Older adults living alone at home are at risk of many adverse outcomes, including injuries from falls, firearms, and driving; adverse drug events due to drug errors; and self-neglect or elder abuse. An estimated 4.5 million Medicare beneficiaries became homebound between 2012 and 2018. Becoming homebound increases the risk of harm for older adults. Clinicians should evaluate the home safety of older adult patients, which requires assessing their medical conditions, home physical environment, and social circumstances. Identified problems should be addressed with interventions that allow patients to live safely in the least restrictive environment possible. The least restrictive interventions are in-home modifications (eg, installation of handrails and grab bars) and use of remote monitoring, in-home services, and shopping and transportation services. Daytime participation in senior centers or adult day care also can be useful. Some patients will require a change in living situation, with a move to senior housing or retirement communities, group homes, assisted living communities, skilled nursing facilities, or the home of a family member. Some of these alternative living situations require financial resources that a patient or family members may not have. Public assistance is available in some cases, if patients meet eligibility requirements.

Case 4. BG is an 83-year-old woman whose husband died of cancer 4 years ago. She has been living alone since then. Her conditions include diabetes with peripheral neuropathy and mild depression. In the past 3 years, BG has been hospitalized three times. Two of the hospitalizations were because of falls and hyperglycemia. Her adult daughter MG contacts you and is concerned about whether it is safe for BG to be living at home alone.

Aging and Challenges Related to Living at Home

As individuals age, they may become less able to perform basic activities of daily living (ADL), which can create challenges to living at home. Many older adults become homebound because of mobility limitations, lack of family support, decreased social engagement, medical conditions, and other issues.⁹⁶

All of these can decrease the safety of older adults living at home. Lower income older adults, in particular, face greater safety challenges because they have fewer financial resources to modify their home environments.⁹⁷ Serious illnesses, such as dementia, advanced heart failure, lung disease, and others, also can prevent older adults from caring for themselves safely at home.⁹⁸

It is estimated that 4.5 million Medicare beneficiaries became homebound between 2012 and 2018.⁹⁹ Becoming homebound, which often coincides with reduced access to food, drugs, medical care, and social outlets, increases the risk of harm for older adults because of injuries, difficulties taking drugs, self-neglect, and elder abuse.