文章基本信息

标题：Characteristics of Emergency Department Visits by Older Versus Younger Homeless Adults in the United States
本地全文：下载
作者：Rebecca T. Brown ; Michael A. Steinman
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：6
页码：1046-1051
DOI：10.2105/AJPH.2012.301006
语种：English
出版社：American Public Health Association
摘要：Objectives. We compared the characteristics of emergency department (ED) visits of older versus younger homeless adults. Methods. We analyzed 2005–2009 data from the National Hospital Ambulatory Medical Care Survey, a nationally representative survey of visits to hospitals and EDs, and used sampling weights, strata, and clustering variables to obtain nationally representative estimates. Results. The ED visits of homeless adults aged 50 years and older accounted for 36% of annual visits by homeless patients. Although demographic characteristics of ED visits were similar in older and younger homeless adults, clinical and health services characteristics differed. Older homeless adults had fewer discharge diagnoses related to psychiatric conditions (10% vs 20%; P = .002) and drug abuse (7% vs 15%; P = .003) but more diagnoses related to alcohol abuse (31% vs 23%; P = .03) and were more likely to arrive by ambulance (48% vs 36%; P = .02) and to be admitted to the hospital (20% vs 11%; P = .003). Conclusions. Older homeless adults’ patterns of ED care differ from those of younger homeless adults. Health care systems need to account for these differences to meet the needs of the aging homeless population. The average age of the US homeless population is increasing. Whereas 11% of the homeless population was aged 50 years or older in 1990, this percentage had increased to 32% by 2003 1 and has continued to rise since then. 2 The median age of single homeless adults has increased from 37 years in 1990 1 to between 49 and 50 years today. 2,3 This trend is thought to be because of the aging of individuals born in the second half of the baby boom generation (those born 1954–1965), who have a higher risk of homelessness than do other age cohorts. 3 Most homeless adults aged 50 years and older are aged between 50 and 64 years, with adults aged 65 years and older making up less than 5% of the total homeless population. 1,3 In the general population, adults aged 50 to 64 years are considered middle aged and have lower rates of chronic conditions than do those considered elderly, adults aged 65 years and older. 4,5 However, homeless adults aged 50 years and older have rates of chronic illnesses and geriatric conditions similar to or higher than those of housed adults 15 to 20 years older, including conditions often thought to be limited to the elderly, such as falls and memory loss. 6,7 Because middle-aged homeless adults face the same geriatric problems as do elderly housed adults, experts consider them to be elderly when aged 50 years, despite their relatively younger age. 6,8 Similar patterns of premature aging have been found in other vulnerable populations, including prisoners 9 and patients with developmental disabilities. 10 Despite the growth of the older homeless population, relatively little is known about use of health services among older homeless adults. Homeless health services and research have focused on problems that are common among younger homeless adults, including infectious disease, 11 substance use, 12 and mental illness. 13 The few studies that have focused on older homeless adults found that they have medical problems that differ from those of younger homeless adults, including higher rates of chronic illnesses 6,14 and geriatric syndromes 6 and lower rates of substance use. 15 New frameworks for providing care to the vulnerable and growing older population are needed but cannot be developed until more is known about their use of health services. Homeless adults aged 50 years and older use the emergency department (ED) frequently and at rates nearly 4 times those of the general population. 16–18 Knowledge about ED care that older homeless adults receive may allow researchers and clinicians to design interventions to reduce use of the ED and improve ED care for this vulnerable older population. Therefore, we have identified the demographic, clinical, and health services characteristics of ED visits in older versus younger homeless adults, using a nationally representative survey of US ED visits.