Beydoun Hind A, Szymkowiak Dorota, Kinney Rebecca L, Jones Audrey L, Tsai Jack
U.S. Department of Veterans Affairs, VA National Center on Homelessness Among Veterans, Washington, District of Columbia, USA.
Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Gerontologist. 2025 May 10;65(6). doi: 10.1093/geront/gnaf001.
There is a large and growing population of older, formerly homeless adults living in permanent supportive housing, and there are concerns about how to address their healthcare needs. This study compared veterans aged 55 years and older residing in the Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program to an age-matched group of independently housed veterans receiving care through the U.S. Department of Veterans Affairs (VA) healthcare system on health and healthcare service use characteristics.
Cross-sectional analyses were performed on 1,436,537 (66,072 HUD-VASH vs 1,370,465 housed) eligible veterans with index encounter dates between October 1, 2021, and July 31, 2022, using linked data from the VA's Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. Propensity-score-adjusted logistic regression models were constructed to compare aging HUD-VASH versus housed veterans on outpatient and inpatient healthcare utilization.
HUD-VASH veterans were more likely to have physical and mental health morbidities, including substance use disorder than their independently housed counterparts. HUD-VASH veterans were less likely to utilize outpatient medical services, and more likely to use emergency and inpatient care services than independently housed veterans.
Older veterans in the HUD-VASH program have greater healthcare needs and different patterns of healthcare utilization than their independently housed counterparts. Targeted interventions that better engage and reduce barriers to care among aging populations in supported housing are needed.
有大量且不断增加的老年、曾经无家可归的成年人居住在永久性支持性住房中，人们对如何满足他们的医疗需求感到担忧。本研究将居住在住房和城市发展部 - 退伍军人事务部支持性住房（HUD - VASH）项目中的55岁及以上退伍军人与通过美国退伍军人事务部（VA）医疗系统接受护理的年龄匹配的独立居住退伍军人组在健康和医疗服务使用特征方面进行了比较。
使用来自VA的无家可归者运营管理与评估系统和企业数据仓库的关联数据，对2021年10月1日至2022年7月31日期间有索引就诊日期的1,436,537名（66,072名HUD - VASH退伍军人与1,370,465名有住房的退伍军人）符合条件的退伍军人进行了横断面分析。构建倾向得分调整的逻辑回归模型，以比较老年HUD - VASH退伍军人与有住房的退伍军人在门诊和住院医疗利用方面的情况。
与独立居住的退伍军人相比，HUD - VASH退伍军人更有可能患有身心健康疾病，包括物质使用障碍。与独立居住的退伍军人相比，HUD - VASH退伍军人使用门诊医疗服务的可能性较小，而使用急诊和住院护理服务的可能性较大。
HUD - VASH项目中的老年退伍军人比独立居住的退伍军人有更大的医疗需求和不同的医疗利用模式。需要有针对性的干预措施，以更好地促使支持性住房中的老年人群参与并减少护理障碍。
