High rates of geriatric syndromes among adults aged 50 or older who have transitioned from homelessness to permanent supportive housing (PSH) increase risk of high health care utilization and increased morbidity, mortality, and institutionalization. Today, there are more than 280,000 Americans living in PSH, which has been recognized as the clear solution to chronic homelessness by the U.S. federal government. The population of homeless adults aged 50 or older, whose functional age is significantly older than its chronological age, constitutes nearly half of those who are chronicall homeless. As more Americans move into PSH, there is increasing need to address factors that prevent residents from aging in place. This exploratory R21 will provide new data on whether and how evidence-based prevention and management strategies that target geriatric syndromes can be integrated in PSH. Guided by a disablement framework that positions the ability to age in place as a matter of fit between person and environment, this team will investigate how housing and support services can best match the needs of this formerly homeless aging population.
The specific aims i nclude: (1) Determine the rates of geriatric syndromes among PSH residents aged 50 or older; (2) Identify the nature of service gaps to address geriatric syndromes within PSH; and (3) Adapt an evidence-based prevention and screening program to address geriatric syndromes for use within PSH. The study will use a convergent, parallel design in which Aims 1 and 2 will be pursued during Year 1 and inform Aim 3 in Year 2. In year 1 this involves interviews and physical examinations using a representative sample (n = 203) of PSH residents from one of the largest providers of PSH in Los Angeles County, California as well as focus groups with PSH staff (n = 26) and tenants (n = 24). Year 2 includes translating the Assessing Care of Vulnerable Elders (ACOVE) framework for geriatric syndromes in primary care for implementation in PSH. This involves identifying a process for screening, assessment, and referral or treatment of various geriatric syndromes. Based on year 1 results, the investigative team will work with PSH leadership and staff to implement annual screening protocols for all residents aged 50 or older and develop a multifactorial assessment and referral process for select geriatric syndromes. Investigators will monitor the implementation of screenings, assessments, and referrals over a 6-month period by interviewing PSH staff on a monthly basis. This proposal would be the first NIH-funded study to consider factors related to aging in place in PSH, which is relevant to national policies on homelessness and health care reform efforts to achieve the triple aim of improved outcomes and experience at decreased cost for high users of health care such as Medicaid-only and Medicare-Medicaid dually eligible PSH residents. The goal is to determine the facilitators of and barriers to the delivery of this evidence-based program, which will be used to support an R01 application of a multi-site experimental design study that examine how increased capacity to address geriatric syndromes in PSH affects outcomes such as trajectories of geriatric syndromes, quality of life and care, referrals to institutional care versus time spent in the community, and cost.
High rates of geriatric syndromes among adults who have transitioned from homelessness to permanent supportive housing (PSH) increase risk of high health care utilization and increased morbidity, mortality, and institutionalization. This exploratory R21 will provide new data on whether and how evidence-based prevention and management strategies that target geriatric syndromes can be integrated in PSH. This effort is critical to achieving the triple aim of improved outcomes and experience at decreased cost for high users of health care such as PSH residents.
