Health Care Access and Utilization in Older versus Younger Homeless Adults

Division of Gerontology, Beth Israel Deaconess Medical Center, USA.
Journal of Health Care for the Poor and Underserved (Impact Factor: 1.1). 08/2010; 21(3):1060-70. DOI: 10.1353/hpu.0.0344
Source: PubMed


To examine whether demographic characteristics, health care access, and acute health care utilization differ by age among homeless adults.
We interviewed all 2,175 adult attendees of a citywide homeless outreach event.
Older participants were more likely than younger participants to have a regular place for health care (59.8% vs. 44.3%, p<.01), a regular health care provider (53.6% vs. 35.6%, p<.01), and health insurance (45.5% vs. 32.1%, p<.01). Older participants were less likely to be unable to obtain needed health care (15.6% vs. 20.9%, p=.05). In a multivariate analysis, only lack of health insurance predicted inability to obtain needed care (AOR 2.9, CI 1.76-4.8).
Older and younger homeless adults have similarly high rates of acute health care utilization. The better access to care among older homeless adults speaks to the importance of insurance in determining access to care among homeless adults.

Download full-text


Available from: Margot Kushel, Oct 21, 2014
  • Source
    • "From this analysis, we can conclude that health care disparities exist within the homeless population. Health care disparities among the homeless population have been described in other studies [12,14,15]. Socioeconomic status of the homeless was consistently found to influence their utilization of health care. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We examined health care disparities in Korean urban homeless people and individual characteristics associated with the utilization of health care. We selected a sample of 203 homeless individuals at streets, shelters, and drop-in centers in Seoul and Daejeon by a quota sampling method. We surveyed demographic information, information related to using health care, and health status with a questionnaire. Logistic regression analysis was adopted to identify factors associated with using health care and to reveal health care disparities within the Korean urban homeless population. Among 203 respondents, 89 reported that they had visited health care providers at least once in the past 6 months. Twenty persons (22.5%) in the group that used health care (n = 89) reported feeling discriminated against. After adjustment for age, sex, marital status, educational level, monthly income, perceived health status, Beck Depression Inventory score, homeless period, and other covariates, three factors were significantly associated with medical utilization: female sex (adjusted odds ratio [aOR, 15.95; 95% CI, 3.97 to 64.04], having three or more diseases (aOR, 24.58; 95% CI, 4.23 to 142.78), and non-street residency (aOR, 11.39; 95% CI, 3.58 to 36.24). Health care disparities in Seoul and Daejeon homeless exist in terms of the main place to stay, physical illnesses, and gender. Under the current homeless support system in South Korea, street homeless have poorer accessibility to health care versus non-street homeless. To provide equitable medical aid for homeless people, strategies to overcome barriers against health care for the street homeless are needed.
    Full-text · Article · Nov 2011
  • [Show abstract] [Hide abstract]
    ABSTRACT: Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services. Of the 329 participants, 31.6% reported one or more cardiovascular risk factors, 32.2% one or more sexually transmitted infections, and 32.2% any psychiatric condition. Three-fourths (73.5%) had health insurance. Health care use varied: 55.4% used emergency, 48.9% primary care, and 75.9% outpatient mental health services in the past year. Across all participants, 44.7% reported IPV. Participants with IPV compared to those without were more likely to report medical and psychiatric conditions, and be insured. Participants with IPV reported using emergency (64.4%) more than primary care (55.5%) services. History of IPV was independently associated with use of emergency (Adjusted odds ratio (AOR) 1.7, 95% CI 1.0-2.7), but not primary care (AOR 1.5, 95% CI 0.9-2.6) or outpatient mental health services (AOR 1.9, 95% CI 0.9-4.1). Across the whole sample and among the subgroup with IPV, participants used emergency more than primary care services despite being relatively highly insured. Identifying and eliminating non-financial barriers to primary care may increase reliance on primary care among this high-risk group.
    No preview · Article · Dec 2011 · Journal of Community Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Homeless people are known to suffer disproportionately with health problems that reduce physical functioning and quality of life, and shorten life expectancy. They suffer from a wide range of diseases that are known to be painful, but little information is available about the nature and prevalence of chronic pain in this vulnerable group. This study aimed to estimate the prevalence of chronic pain among homeless people, and to examine its location, effect on activities of daily living, and relationship with alcohol and drugs. Methods: We conducted face-to-face interviews with users of homeless shelters in four major cities in the United Kingdom, in the winters of 2009-11. Participants completed the Brief Pain Inventory, Short Form McGill Pain questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and detailed their intake of prescribed and unprescribed medications and alcohol. We also recorded each participant’s reasons for homelessness, and whether they slept rough or in shelters. Findings: Of 168 shelter users approached, 150 (89.3%) participated: 93 participants (63%) reported experiencing pain lasting longer than three months; the mean duration of pain experienced was 82.2 months. The lower limbs were most frequently affected. Opioids appeared to afford a degree of analgesia for some, but whilst many reported symptoms suggestive of neuropathic pain, very few were taking anti-neuropathic drugs. Interpretation: The prevalence of chronic pain in the homeless appears to be substantially higher than the general population, is poorly controlled, and adversely affects general activity, walking and sleeping. It is hard to discern whether chronic pain is a cause or effect of homelessness, or both. Pain is a symptom, but in this challenging group it might not always be possible to treat the underlying cause. Exploring the diagnosis and treatment of neuropathic pain may offer a means of improving the quality of these vulnerable people’s lives.
    Full-text · Article · Jul 2013 · F1000 Research
Show more