Raven Maria C, Tieu Lina, Lee Christopher T, Ponath Claudia, Guzman David, Kushel Margot
Department of Emergency Medicine, University of California at San Francisco, San Francisco, CA.
Philip R. Lee Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA.
Acad Emerg Med. 2017 Jan;24(1):63-74. doi: 10.1111/acem.13070.
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 6 months, 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 6 months based on medical record review. We used negative binomial regression to examine factors associated with ED use.
In the 6 months 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 6 months; 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 6 months. 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 6 months 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.
单身无家可归成年人的年龄中位数超过50岁，但对于他们前往急诊科（ED）就诊的情况却知之甚少。我们描述了50岁及以上无家可归成年人样本中急诊科的就诊情况以及与之相关的因素。
我们在加利福尼亚州奥克兰招募了350名年龄在50岁及以上的无家可归参与者。我们就参与者过去6个月的居住史、健康状况、健康相关行为以及医疗服务使用情况进行了访谈，并评估了他们的认知和行动能力。我们的主要结局是根据病历审查得出的过去6个月内的急诊科就诊次数。我们使用负二项回归来研究与急诊科就诊相关的因素。
在入组前的6个月中，46.3%的参与者大部分时间处于无庇护状态；25.1%的人在多个机构间辗转，包括收容所、医院和监狱；16.3%的人主要与家人或朋友住在一起；还有12.3%的人在过去6个月的大部分时间里有住所，但最近变得无家可归。在过去6个月中，一半（49.7%）的参与者至少去过一次急诊科；6.6%的参与者占了所有就诊次数的49.9%。大多数（71.8%）参与者找到了常规的非急诊科医疗保健来源；7.3%的就诊导致了住院治疗。在多变量模型中，使用多个机构的研究参与者（发病率比[IRR]=2.27；95%置信区间[CI]=1.08至4.77）和无庇护的参与者（IRR=2.29；95%CI=1.17至4.48）的急诊科就诊率高于过去6个月大部分时间有住所的参与者。此外，拥有医疗保险/保障（IRR=2.6；CI=1.5至4.4）、有精神科住院史（IRR=1.80；95%CI=1.09至2.99）以及有严重疼痛（IRR=1.72；95%CI=1.07至2.76）与较高的急诊科就诊率相关。
研究开始时无家可归的50岁及以上成年人样本在过去6个月中的急诊科就诊率高于美国年龄匹配的一般人群。在该样本中，急诊科就诊率因个人居住史而异，这表明个人的急诊科就诊与无家可归的经历有关。
