The journals of gerontology. Series B, Psychological sciences and social sciences · 2026
Family structure and transitions into and out of homeboundness: Evidence from the National Health and Aging Trends Study, 2011-2024.
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Zhang Yan
Аннотация
OBJECTIVES: Homebound status refers to needing assistance or an assistive device to leave home, being normally unable to leave home, or experiencing leaving home as a major effort. This study examines transitions into and out of homeboundness and whether family structure is associated with these transitions, with attention to gender differences.
METHODS: Using National Health and Aging Trends Study data from 2011-2024, transition probabilities across four states-independent, homebound, nursing home residence, and deceased-were estimated using an unadjusted continuous-time homogeneous Markov model. Multinomial logistic regression models then assessed associations between family structure and subsequent transitions, including gender interactions.
RESULTS: Among respondents who were independent, 84.6% remained independent, and 12.2% became homebound by the next wave. Among those who were homebound, 23.6% returned to independence, 60.1% remained homebound, 2.4% entered nursing home residence, and 13.9% died. Unpartnered older adults had higher risks of transitioning from independence to nursing home (RRR = 1.752, p <.01) and death (RRR = 1.265, p <.01). Parents had lower risks than childless older adults of transitioning from independence to nursing home (RRR = 0.523, p <.01) and death (RRR = 0.735, p <.01), and from homeboundness to nursing home (RRR = 0.574, p <.001). The association between being unpartnered and becoming homebound was significantly stronger among men than women.
DISCUSSION: : Homeboundness as a dynamic and socially structured process. Family structure may shape pathways into homeboundness, institutional care, and death, with implications for aging in place.
METHODS: Using National Health and Aging Trends Study data from 2011-2024, transition probabilities across four states-independent, homebound, nursing home residence, and deceased-were estimated using an unadjusted continuous-time homogeneous Markov model. Multinomial logistic regression models then assessed associations between family structure and subsequent transitions, including gender interactions.
RESULTS: Among respondents who were independent, 84.6% remained independent, and 12.2% became homebound by the next wave. Among those who were homebound, 23.6% returned to independence, 60.1% remained homebound, 2.4% entered nursing home residence, and 13.9% died. Unpartnered older adults had higher risks of transitioning from independence to nursing home (RRR = 1.752, p <.01) and death (RRR = 1.265, p <.01). Parents had lower risks than childless older adults of transitioning from independence to nursing home (RRR = 0.523, p <.01) and death (RRR = 0.735, p <.01), and from homeboundness to nursing home (RRR = 0.574, p <.001). The association between being unpartnered and becoming homebound was significantly stronger among men than women.
DISCUSSION: : Homeboundness as a dynamic and socially structured process. Family structure may shape pathways into homeboundness, institutional care, and death, with implications for aging in place.