Homebound status and glycemic control among older adults: results from a national survey

Despite well-documented poor health outcomes among homebound older adults with diabetes, little is known about how homebound status affects glycemic outcomes. This study examined the association between homebound status and glycemic control among community-dwelling older adults with diabetes and identified key factors associated with glycemic outcomes. We conducted a cross-sectional analysis using data from the 2017 National Health and Aging Trends Survey (NHATS). Participants included community-dwelling older adults aged 65 years and older with diabetes. Glycemic control was measured by hemoglobin A1c (HbA1c). Being homebound was defined as the inability to leave one's home independently. A fully adjusted linear regression model that accounted for predisposing, enabling, and need factors was used to assess the association between homebound status and HbA1c. All analyses accounted for the complex survey design. Homebound status was not independently associated with HbA1c in adjusted models. HbA1c was associated with age ≥ 85 years (β = -0.25, p = 0.01), number of comorbid conditions (β = -0.08, p = 0.005), depression (β =  + 0.62, p < .001), anxiety (β = -0.43, p = 0.003), and receipt of food assistance (β = -0.51, p = 0.004). These findings suggest that mental health needs and food access are important factors to consider alongside mobility in diabetes care. Collectively, the results highlight the potential value of a holistic, patient-centered approach to diabetes care among older adults that incorporates medical, psychosocial, and social domains.