文章基本信息

标题：Health Outcomes of Obtaining Housing Among Older Homeless Adults
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作者：Rebecca T. Brown ; Yinghui Miao ; Susan L. Mitchell 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：7
页码：1482-1488
DOI：10.2105/AJPH.2014.302539
语种：English
出版社：American Public Health Association
摘要：Objectives. We determined the impact of obtaining housing on geriatric conditions and acute care utilization among older homeless adults. Methods. We conducted a 12-month prospective cohort study of 250 older homeless adults recruited from shelters in Boston, Massachusetts, between January and June 2010. We determined housing status at follow-up, determined number of emergency department visits and hospitalizations over 12 months, and examined 4 measures of geriatric conditions at baseline and 12 months. Using multivariable regression models, we evaluated the association between obtaining housing and our outcomes of interest. Results. At 12-month follow-up, 41% of participants had obtained housing. Compared with participants who remained homeless, those with housing had fewer depressive symptoms. Other measures of health status did not differ by housing status. Participants who obtained housing had a lower rate of acute care use, with an adjusted annualized rate of acute care visits of 2.5 per year among participants who obtained housing and 5.3 per year among participants who remained homeless. Conclusions. Older homeless adults who obtained housing experienced improved depressive symptoms and reduced acute care utilization compared with those who remained homeless. Over the past 2 decades, the proportion of the homeless population aged 50 years and older has increased substantially. In 1990, only 11% of single homeless adults were aged 50 years and older, but this percentage increased to 32% by 2003 1 and is nearly 50% today. 2 Homeless adults aged 50 years and older have health problems distinct from those of younger homeless adults, including higher rates of medical comorbidities 3 and of geriatric conditions such as functional and cognitive impairment. 4,5 Because homeless adults in their 50s develop medical and geriatric conditions at rates typical of adults 15 to 20 years older in the general population, 4,5 experts consider homeless adults to be elderly at age 50 years, 15 years earlier than housed adults. 4,6 Among elderly adults who have geriatric conditions, environmental factors play a central role in maximizing and maintaining independence. Older adults who live in a stable housing environment may be able to adapt to geriatric impairments more easily and maintain their independence longer than those who lack these advantages. 7,8 By contrast, older adults who live in shelters or on the street may encounter great difficulty in modifying their environment to accommodate functional impairments and other geriatric conditions. 9 Moreover, adaptive equipment used to cope with impairments—such as glasses, hearing aids, or walkers—may be lost or stolen. This mismatch between older homeless people’s environment and their abilities may magnify the negative effect of geriatric conditions on their quality of life and ability to function independently, leading to the premature need for costly long-term care. 9,10 Experts have hypothesized that access to housing could ameliorate high rates of disability and other geriatric conditions among older homeless people and prevent or delay institutionalization. 9 Studies of the adult homeless population have supported the putative health benefits of housing, having found decreased rates of acute care utilization after housing is received. 11–13 However, little is known about the impact of housing on the unique health concerns of older homeless adults, including the geriatric conditions that play a key role in health and quality of life. Therefore, we conducted a prospective cohort study of 250 older homeless adults in Boston, Massachusetts. We previously described the high prevalence of geriatric conditions at baseline in this cohort. 5 The goal of this study was to determine whether obtaining housing was associated with subsequent improvements in health status and geriatric conditions and decreased use of acute care.