Prevalence and Predictors of Non-Frailty Among Homebound Older Adults

Older adults who are homebound, defined as those who rarely or never leave home without assistance or difficulty, experience high levels of multimorbidity, functional impairment, and mortality. Yet their needs remain poorly served by current care delivery models. While research on homebound older adults implies that these individuals are universally frail, this assumption has never been tested empirically. We aimed to better characterize the non-frail homebound older adult population.

Using nationally representative data from the National Health and Aging Trends study (NHATS), years 2011-2019 and 2021-2023, we identified the persistently homebound population (n = 3851 unique older adults). Frailty status was determined using the Fried physical frailty phenotype. We identified socio-demographic, health-related, functional and environmental characteristics associated with the absence of frailty among the homebound using multivariable logistic regression.

Among the homebound, 8.1% were non-frail, 47.9% were pre-frail, and 44.0% were frail. Characteristics associated with not being frail included being female (70% non-frail), married (47%), and Hispanic (15%). Non-frail homebound older adults had fewer mental health symptoms (12.4% depression, 8.3% anxiety non-frail; vs. 40.2% and 33.0% frail), were less likely to be socially isolated (25.3% non-frail vs. 37.7% frail), and more likely to be functionally independent (72.1% non-frail vs. 36.7% frail). Robust homebound older adults self-reported better health (79.0% non-frail vs. 34.6% frail), fewer hospitalizations (22.0% non-frail vs. 51.4% frail), and had lower mortality rates (6.4% non-frail vs. 20.5% frail) compared to frail/pre-frail older adults.

While the vast majority of the homebound population is frail or pre-frail, a considerable portion are not frail. Efforts to manage high-need, high-cost populations such as homebound older adults must account for the heterogeneity of the population with efforts to better understand the non-frail subpopulation and target interventions tailored to their needs with the goal of potentially reversing their homebound status.