Aging Among the Homeless: Social Isolation, Function and Institutional Care

项目摘要/摘要 这项提议的长期目标是减少对机构护理的需求，并找到最佳住房。 有无家可归经历的老年人的选择。该提案寻求对AG041860进行续订， 在无家可归者中：老年条件、健康和保健结果“也被称为健康 中老年无家可归者的结局(希望之家)研究。希望之家 招募并跟踪了350名50岁及以上无家可归的成年人。大约一半的无家可归者 成年人的年龄在50岁或以上；无家可归人口的老龄化预计将继续下去。在希望之家， 尽管年龄中值为58岁，但我们发现老年疾病的患病率和严重性，包括功能性、 行动和认知障碍，类似于70多岁社区生活的成年人。参与者有一个 行为健康问题的高发、社会孤立和狭隘的社会网络。我们发现很高 急性医疗保健利用率和机构护理率，包括经常入住养老院。这个 大多数老年人在日常生活活动方面需要帮助(长期服务和支持 (LTSS))；大多数人将从其社交网络中的无偿照顾者那里获得这种支持。医疗补助将支付 但无家可归的老年人在获得长期社会保障计划方面面临着许多障碍，无论是有偿的还是无偿的。这些 障碍可能会增加他们在昂贵和可避免的护理和养老院使用方面的风险。因此，我们 建议扩展HOPE HOME研究，以检查1)患病率及其之间的关联， 感受到的社会孤立、社会支持、功能和认知障碍，以及医疗保健利用；2) 对家庭和社区长期服务和支持的需求、使用和障碍；以及3)费率 养老院安置和死亡率的风险因素。我们建议再招聘80人。 参与者希望回家接替那些已经去世或走失的人进行后续跟进，并跟踪队列 为期三年，每半年访问一次，进行结构化面谈和临床评估。我们将招聘一名 研究参与者的子样本和主要信息者的样本，以进行深入的定性访谈 了解获得长期住房援助的障碍、克服这些障碍的策略以及最佳住房选择 这使无家可归的老年人能够避免不必要的医疗保健利用和机构护理。考察访问 将在圣玛丽中心举行，这是一个为无家可归的老年人提供多项服务的社区中心。训练有素 研究助理在研究人员的监督下工作，将管理临床评估 并进行结构化访谈，以评估关键变量。社区咨询委员会，由社区和 在无家可归的政策领导和学习参与者中，将与学习团队一起指导学习 发展，并将调查结果转化为实践和政策变化。研究结果将有助于 制定临床、计划和政策建议，以优化住房成果和 为无家可归或最近无家可归的老年人提供长期服务和支持。

Project Summary/Abstract The long term goal of this proposal is to reduce the need for institutional care and identify optimal housing options in older adults with an experience of homelessness. The proposal seeks to renew AG041860, “Aging among the homeless: geriatric conditions, health and health care outcomes” also known as the Health Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study. HOPE HOME recruited and followed a cohort of 350 homeless adults aged 50 and older. Approximately half of all homeless adults are age 50 or older; the aging of the homeless population is expected to continue. In HOPE HOME, despite a median age of 58, we found a prevalence and severity of geriatric conditions, including functional, mobility and cognitive impairments, similar to that of community-living adults in their 70s. Participants had a high prevalence of behavioral health problems, social isolation, and narrow social networks. We found high rates of acute healthcare utilization and institutional care, including frequent stays in nursing homes. The majority of older adults will require assistance with activities of daily living (long-term services and support (LTSS)); most will receive this support from unpaid caregivers within their social network. Medicaid will pay for services but homeless older adults face numerous barriers to receiving LTSS, whether paid or unpaid. These barriers may increase their risk for costly and avoidable care and nursing home utilization. Therefore, we propose to extend the HOPE HOME study in order to examine 1) the prevalence of, and association between, perceived social isolation, social support, functional and cognitive impairments, and health care utilization; 2) the need for, use of, and barriers to home and community-based long-term services and supports; and 3) rates of and risk factors for nursing home placement and mortality. We propose to recruit an additional 80 participants to HOPE HOME to replace those who have died or been lost to follow-up, and to follow the cohort for three years, with six semi-annual visits for structured interviews and clinical assessments. We will recruit a sub-sample of study participants and a sample of key informants for in-depth qualitative interviews to understand the barriers to receiving LTSS, strategies to overcome those barriers, and optimal housing options that allow older homeless adults to avoid unnecessary health care utilization and institutional care. Study visits will take place at St. Mary's Center, a multiservice community-based center for older homeless adults. Trained research assistants, working under the supervision of study investigators, will administer clinical assessments and structured interviews to assess key variables. A Community Advisory Board, made up of community and policy leaders in homelessness and study participants, will work with the study team to guide study development and translate the findings into practice and policy changes. Study findings will contribute to the development of clinical, programmatic, and policy recommendations to optimize both housing outcomes and long-term services and supports for older adults who are, or recently have been, homeless.