Geriatric Homelessness: Association with Emergency Department Utilization

Hategan, Ana; Tisi, Daniel K.; Abdurrahman, Mariam; Bourgeois, James A.

doi:10.5770/cgj.19.253

Cited by 10 publications

(12 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Unterschiede zeigen sich hinsichtlich Alter und begleitender Erkrankung; Patienten über 50 Jahre leiden häufig zusätzlich an chronischem Alkoholmissbrauch, wohingegen bei jüngeren Obdachlosen insbesondere Assoziationen mit psychiatrischen Erkrankungen und Drogenmissbrauch festgestellt wurden [15]. Besorgniserregend ist jedoch, dass, trotz höherem Alter und zunehmender Morbidität, gerade Obdachlose im geriatrischen Alter im Vergleich zu jüngeren Obdachlosen offensichtlich deutlich seltener Notaufnahmen aufsuchen [16]. Auch Infektionserkrankungen sind bei einer Vielzahl dieser Patienten vorhanden.…”

Section: Vermehrte Nutzung Von Gesundheitseinrichtungen Durch Obdachloseunclassified

Alarmierungen der Berliner Notfallrettung zu obdachlosen Frequent Usern

Breuer

Pommerenke

Wollenhaupt

et al. 2020

Notarzt

View full text Add to dashboard Cite

Zusammenfassung Hintergrund Obdachlose stellen eine besonders vulnerable Gruppe dar. Mit Obdachlosigkeit gehen viele zusätzliche Risiken einher, die auch Auswirkungen auf die Gesundheit haben. Viele Obdachlose suchen vermehrt Notaufnahmen auf. Eine Rolle spielt hier insbesondere die Kombination aus einer Abhängigkeitserkrankung mit einem psychischen Leiden. Methodik Die Arbeit untersucht das Vorkommen und die Eigenschaften von obdachlosen Frequent Usern im Rettungsdienst. Weiterhin wird die räumliche Verteilung betrachtet. Es wurde ein Zeitraum von einem Jahr anhand der Daten des Einsatzleitsystems betrachtet und ausgewertet. Ergebnisse In einem Zeitraum von 12 Monaten wurden 131 obdachlose Patienten als High Frequent User (7 – 10 Einsätze/Jahr) und Super Frequent User (≥ 11 Einsätze/Jahr) identifiziert, wobei der Anteil an Super Frequent Usern überwiegt. Insgesamt wurden durch diese 2021 Einsätze verursacht. Die Patienten waren im Durchschnitt 45,6 Jahre alt und zu 81% männlichen Geschlechts. Alarmierungen erfolgten insbesondere zum Stichwort „Intoxikation“ oder zum „Psychiatrischen Notfall“. Zu Einsätzen kam es wiederholt an bestimmten „Hot Spots“, es konnte gezeigt werden, dass sich Einsätze insbesondere in bestimmten lebensweltlich orientierten Räumen (LOR) konzentrieren. Diskussion Einsätze in Zusammenhang mit obdachlosen Frequent Usern sind zahlenmäßig durchaus relevant. Obwohl es verschiedene aufsuchende Systeme, insbesondere durch Wohlfahrtsverbände, zur medizinischen Versorgung gibt, scheinen sie diese Patientengruppe nicht zu erreichen. Eine Anbindung aufsuchender Sozialarbeit an die Notfallrettung, wie bereits in anderen Ländern erprobt, könnte insbesondere im Bereich von „Hot Spots“ zu einer Reduktion der Einsätze beitragen.

show abstract

Section: Vermehrte Nutzung Von Gesundheitseinrichtungen Durch Obdachloseunclassified

Alarmierungen der Berliner Notfallrettung zu obdachlosen Frequent Usern

Breuer

Pommerenke

Wollenhaupt

et al. 2020

Notarzt

View full text Add to dashboard Cite

show abstract

“…2,10,11 Hategan et al demonstrated gender differences in which homeless women were more likely to return to the ED even when provided with access to a primary care provider. 12 Rosenheck et al studied the promotion of healthcare integration using outreach ACCESS program (Access to Community Care and Effective Services and Support) among homeless patients and failed to show better clinical outcomes. 13 A study to assist homeless veterans with increasing engagement in their care showed no improvement in the rates of alcohol use, drug use, or hospitalization between patients receiving high and low intensity outreach programs.…”

Section: Introductionmentioning

confidence: 99%

Dedicated homeless clinics reduce inappropriate emergency department utilization

Holmes

Macdonald

et al. 2020

JACEP Open

View full text Add to dashboard Cite

Background The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. Methods We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. Results A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty‐nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate ( P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50–0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. Conclusion Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.

show abstract

“…A multidisciplinary approach that offers psychiatric and gerontology consultations may lead to more cost-effective care and reduced LOS (McKevitt et al 2003). Although there are published studies looking at geriatric, homeless individuals, there is little to no literature comparing two complex and vulnerable populations, geriatric and homeless, in a trauma setting (Hategan et al 2016;Spiker et al 2001;Brown et al 2013;Brown et al 2017;Brown et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Disparities in triage and management of the homeless and the elderly trauma patient

et al. 2020

View full text Add to dashboard Cite

Background: Trauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community. Methods: A retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed. Results: Of 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates. Conclusions: Homeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to preexisting health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.

show abstract

Geriatric Homelessness: Association with Emergency Department Utilization

Cited by 10 publications

References 10 publications

Alarmierungen der Berliner Notfallrettung zu obdachlosen Frequent Usern

Alarmierungen der Berliner Notfallrettung zu obdachlosen Frequent Usern

Dedicated homeless clinics reduce inappropriate emergency department utilization

Disparities in triage and management of the homeless and the elderly trauma patient

Contact Info

Product

Resources

About