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

无家可归者的老龄化：社会孤立、功能和机构照顾

• 批准号: 10179260
• 负责人: Margot B Kushel
• 金额: $ 60.82万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10179260
• 关键词: Activities of Daily Living; Acute; Adult; Age; Aging; American; Americans with Disabilities Act; Baby Booms; Birth; Caregivers; Caring; Clinical assessments; Cognitive; Communities; Development; Elderly; Eligibility Determination; Epidemiologist; Face; Fright; Funding; Goals; Health; Healthcare; High Prevalence; Home; Homelessness; Housing; Impaired cognition; Individual; Institutionalization; Intervention; Interview; Low Prevalence; Medicaid; Medical; Methods; Nursing Homes; Outcome; Participant; Physicians; Policies; Population; Prevalence; Recommendation; Recording of previous events; Research Assistant; Research Personnel; Research Training; Risk; Risk Factors; Sampling; Sampling Studies; Scientist; Services; Severities; Shelter facility; Social Network; Social isolation; Social support; Structure; Supervision; Translating; Visit; Vulnerable Populations; Work; acute care; aged; base; behavioral health; care outcomes; clinical development; cohort; community living; cost; court; evidence base; experience; follow-up; functional decline; functional disability; functional status; health care service utilization; high risk population; informant; interest; middle age; mortality; preference; programs; recruit; social; substance use

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.

项目总结/摘要 该提案的长期目标是减少对机构护理的需求，并确定最佳住房 有无家可归经历的老年人的选择。该提案旨在更新AG 041860，“老龄化 无家可归者：老年状况、健康和保健结果”，也称为“健康 结果在经历无家可归的人在中老年（希望之家）研究。希望家园 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 成年人年龄在50岁或50岁以上;无家可归人口的老龄化预计将继续下去。在希望之家， 尽管中位年龄为58岁，但我们发现老年疾病的患病率和严重程度，包括功能性， 行动和认知障碍，类似于70多岁的社区生活成年人。参与者有一个 行为健康问题、社会孤立和社交网络狭窄的高患病率。我们发现高 急性医疗保健利用率和机构护理，包括经常入住疗养院。的 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））;大多数人将从其社会网络内的无偿照顾者那里获得这种支持。医疗补助将支付 但是，无家可归的老年人在接受长期社会支助服务方面面临着许多障碍，无论是有偿还是无偿的。这些 障碍可能会增加他们使用昂贵和可避免的护理和疗养院的风险。所以我们 建议扩大HOPE HOME研究，以检查1）患病率， 感知的社会孤立、社会支持、功能和认知障碍以及医疗保健利用; 2） 家庭和社区长期服务和支持的需求、使用和障碍; 3）费率 和危险因素的养老院安置和死亡率。我们建议增聘80名 参与者到HOPE HOME，以替代那些已经死亡或失访的参与者，并随访队列 为期三年，每半年进行六次访问，进行结构化访谈和临床评估。我们将招募一名 研究参与者的子样本和深入定性访谈的关键信息提供者样本， 了解获得LTSS的障碍，克服这些障碍的策略以及最佳住房选择 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。研究访视 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种服务的社区中心。训练 研究助理将在研究者的监督下进行临床评估 和结构化访谈来评估关键变量。社区咨询委员会，由社区和 无家可归问题的政策领导人和研究参与者将与研究小组合作， 发展并将研究结果转化为实践和政策变化。研究结果将有助于 制定临床、方案和政策建议，以优化住房成果， 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。