults, who may be at heightened risk for infection with SARS-CoV-2. The size and characteristics of the homebound population in the United States in 2020, including household size, were investigated herein given their relevance for disease transmission risks, and digital access, which is important for telemedicine and online vaccination registration.

  • From the National Health and Aging Trends Study (NHATS), an annual cohort study of aging among community-dwelling older adults, researchers retrieved data of a total of 10,785 individuals aged 70 years or older; these were observed a mean (SD) of 4.6 (3.0) times, for 49,267 total observations during the 10 years of the study, including 3,861 in 2020.

  • A substantial increase occurred in the proportion of community-dwelling homebound adults aged 70 years or older in the United States in 2020, this was particularly evident among Black non-Hispanic and Hispanic/Latino individuals.

  • This first major increase in the homebound population in a decade is possibly linked with the compliance with social distancing and other public health recommendations to reduce the risk of infection with SARS-CoV-2.

  • In addition, notable racial and ethnic differences were recorded; for instance, there appeared a greater likelihood of White non-Hispanic individuals to reside alone, which may have left them without caregiving assistance.

  • In contrast, multi person households appeared more frequent for Black non-Hispanic and Hispanic/Latino individuals, which may have increased their risk of being exposed to SARS-CoV-2.

  • Higher rates of being homebound among Black non-Hispanic and Hispanic/Latino populations is possibly due to greater regional incidence of SARS-CoV-2 or decreased resources to safely navigate leaving home (eg, private transportation and safe grocery shopping options).

  • Use of digital technologies was infrequent among respondents, particularly Black non-Hispanic and Hispanic/Latino individuals, a finding that is consistent with results of a prior study and has implications for equity regarding expanded telemedicine use.

  • As per estimations, the increased prevalence of homebound older adults that was observed in 2020 will continue in 2021 as the COVID-19 pandemic abates.

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