Health services utilization between older and younger homeless adults
Center for Biostatistics & Clinical Science and Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8828, USA. The Gerontologist
(Impact Factor: 3.21).
05/2005; 45(2):249-54. DOI: 10.1093/geront/45.2.249
Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being served by the Parkland Health and Hospital System.
The HOMES program uses two 40-ft-long mobile medical units and a fixed-site outpatient clinic to provide primary health care on a walk-in, no-charge basis to individuals who are homeless. We used a quasi-experimental design, and we randomly selected health services utilization data from 293 male (50.4%) and 288 female (49.6%) homeless patients from among the 14,876 homeless patients aged 20-64 years who used HOMES and the Parkland Health and Hospital System between June 1, 1992, and June 30, 1999. The dependent variables were measurements of inpatient and outpatient utilization of psychiatric, substance abuse, and musculoskeletal services by homeless patients. Inpatient and outpatient utilization patterns by age were assessed. Data were analyzed using a split-plot repeated measures multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), and simple linear regression.
Older homeless individuals utilized the HOMES more than inpatient services for substance abuse and musculoskeletal conditions, but they utilized inpatient services the most for psychiatric-related conditions.
This level of inpatient utilization is perhaps a result of greater severity or progression of mental illness among older homeless adults. The level of outpatient utilization is probably because the HOMES program mitigates many of the barriers that prevent homeless individuals from obtaining primary medical care.
Available from: email.nursing.arizona.edu
Available from: Dennis P Watson
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ABSTRACT: In this article I discuss providers of homeless services' perceptions of the mental health needs of individuals who are homeless and aged 50 to 64 as they relate to service provision.1 To accomplish this task, I analyzed fifty-six interviews conducted with providers of homeless services in the city of Chicago. These interviews were completed as part of a larger study conducted in collaboration with the coordinating body of the local homeless service system in an effort to better understand the unique issues affecting the older homeless population and to develop appropriate policy and programmatic responses to these issues. Issues providers most readily point to are important to understand when developing policy and programming because they are likely to represent problems providers most frequently encounter or that providers find to be the most difficult to resolve in their daily work. Qualitative analysis of interviews pointed to six recognizable issues providers were concerned with regarding this older homeless population and mental health, including: (1) specific mental health problems, (2) specific mental health subpopulations, (3) substance use/abuse, (4) therapeutic needs, (5) medication management, and (6) outreach and active engagement. Based on this analysis, policy and programmatic suggestions for the homeless service system are discussed.
Journal of Applied Social Science 03/2010; 4(1). DOI:10.1177/193672441000400104
Available from: psychiatryonline.org
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ABSTRACT: To better inform treatment strategies, this study compared mental health, substance use, physical health, and social support among young, middle-aged, and older homeless adults before and after participation in intensive case management services.
Data were obtained from the Access to Community Care and Effective Services and Supports (ACCESS) public database. Young (age 18 to 34; N=2,469), middle-aged (age 35 to 54; N=4,358), and older (age 55 or older; N=408) homeless adults with a mental illness were compared on the basis of demographic characteristics and measures of substance use, mental and general medical health, and social support at baseline by using Kruskal-Wallis and chi square tests and at three-month and 12-month follow-ups by using mixed-model analysis.
Older adults had fewer severe mental health and substance abuse problems than the two groups of younger adults at baseline. At 12-month follow-up, all age groups had improvements in housing, substance use, and psychiatric symptoms, but rates of psychiatric symptoms had improved the most among young adults, and their scores for psychiatric symptoms were the lowest on average of any group. Compared with older adults, adults in the younger groups showed greater decreases in substance use.
Older homeless adults appeared to follow a different treatment trajectory than their younger counterparts, possibly because of lower severity of mental illness at baseline, and may need specific interventions to address their unique pathways to homelessness.
Psychiatric services (Washington, D.C.) 04/2012; 63(6):561-8. DOI:10.1176/appi.ps.201100175 · 2.41 Impact Factor
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