Shedding Light on an Invisible Population in Geriatric Medicine: A Scoping Review of Older Adults Who Are Homebound

J Am Geriatr Soc. 2025 Jul 29. doi: 10.1111/jgs.19620. Online ahead of print.

ABSTRACT

BACKGROUND: Older adults who are homebound, defined as individuals who rarely or never leave their homes without assistance, represent a vulnerable and growing population with complex social and medical needs. Despite their significant healthcare utilization and unmet care needs, research on this group is fragmented and has not been comprehensively synthesized. This scoping review aimed to summarize the determinants, characteristics, and outcomes of being homebound to identify care gaps and propose directions for future research.

METHODS: This review followed the PRISMA-ScR framework, conducting systematic searches in PubMed, Embase, Web of Science, and CINAHL using terms such as “homebound,” “housebound,” and “home-limited.” Eligible studies were peer-reviewed, community-based, and written in English. Data extracted included demographics, health outcomes, care gaps, and interventions. Results were categorized into three themes: Risk Factors, Problems and Needs, and Implications of Being Homebound.

RESULTS: The prevalence of homebound sample populations ranged from 4.2% to 65%, stratified by factors such as age, gender, socioeconomic status, and the presence of chronic conditions. Studies highlighted a need to address dental care, nutrition, and fall prevention among individuals who are homebound. Cognitive impairment (31.7%-48%) and mental health conditions, particularly depression (present among up to 43.9%), were highly prevalent, yet access to neuropsychology services remained limited. Frailty and functional dependence were pervasive, contributing to undesired healthcare utilization, including emergency department visits and hospitalizations. Care gaps in advance care planning, social support, and rehabilitation were identified as critical barriers to improving quality of life.

CONCLUSION: Older adults who are homebound face multifaceted challenges that require integrated, multidisciplinary, home-based care approaches. Expanding home-based primary and palliative care, addressing unmet care needs, and providing caregiver support are critical priorities among countries with aging populations. Future research should focus on home-based healthcare delivery models and targeted interventions to address gaps in mental health services, cognitive assessment and management, and physical rehabilitation for older adults who are homebound.

PMID:40729452 | DOI:10.1111/jgs.19620