Pain in Homebound Older Adults: Association with Race and Ethnicity and Neighborhood Socioeconomic Deprivation
Background: There are over 7 million homebound older adults in the US. Despite having significant multimorbidity and high risk of hospitalization and mortality, just 11% of this population access medical care in the home. New models of home-based care, including home-based palliative care, are needed to address the complex needs of this population and should be informed by robust epidemiological studies in nationally representative samples. Given its prevalence, impact on well-being, and ready availability in national surveys, pain is an ideal metric to estimate the need for home-based palliative care in homebound older adults.
Aims: To characterize pain in a nationally representative sample of homebound older adults and specifically examine (i) the association between race and ethnicity and pain; and (ii) the association between neighborhood socioeconomic deprivation and pain.
Research Design and Methods: Cross sectional analysis of 1730 homebound older adults drawn from 2015 National Health and Aging Trends Study and linked census data from American Community Survey. Bivariate and multivariable analyses to explore the association between race and ethnicity and pain and census tract socioeconomic deprivation and pain.
Implications: This study, the first to examine pain in a nationally representative sample of homebound older adults, represents an important first step towards characterizing the symptom needs of homebound older adults and expanding the evidence base to plan home-based palliative care. The results will provide important insights into disparities in pain in this population and the association between neighborhood socioeconomic deprivation and symptoms. Additionally, the multilevel linked dataset we create will lay the groundwork for future research on the impact of neighborhood factors on diverse outcomes among homebound older adults.
Career Development: The research aims and accompanying career development plan, together with the expert mentorship/ advisory team and research environment, collectively provide the perfect catalyst for a successful K award application.
Harriet Mather, MD MSc, is an Assistant Professor in the Brookdale Department of Geriatrics and Palliative Medicine. Originally from the UK, she earned her medical degree from the University of Oxford and went on to complete postgraduate medical training in internal medicine and palliative medicine in London. Alongside, she completed an MSc in Palliative Care at King’s College London (Distinction), conducting her research on case mix complexity in specialty palliative care. Following this, she moved to Mount Sinai as a research project manager and was involved with the development and evaluation of a community health worker centered home-based palliative care program and a large multi-center randomized controlled trial of a patient-physician communication intervention in advanced heart failure. She completed a Fellowship in Hospice and Palliative Medicine in2021 and was recruited to join faculty at Mount Sinai in July 2021. Motivated by her experiences as an actively practicing palliative care physician in the US and the UK, she conducts health services research into the experience of care of homebound older adults and their family caregivers, with the goal of identifying mutable targets for interventions and policies to improve care and outcomes for this underserved population. Supported by the NPCRC Kornfeld Scholars Program Award, and using population representative data, she will lead a study characterize pain in homebound older adults and its association with race and ethnicity and neighborhood socioeconomic deprivation.