Geriatric Conditions in a Population-Based Sample of Older Homeless Adults

Brown, Rebecca T.; Hemati, Kaveh; Riley, Elise D.; Lee, Christopher T.; Ponath, Claudia; Tieu, Lina; Guzman, David; Kushel, Margot

doi:10.1093/geront/gnw011

Cited by 115 publications

(181 citation statements)

References 46 publications

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“…3 The high prevalence of cognitive impairment in this population could be due to dementia, depression, or acute substance use. Their functional status is worse than those 20 years older in the general population.…”

Section: Discussionmentioning

confidence: 95%

“…2 Due to poor health, homeless adults are considered older at age 50. 3,4 Studies on older homeless populations show high rates of psychiatric morbidity, including depressive symptoms, psychiatric hospitalization, and alcohol use disorders. 5 Despite the high prevalence of mental health problems, there is limited research on predictors of psychiatric morbidity among older homeless adults.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Lee

Mangurian

Tieu

et al. 2017

The American Journal of Geriatric Psychiatry

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Objective To examine whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization. Design History of seven childhood adversities (physical neglect, verbal abuse, physical abuse, sexual abuse, parental death, parental incarceration, and child welfare system placement) was gathered through in-person interviews. Multivariate models examined associations between history of childhood adversities and moderate to severe depressive symptoms, lifetime history of suicide attempt, or lifetime history of psychiatric hospitalization. Setting General community. Participants The study enrolled 350 homeless adults, aged 50 and older, in Oakland, CA using population-based sampling methods. Measurements Moderate to severe depressive symptoms measured on a Center for Epidemiologic Studies–Depression Scale (CES-D ≥22), self-reported lifetime history of suicide attempt, and self-reported lifetime history of psychiatric hospitalization. Results Participants with exposure to one childhood adversity had elevated odds of reporting moderate to severe depressive symptoms (adjusted odds ratio [AOR] 2.0; 95% confidence interval [CI] 1.1–3.7) and lifetime history of suicide attempt (AOR 4.6; 95% CI 1.0–21.6) when compared to those who had none; the odds of these two outcomes increased with exposure to additional childhood adversities. Participants with four or more childhood adversities had higher odds of having a lifetime history of psychiatric hospitalization (AOR 7.1; 95% CI 2.8–18.0); there was no increase with fewer adversities. Conclusion Childhood adversities are associated with poor mental health outcomes among older homeless adults. Clinicians should collect information about childhood adversities among this high-risk population to inform risk assessment and treatment recommendations.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Lee

Mangurian

Tieu

et al. 2017

The American Journal of Geriatric Psychiatry

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“…Those born in the latter half of the baby boom (1954–1963) have had an elevated risk of homelessness throughout their lives (Culhane et al, 2013). For older homeless adults, chronic medical conditions, including geriatric syndromes, are causally linked to healthcare utilization and mortality (Brown et al, 2016b; Brown et al, 2012; Garibaldi et al, 2005; Gelberg et al, 1990). …”

Section: Introductionmentioning

confidence: 99%

Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study

Hurstak

Johnson

Tieu

et al. 2017

Drug and Alcohol Dependence

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Background We evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. We hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment. Methods We recruited 350 homeless individuals aged ≥50 years using population-based sampling and conducted structured interviews and neuropsychological testing. We evaluated alcohol use with the Alcohol Use Disorder Identification Test, defining high-severity alcohol use as a total score ≥16 or ≥4 on the alcohol dependency sub-scale. We assessed global cognition with the Modified Mini-Mental State Test (3MS) and processing speed and executive function with the Trail Making Test (TMTB), defining impairment as performing 1.5 standard deviations below the standardized mean. We used multivariable logistic regression to examine the association between alcohol use and cognition. Results Participants had a median age of 58 years [IQR 54–61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19–4.79) and executive dysfunction (AOR 3.09, CI 1.61–5.92). Conclusions Older homeless adults displayed a prevalence of cognitive impairment 3–4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders.

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“…(7) A recent population-based study from homeless shelters in Oakland, California, has shown that homeless adults in their 50s have more geriatric conditions amenable to treatment than those two decades older who are stably housed. (8) It is evident that services that address geriatric conditions are needed for older homeless adults living across diverse environments such as homeless shelter or hotel, or those living transiently with family/friends.…”

Section: Introductionmentioning

confidence: 99%

Geriatric Homelessness: Association with Emergency Department Utilization

et al. 2016

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BackgroundHomeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs.MethodsED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period.ResultsOf all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED.ConclusionsDespite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services.

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Geriatric Conditions in a Population-Based Sample of Older Homeless Adults

Cited by 115 publications

References 46 publications

Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study

Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study

Geriatric Homelessness: Association with Emergency Department Utilization

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