Differences in Fall Risks between Homebound and Non-Homebound Older Adults

Purpose/Background: Falls in community-dwelling older adults are a severe public health concern. Falls negatively impact older adults, their families, and public health. With fall-related injuries, older adults may experience functional decline, hospitalization, nursing home placement and decreased quality of life. Homebound and non-homebound older adults have different characteristics, which may affect their fall risks differently. The objectives of this study were to a) examine the characteristics of homebound and non-homebound community-dwelling older adults, and b) compare the differences in fall risks between homebound and non-homebound community-dwelling older adults.

Conceptual Framework: We used the National Health and Aging Trend Study (NHATS) disability conceptual framework for this study. We selected factors associated with falls including sociodemographic characteristics, health conditions, physical functioning, and environmental factors via literature review.

Methods: Using the NHATS round 6 data, this was a cross-sectional, correlational study with a sample of 5,930 community-dwelling older adults (65 and above), including 1,356 homebound and 4,574 non-homebound older adults. We conducted bivariate chi-square tests to compare the sample characteristics with fall status stratified by homebound status. We used multiple logistic regression analyses to identify fall risk factors specific to homebound and non-homebound older adults.

Results: The fall incidence for homebound and non-homebound older adults was 288 (21.1%) and 395 (7.98%), respectively. Homebound and non-homebound older adults shared two common risk factors for falls: difficulty getting out of bed (OR = 1.729, p = 0.003; OR = 1.882, p = 0.002, respectively for the homebound and non-homebound), and balance problems limiting activities (OR = 1.531, p = 0.026; OR = 3.004, p <0.001, respectively for the homebound and non-homebound). More significant risk factors for falls were identified in the homebound than the non-homebound. Specifically, male homebound older adults were 59% more likely to experience a fall than their female counterparts (OR = 1.59, p = 0.005). Homebound older adults with hypertension, depression/anxiety or hearing impairment had increased risk for falls (OR = 1.647, p = 0.031; OR = 1.269, p = 0.049; OR = 1.624, p = 0.022). Among non-homebound older adults, home tripping hazards was identified as a significant risk factor (OR = 1.77, p = 0.031). Having strength problems limiting activities (OR = 1.425, p = 0.028) or vision impairment (OR = 3.004, p <0.001) placed non-homebound older adults at increased risk for falls compared to those without these functional limitations.

Implications: Using a national representative sample, we examined the differences in risk factors for falls between homebound and non-homebound community-dwelling older adults. Findings from the study suggest that community fall prevention programs need to be tailored based on the different risk factors in homebound and non-homebound older adults. Community health nurses need to address the common risk factors, while also considering risk factors specific to homebound or non-homebound older adults living in the community. Additional research is needed to develop tailored fall interventions for homebound versus non-homebound older adults.