Abstract
BACKGROUND
The average age of the US homeless population is increasing. Little is known about the prevalence of geriatric syndromes in older homeless adults.
OBJECTIVE
To determine the prevalence of common geriatric syndromes in a sample of older homeless adults, and to compare these prevalences to those reported in the general older population.
DESIGN
Cross-sectional.
PARTICIPANTS
Two hundred and forty-seven homeless adults aged 50–69 recruited from eight homeless shelters in Boston, MA.
MAIN MEASURES
Interviews and examinations for geriatric syndromes, including functional impairment, cognitive impairment, frailty, depression, hearing impairment, visual impairment, and urinary incontinence. The prevalences of these syndromes in the homeless cohort were compared to those reported in three population-based cohorts.
KEY RESULTS
The mean age of the homeless cohort was 56.0 years, and 19.8% were women. Thirty percent of subjects reported difficulty performing at least one activity of daily living, and 53.2% fell in the prior year. Cognitive impairment, defined as a Mini-Mental State Examination score <24, was present in 24.3% of participants; impaired executive function, defined as a Trail Making Test Part B duration >1.5 standard deviations above population-based norms, was present in 28.3% of participants. Sixteen percent of subjects met criteria for frailty, and 39.8% had major depression, defined as a score ≥10 on the Patient Health Questionnaire 9. Self-reported hearing and visual impairment was present among 29.7% and 30.0% of subjects, respectively. Urinary incontinence was reported by 49.8% of subjects. After multivariate adjustment for demographic characteristics, homeless adults were more likely to have functional impairment, frailty, depression, visual impairment and urinary incontinence compared to three population-based cohorts of older persons.
CONCLUSIONS
Geriatric syndromes that are potentially amenable to treatment are common in older homeless adults, and are experienced at higher rates than in the general older population.
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REFERENCES
Hahn JA, Kushel MB, Bangsberg DR, Riley E, Moss AR. BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco. J Gen Intern Med. 2006;21(7):775–8.
Hibbs JR, Benner L, Klugman L, et al. Mortality in a cohort of homeless adults in Philadelphia. N Engl J Med. 1994;331(5):304–9.
Garibaldi B, Conde-Martel A, O'Toole TP. Self-reported comorbidities, perceived needs, and sources for usual care for older and younger homeless adults. J Gen Intern Med. 2005;20(8):726–30.
Gelberg L, Linn LS, Mayer-Oakes SA. Differences in health status between older and younger homeless adults. J Am Geriatr Soc. 1990;38(11):1220–9.
Tschanz JT, Corcoran C, Skoog I, et al. Dementia: the leading predictor of death in a defined elderly population: the cache county study. Neurology. 2004;62(7):1156–62.
Tinetti ME, Liu WL, Claus EB. Predictors and prognosis of inability to get up after falls among elderly persons. JAMA. 1993;269(1):65–70.
Mor V, Wilcox V, Rakowski W, Hiris J. Functional transitions among the elderly: patterns, predictors, and related hospital use. Am J Public Health. 1994;84(8):1274–80.
Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2009;2:CD007146.
Quirk M, Greene J, Owens C. Homelessness in the City of Boston, Winter 2008–2009: Annual census report. Available at: www.cityofboston.gov/Images_Documents/homeless2008_-_2009_tcm3-1764.pdf. Accessed July 7, 2011.
Burt MR, Aron LY, Douglas T, Valente J, Lee E, Iwen B. Homelessness: Programs and the People they Serve. Washington, DC: Urban Institute; 1999.
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113(12):941–8.
McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abuse Treat. 1992;9(3):199–213.
Hwang SW, Colantonio A, Chiu S, et al. The effect of traumatic brain injury on the health of homeless people. CMAJ. 2008;179(8):779–84.
Katz S, Downs TD, Cash HR, Grotz RC. Progress in development of the Index of ADL. Gerontologist. 1970;10(1):20–30.
Sullivan G, Dumenci L, Burnam A, Koegel P. Validation of the brief instrumental functioning scale in a homeless population. Psychiatr Serv. 2001;52(8):1097–1099.
Cummings SR, Nevitt MC, Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988;36(7):613–6.
Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003;348(1):42–9.
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.
Reitan RM. The validity of the trail-making test as an indicator of organic brain disease. Percept Mot Skills. 1958;8:271–6.
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993;269(18):2386–91.
Heaton RK, Miller W, Taylor MJ, Grant I. Revised comprehensive norms for an expanded Halstead-Reitan battery: demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz, Florida: Psychological Assessment Resources; 2004.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.
Bagai A, Thavendiranathan P, Detsky AS. Does this patient have hearing impairment? JAMA. 2006;295(4):416–28.
Calonge N, Petitti DB, DeWitt TG, et al. US Preventive Services Task Force. Screening for impaired visual acuity in older adults: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;15(1):37–43,W10.
Avery K, Donovan J, Peters TJ, Shaw C, Gotoh M, Abrams P. ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourol Urodyn. 2004;23(4):322–30.
Leveille SG, Kiel DP, Jones RN, et al. The MOBILIZE Boston Study: design and methods of a prospective cohort study of novel risk factors for falls in an older population. BMC Geriatr. 2008;8:16.
Centers for Disease Control and Prevention. National Health and Nutrition Examination Survey, 2007–2008. Available at: www.cdc.gov/nchs/nhanes/nhanes2007-2008/nhanes07_08.htm. Accessed July 7, 2011.
Centers for Disease Control and Prevention. National Health Interview Survey questionnaires, datasets and related documentation, 1997 to the present. Available at: www.cdc.gov/nchs/nhis/quest_data_related_1997_forward.htm. Accessed July 7, 2011.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385–401.
Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA. 2001;285(2):200–6.
White MC, Tulsky JP, Dawson C, Zolopa AR, Moss AR. Association between time homeless and perceived health status among the homeless in San Francisco. J Community Health. 1997;22(4):271–82.
Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002;92(5):778–84.
Ayanian JZ, Weissman JS, Schneider EC, et al. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284(16):2061–9.
Burra TA, Stergiopoulos V, Rourke SB. A systematic review of cognitive deficits in homeless adults: implications for service delivery. Can J Psychiatry. 2009;54(2):123–33.
Cohen CI, Teresi J, Holmes D. The mental health of old homeless men. J Am Geriatr Soc. 1988;36(6):492–501.
Pitz S, Kramann C, Krummenauer F, Pitz A, Trabert G, Pfeiffer N. Is homelessness a risk factor for eye disease? Results of a German screening study. Ophthalmologica. 2005;219(6):345–9.
Gelberg L, Siecke N. Accuracy of homeless adults' self-reports. Med Care. 1997;35(3):287–90.
Acknowledgements
We thank the data management team (Margaret Bryan, Ellen Gornstein, Diane Engorn); Michele Shaffer, PhD, for statistical consultation; the staff at participating shelters; and the subjects who generously gave their time to this study. This work was supported by the Hartford Foundation, NIH-NIA T32 AG023480, and the HRCA/Harvard Research Nursing Home Program Project, funded by NIH-NIA AG004390. Dr. Mitchell was supported by NIH-NIA K24 AG033640.
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None disclosed.
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Brown, R.T., Kiely, D.K., Bharel, M. et al. Geriatric Syndromes in Older Homeless Adults. J GEN INTERN MED 27, 16–22 (2012). https://doi.org/10.1007/s11606-011-1848-9
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DOI: https://doi.org/10.1007/s11606-011-1848-9