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

描述（由申请人提供）：本研究的长期目标是确定50岁及以上无家可归的成年人的关键生活事件和无家可归的诱因，以及这些事件和因素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措施。在过去的20年里，美国无家可归者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，而现在这一比例已达到一半。人们对导致晚年无家可归的生活轨迹或与老年相关的疾病在不良结果中的作用知之甚少。旨在预防和改善无家可归的政策和计划是在年龄分布改变之前设计的，并没有解决老龄化问题。无家可归的成年人经历过早衰老，无法在他们的环境中做出补偿性改变，这表明老年状况可能是导致不良结果的一个重要因素。人们对这一人群中老年疾病的特征或后果知之甚少；这些数据是设计和实施有效政策和方案所必需的。拟议的研究将通过召集和跟踪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)确定无家可归的关键生活事件和诱因2)确定老年疾病的患病率、严重程度和轨迹及其与生命历程事件的关联3 .检查急性医疗保健利用（急诊科就诊和住院）的预测因子（包括生命历程事件和老年疾病）。参与者将从

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.