Aging among the homeless; geriatric conditions, health and healthcare outcomes

无家可归者的老龄化；

• 批准号: 8437103
• 负责人: Margot B Kushel
• 金额: $ 61.49万
• 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 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8437103
• 关键词: Accident and Emergency department; Acute; Address; Adult; Adverse event; Age; Age Distribution; Aging; Alcohol or Other Drugs use; Alcohols; Attention; California; Categories; Characteristics; Childhood; Chronic Disease; Clinical; Clinical assessments; Cognition; Cohort Studies; Communicable Diseases; Communities; County; Data; Death Records; Development; Disease; Elderly; Emergency Situation; Enrollment; Environment; Event; Food; General Population; Goals; Guide prevention; Health; Health Status; Healthcare; Homelessness; Hospitalization; Housing; Impaired cognition; Individual; Inpatients; Intervention; Interview; Lead; Life; Life Cycle Stages; Mental Health; Mental disorders; Methods; Occupations; Outcome; Participant; Persons; Policies; Population; Premature aging syndrome; Prevalence; Prevention; Probability Samples; Public Health; Recommendation; Recruitment Activity; Registries; Research; Research Methodology; Research Personnel; Research Training; Risk Factors; Role; Sampling; San Francisco; Severities; Shelter facility; Social Work; Staging; Structure; Substance Use Disorder; Supervision; Translating; United States; Visit; Work; age related; aged; base; behavioral health; cohort; demographics; design; early onset; evidence base; experience; follow-up; functional disability; functional status; health care service utilization; instrument; mortality; physical conditioning; prevent; programs; response; service intervention; young adult

DESCRIPTION (provided by applicant): The long-term goal of this study is to determine, in homeless adults aged 50 and over, the key life events and precipitants of homelessness and how these are associated with the prevalence, severity, trajectory and consequences of geriatric conditions in order to guide prevention, healthcare, social service and housing interventions. The average age of homeless adults in the United States has risen dramatically in the last 20 years; while only 11% of the homeless population was age 50 and older in 1990, half is now. Little is known about the life trajectories that lead to late-life homelessness or the role of agin-related conditions in poor outcomes. Policies and programs directed at preventing and ameliorating homelessness were designed before the age distribution changed and do not address aging issues. Homeless adults experience premature aging and are not able to make compensatory changes in their environment, suggesting that geriatric conditions may be a substantial factor in poor outcomes. Little is known about the characteristics or consequences of geriatric conditions in this population; these data are needed to design and implement effective policies and programs. The proposed study will address this gap by assembling and following a cohort of 350 homeless adults age 50 and older in order to address the following aims: 1) To identify key life events and precipitants of homelessness 2) To determine the prevalence, severity and trajectory of geriatric conditions and their association with life course events and 3 To examine predictors (including life course events and geriatric conditions) of acute health care utilization (Emergency Department visits and hospitalizations). Participants will be recruited from emergency shelters, subsidized food programs, and homeless encampments in Oakland, CA using a multi- stage probability sampling design. Participants will be followed for 3 years, with a baseline study visit and 6 semi-annual follow-up visits for structured interviews. Subsamples will undergo in-depth interviews to explore key events and precipitants. 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 close supervision of the study investigators and a neuropsychologist, will administer clinical assessments and structured interviews using validated instruments to assess life course events preceding homelessness, geriatric conditions (functional and cognitive impairments), behavioral health (mental health and alcohol and illicit substance use), physical health (chronic diseases), and acute healthcare utilization (Emergency Department visits, inpatient hospitalizations). We will gather mortality data through death record registries. An Advisory Board of community and policy leaders with extensive expertise with homeless programs and policies will work with the study team to guide study development and help translate the findings into practice and policy changes. Study findings will ultimately contribute to the development of clinical, programmatic and policy recommendations to prevent and ameliorate the effects of homelessness among older adults. PUBLIC HEALTH RELEVANCE: The proposed study will identify the key life events and precipitants of homelessness as well as the prevalence, severity and consequences of geriatric conditions among homeless adults aged 50 and older. While half of homeless adults are aged 50 or older, there is little data on life trajectories or aging-related conditions in this populatin. The results of this study will provide an evidence-base to guide policies and programs to prevent late-life homelessness and ameliorate poor outcomes in older homeless adults.

描述（由申请人提供）：本研究的长期目标是确定 50 岁及以上无家可归成年人的关键生活事件和无家可归的诱因，以及这些事件与老年疾病的患病率、严重程度、轨迹和后果之间的关系，以指导预防、医疗保健、社会服务和住房干预。过去 20 年来，美国无家可归成年人的平均年龄急剧上升； 1990 年，只有 11% 的无家可归者年龄在 50 岁及以上，而现在这一数字已达到一半。人们对导致晚年无家可归的生活轨迹或与阿格相关的疾病在不良后果中的作用知之甚少。旨在预防和改善无家可归状况的政策和计划是在年龄分布发生变化之前制定的，并未解决老龄化问题。无家可归的成年人会过早衰老，并且无法对其环境做出补偿性改变，这表明老年状况可能是导致不良结果的一个重要因素。人们对这一人群老年病的特征或后果知之甚少；需要这些数据来设计和实施有效的政策和方案。拟议的研究将通过收集和跟踪 350 名 50 岁及以上无家可归的成年人来解决这一差距，以实现以下目标： 1) 确定关键的生活事件和无家可归的诱因 2) 确定老年病的患病率、严重程度和轨迹及其与生命历程事件的关系 3) 检查急性医疗保健利用（急诊科就诊和就诊）的预测因素（包括生命历程事件和老年病） 住院治疗）。参与者将从 使用多阶段概率抽样设计，对加利福尼亚州奥克兰的紧急避难所、食品补贴计划和无家可归者营地进行了研究。参与者将被跟踪 3 年， 基线研究访问和 6 次半年随访的结构化访谈。子样本将接受深入访谈，以探索关键事件和促成因素。研究访问将在圣玛丽中心进行，这是一个为无家可归的老年人提供多功能服务的社区中心。训练有素的研究助理在研究人员和神经心理学家的密切监督下工作，将使用经过验证的仪器进行临床评估和结构化访谈，以评估无家可归之前的生命历程事件、老年疾病（功能和认知障碍）、行为健康（心理健康、酒精和非法药物使用）、身体健康（慢性病）和急性医疗保健利用（急诊科就诊、住院病人） 住院治疗）。我们将通过死亡记录登记处收集死亡率数据。由在无家可归者计划和政策方面拥有丰富专业知识的社区和政策领导人组成的咨询委员会将与研究团队合作，指导研究进展，并帮助将研究结果转化为实践和政策变化。研究结果最终将有助于制定临床、规划和政策建议，以预防和改善老年人无家可归的影响。 公共卫生相关性：拟议的研究将确定 50 岁及以上无家可归者的关键生活事件和诱因，以及老年疾病的患病率、严重程度和后果。虽然一半无家可归的成年人年龄在 50 岁或以上，但关于该人群的生活轨迹或衰老相关状况的数据却很少。这项研究的结果将为指导政策和计划提供证据基础，以防止晚年无家可归并改善老年无家可归者的不良后果。