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

项目摘要/摘要 该项目的长期目标是增加医疗保健提供者和机构的可信度，并 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。该提案寻求更新2AG041860，“无家可归者中的老龄化：社会孤立，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 中年(希望之家)研究，招募并跟踪了450名50岁或以上无家可归的成年人 年纪更大了。所有无家可归的成年人中约有一半是50岁或50岁以上的人；这一趋势预计将继续下去。希望 家庭参与者的健康状况不佳，包括身体健康问题、老年状况和功能 类似于70多岁和80多岁的住房个人的损害。美国黑人，LGBTQ+个人，以及 有精神健康问题和/或药物使用障碍的人在无家可归者中比例过高 人口，包括在希望之家学习的样本。具有这些身份的个人可能会经历 歧视和耻辱，这影响了医疗不信任。不信任可能是医疗保健利用的障碍 并与老年无家可归者的健康状况不佳有关；对这种联系知之甚少。 我们建议再招募150名希望之家的参与者，以取代那些已经去世或走失的人。 随访，并跟踪队列54个月，每半年访问一次，进行结构化访谈。我们 将招募30名参与者进行深入定性访谈，其中20名进行临床访谈 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 在为无家可归的老年人提供服务的环境中工作的20名关键线人进行深入的定性采访。 参与者的考察访问将在一座属于终身医疗的行政大楼进行，这是一家FQHC 为无家可归的老年人提供服务。参与者将在当地诊所和医疗保健机构进行观察 机构。训练有素的面试者，在研究调查人员的监督下，将管理结构化 将与研究人员进行访谈，以评估关键变量和研究调查人员 观察初级保健探视情况。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发展和翻译 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的发展， 在工具包中总结的方案和政策建议，旨在增加 卫生保健机构。

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.