What does “housebound” mean?

Problem

There is no consensus definition for “housebound” internationally or in the UK. Research in other countries has shown that housebound people have more mental and physical health problems than other people and are less likely to have their healthcare needs met. In the UK, about one in five people aged 85 years or over are thought to be housebound (around 340,000 people). This number is set to double by 2041 and treble by 2066. Despite this, GPs are doing fewer home visits than before. In 2019, because of high workload pressures, GP representatives voted to remove visits from their NHS contract. This project aims to find a consensus definition of “housebound” for use in UK healthcare research.

Approach

We have completed a systematic review to identify definitions of housebound within the peer reviewed and grey literature. We (PI and lay co-facilitator, KS) then interviewed seven housebound people and five carers to explore which definitions of housebound were most relevant to them and any that raise concerns. For each definition, we created an evidence summary, including the context (e.g. country, year, type of study/article), description of housebound and the way in which housebound people were identified. The evidence summaries will be presented alongside views from the housebound people and carers to an expert panel, comprising around ten health and social care professionals and researchers, who will undertake a consensus exercise to agree a definition which can be used in UK research. This will be completed by April 2023.

Findings

For the systematic review (PROSPERO 2022 CRD42022332023), 847 titles/abstracts were screened and 52 definitions of housebound were identified. Interview participants were generally positive about GP records flagging up that someone was housebound because this meant that they were not expected to attend the GP surgery and were prioritised for some treatment, such as vaccinations. Views towards the word ‘housebound’ were mixed, with half of participants expressing negative views of the word and its meaning. They commented that it was a ‘scary word’, ‘not a pretty word’, ‘a label’ and ‘old fashioned’, and described feeling ‘bound in chains’, ‘trapped’, ‘shut in’ and ‘a prisoner’. Half of the participants thought the word ‘housebound’ was acceptable, describing it as ‘the best we got’ and ‘a matter-of-fact word’. Several of the carer participants considered themselves to be housebound by virtue of not being able to leave the house due to their caring commitments.

Consequences

Housebound people are an under-researched group. This is the first of a series of projects that will help us understand more about the characteristics, healthcare utility and unmet healthcare needs of housebound people. These studies will provide important evidence to policy makers and will help in planning services and providing better healthcare in the future.