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

描述(由申请人提供)：这项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，以及这些事件和诱因与老年病的流行率、严重性、发展轨迹和后果之间的关系，以指导预防、保健、社会服务和住房干预。在过去的20年里，美国无家可归的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，而现在有一半。人们对导致晚年无家可归的生活轨迹或老年相关疾病在不良结局中的作用知之甚少。旨在预防和改善无家可归现象的政策和方案是在年龄分布发生变化之前制定的，没有解决老龄化问题。无家可归的成年人经历了过早的衰老，无法对他们的环境进行补偿性改变，这表明老年条件可能是导致不良结果的一个重要因素。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。拟议的研究将通过收集和跟踪350名50岁及以上的无家可归成年人的队列来解决这一差距，以解决以下目标：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、严重性和发展轨迹及其与生活事件的关系；3检查急性卫生保健利用(急诊科就诊和住院)的预测因素(包括生命过程事件和老年病情况)。参与者将从以下地点招募 使用多阶段概率抽样设计，在加利福尼亚州奥克兰的紧急避难所、补贴食品计划和无家可归者营地。参与者将被跟踪3年，并获得 基线研究访问和6次半年一次的跟踪访问以进行结构化访谈。子样本将接受深入访谈，以探索关键事件和沉淀物。考察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项服务的社区中心。训练有素的研究助理将在研究人员和一名神经心理学家的密切监督下进行临床评估和结构化访谈，使用经过验证的工具来评估无家可归之前的生活事件、老年状况(功能和认知障碍)、行为健康(精神健康、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、住院治疗)。我们将通过死亡记录登记收集死亡数据。一个由社区和政策领导人组成的咨询委员会在无家可归者方案和政策方面拥有广泛的专业知识，将与研究小组合作，指导研究发展，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、方案和政策建议，以预防和改善老年人无家可归的影响。

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.