养老院中的无家可归退伍军人：满足复杂的医疗、药物使用和社会需求的护理。
Homeless Veterans in Nursing Homes: Care for Complex Medical, Substance Use, and Social Needs.
机构信息
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island.
Providence Veterans Affairs (VA) Medical Center, Center of Innovation in Long Term Services and Supports, Providence, Rhode Island.
出版信息
J Am Geriatr Soc. 2019 Aug;67(8):1707-1712. doi: 10.1111/jgs.15993. Epub 2019 Jun 17.
OBJECTIVES
The homeless population is aging, and their use of nursing homes is not well understood. We compared comorbidities (substance use, mental health conditions, and physical illness) and nursing home measures (source of admission, length of stay, and mortality in the facility) of veterans who were homeless, at risk for being homeless, or stably housed in the year prior to admission.
DESIGN
Cross-sectional analysis.
SETTING AND PARTICIPANTS
All veterans admitted to a nursing home between January 2010 and December 2016 and their housing status in the year prior to their nursing home admission.
MEASUREMENTS
Adjusted relative risks (ARRs) for the association between housing status, comorbidities, and nursing home measures.
RESULTS
Veterans who were homeless in the year prior to their community nursing home admission were younger (n = 3355; 62.5 years [SD = 10.3 years]) at admission compared to stably housed veterans (n = 64 884; 75.3 years [SD = 11.9 years]). After adjustment for demographic characteristics, homeless veterans were more likely to have diagnoses for alcohol abuse (ARR = 2.18; 95% confidence interval [CI] = 2.05-2.31), drug abuse (ARR = 3.03; 95% CI = 2.74-3.33), mental health condition (ARR = 1.49; 95% CI = 1.45-1.54), dementia (ARR = 1.14; 95% CI = 1.04-1.25), liver disease (ARR = 1.32; 95% CI = 1.23-1.41), lung disease (ARR = 1.08; 95% CI = 1.04-1.13), and trimorbidity (co-occurring substance abuse, mental illness, and physical illness) (ARR = 2.57; 95% CI = 2.40-2.74) compared to stably housed veteran nursing home users. Homeless veterans were more likely to be admitted to a nursing home from a hospital (ARR = 1.13; 95% CI = 1.08-1.17) and remain in the nursing home 90 days after admission (ARR = 1.10; 95% CI = 1.04-1.16), but were less likely to die in the facility (ARR = 0.72; 95% CI = 0.67-0.78) compared to stably housed veterans.
CONCLUSIONS
Homeless veteran nursing home users have different characteristics than stably housed veteran nursing home users. These differences may challenge nursing home staff caring for homeless patients. Nursing homes should assess resident housing status to help provide linkages with existing social services. J Am Geriatr Soc 67:1707-1712, 2019.
目的
无家可归者人口老龄化，他们对养老院的使用情况尚不清楚。我们比较了无家可归者、有沦为无家可归者风险者和在入住前一年稳定居住者的合并症（药物滥用、心理健康状况和身体疾病）和养老院措施（入院来源、住院时间和设施内死亡率）。
设计
横断面分析。
地点和参与者
2010 年 1 月至 2016 年 12 月期间入住养老院的所有退伍军人及其在入住前一年的住房状况。
测量
住房状况、合并症和养老院措施之间关联的调整后相对风险（ARR）。
结果
与稳定居住的退伍军人（n = 64884；75.3 岁[SD = 11.9 岁]）相比，在社区疗养院入院前一年无家可归的退伍军人（n = 3355；62.5 岁[SD = 10.3 岁]）入院时年龄较小。在调整了人口统计学特征后，无家可归的退伍军人更有可能被诊断为酒精滥用（ARR = 2.18；95%置信区间[CI] = 2.05-2.31）、药物滥用（ARR = 3.03；95% CI = 2.74-3.33）、心理健康状况（ARR = 1.49；95% CI = 1.45-1.54）、痴呆症（ARR = 1.14；95% CI = 1.04-1.25）、肝病（ARR = 1.32；95% CI = 1.23-1.41）、肺病（ARR = 1.08；95% CI = 1.04-1.13）和三联症（同时存在药物滥用、精神疾病和身体疾病）（ARR = 2.57；95% CI = 2.40-2.74）与稳定居住的退伍军人疗养院使用者相比。与稳定居住的退伍军人相比，无家可归的退伍军人更有可能从医院（ARR = 1.13；95% CI = 1.08-1.17）入院，并在入院后 90 天内留在疗养院（ARR = 1.10；95% CI = 1.04-1.16），但在疗养院死亡的可能性较小（ARR = 0.72；95% CI = 0.67-0.78）。
结论
无家可归的退伍军人疗养院使用者与稳定居住的退伍军人疗养院使用者具有不同的特征。这些差异可能对护理无家可归患者的疗养院工作人员构成挑战。疗养院应评估居民的住房状况，以帮助与现有的社会服务建立联系。美国老年学会杂志 67：1707-1712，2019。
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