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: 10467926
• 负责人: Margot B Kushel
• 金额: $ 66.08万
• 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 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10467926
• 关键词: 2019-nCoV; Adherence; Adult; Age; Aging; Black American; COVID-19 pandemic; Caring; Characteristics; Clinic; Clinical; Communication; Communities; Criminal Justice; Development; Discrimination; Elderly; Epidemiologist; Ethnography; General Population; Goals; Government; Health; Health Personnel; Health system; Healthcare; Healthcare Systems; Homelessness; Housing; Individual; Institution; Insurance; Intervention; Interview; Interviewer; Knowledge; Lesbian Gay Bisexual Transgender Queer; Link; Longitudinal cohort study; Mediating; Medical; Mental Health; Methodology; Methods; Morbidity - disease rate; Native Americans; Nature; Nurses; Outcome; Participant; Persons; Physicians; Play; Policies; Population; Preventive; Primary Health Care; Psychologist; Public Health; Recommendation; Research; Research Methodology; Research Personnel; Role; Sampling; Sampling Studies; Scientist; Sexual and Gender Minorities; Social Environment; Social Work; Social isolation; Structure; Substance Use Disorder; Supervision; System; Training; Translating; Transportation; Trust; Visit; Work; barrier to care; base; care providers; clinical development; cohort; distrust; experience; follow-up; functional decline; functional disability; gender minority group; health care service utilization; high risk population; improved; informant; medication compliance; member; middle age; mortality; novel; perceived discrimination; physical conditioning; policy recommendation; racial and ethnic; racial minority; racism; recruit; social stigma; therapy design; trend; trustworthiness; uptake; working group

PROJECT SUMMARY/ABSTRACT The long-term goal of this project is to increase the trustworthiness of health care providers and institutions and decrease the rates of medical mistrust among homeless-experienced older adults, thereby, improving health outcomes. The proposal seeks to renew 2AG041860, “Aging Among the Homeless: Social Isolation, Function and Institutional Care” and continue the Health Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study, which recruited and followed a cohort of 450 homeless adults age 50 or older. Approximately half of all homeless adults are age 50 or older; this trend is expected to continue. HOPE HOME participants have poor health, including physical health problems, geriatric conditions, and functional impairments similar to housed individuals in their 70s and 80s. Black Americans, LGBTQ+ individuals, and those with mental health problems and/or substance use disorders are overrepresented in the homeless population, including in the HOPE HOME study sample. Individuals with these identities may experience discrimination and stigma, which influence medical mistrust. Mistrust may be a barrier to health care utilization and related to poor health outcomes in older homeless adults; little is known about this association. We propose to recruit an additional 150 HOPE HOME participants to replace those who have died or been lost to follow-up, and to follow the cohort for 54 months with nine semi-annual visits for structured interviews. We will recruit a sub-sample of 30 participants for in-depth qualitative interviews and 20 of those for clinical observation to understand the factors associated with medical mistrust and its dynamic nature. We will recruit 20 key informants who work in settings that serve homeless older adults for in-depth qualitative interviews. Study visits for participants will take place at an administrative building belong to Lifelong Medical, a FQHC which serves older homeless adults. Participant observations will take place at local clinics and health care institutions. Trained interviewers, under the supervision of study investigators, will administer structured interviews to assess key variables and study investigators with research personnel will conduct participant observation of primary care visits. A Community Advisory Board, composed 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 a toolkit, practice, and policy. Study findings will contribute to the development of clinical, programmatic, and policy recommendations summarized in a toolkit aimed to increase trustworthiness of health care institutions.

项目概要/摘要 该项目的长期目标是提高医疗保健提供者和机构的可信度， 减少无家可归的老年人对医疗的不信任率，从而改善健康 结果。该提案旨在更新 2AG041860，“无家可归者的老龄化：社会隔离、功能 和机构护理”，并继续改善老年人无家可归者的健康状况 Middle agE (HOPE HOME) 研究招募并跟踪了 450 名 50 岁或以上无家可归的成年人 年纪大了。大约一半无家可归的成年人年龄在 50 岁或以上；预计这一趋势将持续下去。希望 HOME 参与者健康状况不佳，包括身体健康问题、老年病和功能障碍 与 70 多岁和 80 多岁的居住者类似的损伤。美国黑人、LGBTQ+ 个人，以及 无家可归者中有心理健康问题和/或药物滥用障碍的人数过多 人口，包括 HOPE HOME 研究样本。具有这些身份的个人可能会经历 歧视和耻辱会影响医疗不信任。不信任可能是医疗保健利用的障碍 与无家可归的老年人健康状况不佳有关；人们对这个协会知之甚少。 我们建议再招募 150 名 HOPE HOME 参与者来代替那些已经死亡或失踪的人 进行随访，并对队列进行为期 54 个月的跟踪，每半年进行 9 次访问进行结构化访谈。我们 将招募 30 名参与者的子样本进行深入的定性访谈，其中 20 名参与者进行临床 观察以了解与医疗不信任相关的因素及其动态性质。我们将招募 20 位在为无家可归的老年人提供服务的环境中工作的关键信息提供者进行了深入的定性访谈。 参与者的考察访问将在终身医疗 (FQHC) 所属的行政大楼进行 为无家可归的老年人提供服务。参与者观察将在当地诊所和医疗机构进行 机构。训练有素的访谈员在研究调查员的监督下，将进行结构化的访谈 评估关键变量和研究调查人员与研究人员的访谈将对参与者进行 初级保健就诊的观察。社区咨询委员会，由社区和政策领导人组成 无家可归者和研究参与者将与研究团队合作，指导研究开发和翻译 将调查结果转化为工具包、实践和政策。研究结果将有助于临床、 工具包中总结的纲领性和政策建议旨在提高 医疗保健机构。