Powerlessness and Hope in the Homebound Elderly
Authors:   , Bansemer Nancy 
Published: February 2023

Elderly clients are often homebound due to culminating health problems. The deteriorating health status of the elderly combined with the accumulating losses of family, friends, financial support, and autonomy may result in diminished resources. The devastation that results from the overwhelming losses endured by the homebound elderly may lead to powerlessness and hopelessness (Johnson, Roberts, & Cheffer, 1996; Miller, 1992). This investigation explored if there was a relationship between powerlessness and the level of hope in the homebound elderly. Further exploration was also conducted to determine if the number of visits provided to the homebound elderly by home health care personnel and the length of time homebound had a relationship with the homebound elderly’s powerlessness and their level of hope. The overriding theoretical framework for this investigation was based on Roy’s Adaptation Model (Phillips et al., 1998). Additional theoretical support was based on the mid-range theory of the Powerlessness/Hopelessness Cycle (Miller, 1992) and the Holistic Power Model by Kubsch and Wichowski (1997). Participants for this investigation were homebound elderly individuals (60 years or older) who were clients of Medicare certified home health care agencies (HHC), and who did not have a terminal illness. Fifteen participating HHC agencies distributed survey packets to qualifying clients, who in turn completed and returned the survey packets to this investigator for data analysis. The sample (N=87) population consisted of individuals ranging in age from 60-99 with a mean age of 81.94. Participants were 76% female and 24% male. All respondents were Caucasian and 80.5% were of the Protestant faith. The demographic information indicated that 60.9% of the subjects were widowed and 26% were married. The Powerlessness Assessment Tool (PAT) (Kubsch & Wichowski, 1997) measured the homebound client’s level of powerlessness and the strength of this/her seven power resources. Powerlessness scores ranged from the minimum of five to the highest possible score of 25 (M=16.99, SD=4.41) with higher scores indicating less powerlessness. The seven power resources measured for each client included (a) self-esteem, (b) energy, (c) knowledge about their condition, (d) physical strength, (e) belief system, (f) psychological stamina and support network, and (g) motivation to get better. Possible power resource scores could range from 7 to 35, and the mean for this sample group was 22.9. Assessment of the samples’ level of hope was accomplished by utilizing the Miller Hope Scale (MHS). Possible scores on the 40-item, 6-point scale could range from 40 to 240, with higher scores indicating higher levels of hope. Data analysis indicated the hope scores of the sample (N=87) ranged from 90 to 225 (M=165.95, SD=27.564). To answer the research questions the levels of powerlessness and hope were examined using Pearson’s r. A significant negative correlation was found between the length of time homebound and the level of powerlessness (r=-0.26, p=0.02), however a significant relationship between the length of time being homebound and the level of hope was not found (r=-0.05, p=0.65). Correlational analysis also did not find significant relationships between the number of visits from the HHC providers and the levels of powerlessness and the levels of hope. However, a highly significant relationship was noted between the two variables, powerlessness and hope (r=0.54, p=0.00). The homebound clients’ total power resource scores also were positively correlated with levels of powerlessness (r=0.70, p=0.00) and levels of hope (r=0.71, p=0.00). These data indicated that as the clients’ level of hope and level of power resources increased their feelings of powerlessness decreased. Additional findings revealed other significant correlations. Phone calls from friends were significantly related to levels of powerlessness (r=0.43, p=0.00) and levels of hope (r=0.38, p=0.00) indicating that those who received more phone calls from friends had higher levels of hope and less powerlessness. Significant relationships also were noted between the levels of hope and visits with friends (r=0.22, p=0.05), which indicated that those with higher levels of hope had a greater number of visits from friends. The homebound clients who indicated religion or spirituality was an important part of their life had fewer feelings of powerlessness (M=17.18, SD=3.82) than those who did not (M=16.68, SD=5.93), and had higher hope scores (M=170.46, SD=25.32) than those who did not (M=155.05, SD=31.30). Future research to explore whether the relationships found in this investigation are evident in other homebound individuals who are not receiving services from a HHC agency may be beneficial. HHC providers and nurses in all clinical fields need to become aware of the relationship between powerlessness and hopelessness.