title: Difference in the impact of homebound status on functional decline between independent older men and women: A 2 year follow-up study.
abstract: OBJECTIVE
  To investigate the association between homebound status and functional decline over a 2 year follow-up period and the sex difference in its association.
  
  
  METHODS
  The study subjects were 2956 independently living older individuals (1267 men, 1679 women). Homebound persons were defined as individuals who left home less than once a week. Subjects judged to be eligible for a support program or long-term care by the committee of the long-term care insurance system were considered functionally dependent. Using a Cox proportional hazard model, the present authors evaluated the association between homebound status and onset of functional dependence.
  
  
  RESULTS
  Of the 2946 subjects, 223 (7.6%) were homebound. During the follow-up period, 153 subjects became functionally dependent. Adjusting for age and household type, the hazard ratio (HR) for onset of functional dependence in the homebound group (compared with the non-homebound group) was 5.46 (95% confidence interval [CI], 3.00-9.94) for men and 2.62 (95% CI, 1.66-4.14) for women. After adjustment for locomotor function, cognitive function, depressive state, age, and household type, the HR for onset of functional dependence in association with homebound status remained significantly increased in men (HR, 3.12 [95% CI, 1.59-6.10]), but not in women (HR, 1.43 [95% CI, 0.87-2.35]).
  
  
  CONCLUSIONS
  This study suggests that homebound status is a risk for functional dependence in both men and women. In men, being homebound despite intact functional ability was also a risk for functional dependence. Considering the respective characteristics of each sex may be important for planning support programs to prevent homebound for older persons.
authors.affiliation: School of Nursing, Kanazawa Medical University, Uchinada, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Hamazaki
authors.affiliation: School of Nursing, Kanazawa Medical University, Uchinada, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Morikawa
authors.affiliation: Geriatric Medicine, Kanazawa Medical University, Uchinada, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: Epidemiology and Public Health, Kanazawa Medical University, Uchinada, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Nakagawa
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D018577:Homebound Persons; D006801:Humans; D007564:Japan; D008297:Male; D016016:Proportional Hazards Models
keywords: follow-up study; functional decline; homebound; older persons; sex difference