Are We Failing the Homebound? A Scoping Review of Homebound Older Adults

Abstract Background Older adults who are homebound, those who rarely or never leave home without assistance, represent a growing and under-recognised population. They experience high levels of multimorbidity, functional decline, and mortality, yet their needs remain poorly integrated into health systems. This review aimed to summarise the determinants, characteristics, and outcomes of being homebound to identify care gaps and propose directions for future research. Methods We conducted a scoping review in accordance with PRISMA-ScR guidelines. A systematic search of four databases (PubMed, Embase, Web of Science, and CINAHL) was performed. English-language, peer-reviewed studies involving adults who are homebound were included. Data extraction captured study setting, population, design, and key findings. Thematic analysis was performed and categorised by consensus. Results Of 6,406 studies screened, 159 were included. Prevalence of homebound status ranged from 4% to 65%, reflecting differences across populations and settings. Risk factors included advanced age, female sex, cognitive impairment, depression, frailty, social isolation, and substance misuse. Once homebound, individuals faced multiple unmet needs: untreated dental disease, malnutrition, falls, medication-related harm, and limited access to rehabilitation and mental health services. Functional dependence and high symptom burden were common. Caregiver burden was substantial, with some studies reporting depressive symptoms in over half of carers. Homebound status was associated with increased emergency department visits, hospitalization, and early mortality. Studies of home-based primary care showed improved continuity, reduced hospital use, and better end-of-life care. However, service delivery remained inconsistent and often excluded allied health and social care. No studies addressed the prevalence or care needs of homebound individuals in Ireland, highlighting a lack of national data. Conclusion This scoping review maps the fragmented literature on older adults who are homebound. It highlights complex medical, functional, and social vulnerabilities and identifies substantial care gaps. Ireland’s homebound population must be assessed to inform equitable, integrated, person-centred care.