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

项目总结/摘要 该项目的长期目标是提高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，从而改善健康状况 结果。该提案旨在更新2AG 041860，“无家可归者中的老龄化：社会隔离，功能 和机构护理”，并继续在老年人经历无家可归的人的健康结果 中年（HOPE HOME）研究，该研究招募并跟踪了450名50岁或60岁以上无家可归的成年人。 老了所有无家可归的成年人中约有一半年龄在50岁或50岁以上;预计这一趋势将继续下去。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。 与七八十岁的人相似的损伤。美国黑人，LGBTQ+个人，以及 无家可归者中有精神健康问题和/或物质使用障碍的人数过多 包括HOPE HOME研究样本。拥有这些身份的人可能会经历 歧视和耻辱，这影响了对医疗的不信任。不信任可能是利用卫生保健的障碍 并与无家可归的老年人的健康状况不佳有关;对这种关联知之甚少。 我们建议增聘150名“希望之家”的参与者，以代替那些已经死亡或失踪的人士 随访，并随访队列54个月，每半年进行9次结构化访谈。我们 将招募30名参与者进行深入的定性访谈，其中20人进行临床研究。 观察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名在为无家可归的老年人提供服务的环境中工作的关键线人进行深入的定性访谈。 受试者的研究访视将在属于Lifelong Medical（一家CIMHC）的行政大楼进行 为无家可归的老年人服务参与者观察将在当地诊所和医疗保健机构进行 机构职能体系在研究者的监督下，经过培训的访谈者将进行结构化的 访谈以评估关键变量，研究人员和研究人员将对参与者进行 观察初级保健访问。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， 在一个工具包中总结的方案和政策建议，旨在提高 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.