Emergency Department Use in a Cohort of Older Homeless Adults: Results From the HOPE HOME Study.

Abstract

The median age of single homeless adults is over 50, yet little is known about their emergency department (ED) use. We describe use of and factors associated with ED use in a sample of homeless adults 50 and older. We recruited 350 participants who were homeless and 50 or older in Oakland, California. We interviewed participants about residential history in the prior 6months, health status, health-related behaviors, and health services use and assessed cognition and mobility. Our primary outcome was the number of ED visits in the prior 6months based on medical record review. We used negative binomial regression to examine factors associated with ED use. In the 6months prior to enrollment, 46.3% of participants spent the majority of their time unsheltered; 25.1% cycled through multiple institutions including shelters, hospitals, and jails; 16.3% primarily stayed with family or friends; and 12.3% had become homeless recently after spending much of the prior 6 months housed. Half (49.7%) of participants made at least one ED visit in the past 6months; 6.6% of participants accounted for 49.9% of all visits. Most (71.8%) identified a regular non-ED source of healthcare; 7.3% of visits resulted in hospitalization. In multivariate models, study participants who used multiple institutions (incidence rate ratio [IRR]=2.27; 95% confidence interval [CI]=1.08 to 4.77) and who were unsheltered (IRR=2.29; 95% CI=1.17 to 4.48) had higher ED use rates than participants who had been housed for most of the prior 6months. In addition, having health insurance/coverage (IRR=2.6; CI=1.5 to 4.4), a history of psychiatric hospitalization (IRR=1.80; 95% CI=1.09 to 2.99), and severe pain (IRR=1.72; 95% CI=1.07 to 2.76) were associated with higher ED visit rates. A sample of adults aged 50 and older who were homeless at study entry had higher rates of ED use in the prior 6months than the general U.S. age-matched population. Within the sample, ED use rates varied based on individuals' residential histories, suggesting that individuals' ED use is related to exposure to homelessness.