Association between homebound status and newly certified need of care among elderly in a rural community: The Iwate-Kenpoku cohort (Iwate-KENCO) study

Abstract

Objective: The purpose of this study was to evaluate the association between homebound status and newly certificated need of care among elderly in a rural community and to clarify the characteristics of those in homebound status. Methods: The Iwate-KENpoku COhort (Iwate-KENCO) study (26,469 participants) spanned the period from 2002 to 2004 and was conducted in northern Iwate Prefecture, Japan. In the present study, 12,056 elderly (men, 4,751; women, 7,305) participated after being screened for eligibility (≤65 years of age; without certification for need of care; and without a history of stroke, cardiac heart failure, or ischemic heart disease). Being homebound was operationally defined as walking outdoors for less than 5 minutes per day. Cox's proportional hazard model was used to estimate the hazard risk (HR) for newly certificated need of care and the 95% confidence interval (95% CI) after controlling for confounding factors by gender. Results: After a mean follow-up period of 2.65 years, 200 men (4.2%) and 412 women (5.6%) obtained certification for need of care. Homebound status was significantly associated with newly certified need of care in women (HR = 1.64, 95% CI = 1.29- 2.09), but not in men (HR = 1.07, 95%CI = 0.76-1.52). Homebound status among elderly women was associated with nutritional status, missing teeth, and irregular daily rhythms. Conclusion: These findings suggest that being homebound is a risk factor for elderly women receiving certification for need of care.