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Associations Between Visual Impairment and Homebound Status, Home Hazards, and Support Service Utilization: The
Xindi Chen1, Louay Almidani1, Seema Banerjee1
1From the Wilmer Eye Institute (X.C., L.A., S.B., J.T., A.M., F.A.W., P.Y.R.), Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Objective:
To examine the association between visual impairment (VI) and (1) homebound status, (2) presence of home hazards, and (3) utilization of home-based long-term services and supports (LTSS) among older adults.
Design:
Longitudinal and cross-sectional analyses using National Health and Aging Trends Study (NHATS) data (2021-2023).
Subjects:
A total of 3022 Medicare beneficiaries aged ≥71 years (mean age 78.8 years, 55.3% female) with complete data on homebound status and visual function.
Methods:
VI was defined as impairment in distance visual acuity or near visual acuity (<0.3 logMAR), or in contrast sensitivity (<1.55 logCS). Homebound status was classified as homebound, semi-homebound, or non-homebound based on frequency and difficulty leaving home. Home hazards (peeling paint, broken furniture, flooring damage, and tripping hazards) were documented during in-home visits. LTSS utilization encompassed assistive devices, home modifications, transportation services, senior housing, meal delivery, paid care, and high-burden family caregiving. Regression models (logistic and Cox proportional hazards) assessed cross-sectional and longitudinal relationships between VI - its presence, severity, and rate of decline - and outcomes.
Main Outcome Measures:
Presence or transition to homebound or semi-homebound status, presence of home safety hazards, and utilization of home-based LTSS.
Results:
Among 3,022 participants (mean age 78.8 years, 55.3% female), 5.7% were homebound, and 14.4% semi-homebound. The presence of any VI was associated with a higher likelihood of both being (OR = 1.52, 95% CI: 1.17-1.98, P = .002) and becoming homebound or semi-homebound (HR = 1.35, 95% CI: 1.04-1.74, P = .02). Participants meeting all three VI criteria had an even higher risk (HR = 1.86, 95% CI: 1.35-2.58, P < .001). Individuals with VI were more likely to have home hazards (OR = 1.88, 95% CI: 1.32-2.69, P = .001) and utilize home-based LTSS (OR = 1.35, 95% CI: 1.10-1.66, p = 0.005).
Conclusions:
VI is a significant risk factor for being and becoming homebound in older adults, with increasing severity and breadth of VI compounding this risk. Individuals with VI also face greater home hazards and require more home-based LTSS, suggesting challenges maintaining home safety and functionality as they become more confined to the home. Early vision interventions, comprehensive home safety assessments, and targeted LTSS may be important preventive strategies for maintaining independence in visually impaired older adults.
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