부산대학교 도서관

An estimated two million older adults in the United States are homebound, higher than the number living in nursing homes. Older people, people of color, and women are more likely to be homebound, as well as those on low incomes and with lower education levels. Being homebound is associated with higher rates of depression, cognitive impairment, and mortality. Despite the many challenges faced by homebound people, few qualitative studies exploring their experiences have been published. There is also a lack of conceptual clarity around the meaning of being homebound; multiple definitions have been used in previous research, making it difficult to compare and synthesize findings across studies.The purpose of this dissertation was to explore what it is like to be homebound, and to contribute to the conceptual literature on both aging in place and homeboundness. The aims of this dissertation were: 1) to synthesize and evaluate the existing qualitative evidence on experiences of aging in place in the US; 2) to explore experiences of homebound adults living in the San Francisco Bay Area and to build a conceptual understanding of what it means to be homebound; and 3) to explore experiences of homebound older adults during the COVID-19 pandemic.The primary finding of my systematic review and meta-ethnography was that aging in place is a dynamic process driven by tension between threats and agency across three core experiences – identity, connectedness, and place. In my qualitative analysis, I found that being stuck was at the core of the experiences of being homebound. Participants felt stuck in place, stuck with inadequate help, and stuck with the limited range of choices available to them. Homebound people also emphasized the ways in which they retained their independence, distancing themselves from negative images of aging and being homebound while demonstrating their autonomy and resilience. While most people around the world felt restricted by being stuck at home during COVID-19 shelter-in-place orders, homebound people were struggling most with decisions about who to allow into their homes. They weighed risk of infection against their abilities to cope alone or with reduced levels of help at home. Most were offered virtual services; experiences of these were mixed.The findings of this dissertation research provide new insights into the lives of homebound people and those aging in place They also indicate important directions for future research, clinical practice, and policy, such as improvements to home care workforce policy, support related to aging in place and maintaining social connectedness, and access to healthcare for homebound people. Improving the supports and services available to homebound people, with a particular focus on safeguarding autonomy, could help enhance quality of life and alleviate the frustration and pain associated with feeling stuck at home.