title: Geriatric Homelessness: Association with Emergency Department Utilization.
abstract: BACKGROUND
  Homeless adults frequently use emergency departments (EDs), yet previous studies investigating ED utilization by the older segment received little attention. This study sought to characterize older homeless adults who utilized local urban EDs.
  
  
  METHODS
  ED encounters at three hospitals in Hamilton (Ont.) were analyzed, and demographic and clinical characteristics of the older homeless (age > 50) vs. younger counterparts (age ≤ 50) were compared during a 24-month period.
  
  
  RESULTS
  Of all adults, 1,330 were homeless, of whom 66% were above age 50. Older homeless adults sought less acute care within 30 days from an index visit compared with their younger counterparts. Non-acute illnesses constituted only 18% of triaged cases. Older homeless women with access to a primary care physician (PCP) were 3.3 times more likely to return to ED within 30 days, whereas older homeless men (irrespective of PCP access) were less likely to return to ED.
  
  
  CONCLUSIONS
  Despite high homeless patient acuity, a lesser number of ED visits with increasing age remains concerning because of previously reported high morbidity and mortality rates. Access to primary care may not be enough to reduce ED utilization. Further research is needed to evaluate acute care interventions and their effectiveness in ED, and to identify homeless patients requiring more targeted services.
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
authors.forename: Ana
authors.initials: A
authors.lastname: Hategan
authors.affiliation: St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tisi
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors.forename: Mariam
authors.initials: M
authors.lastname: Abdurrahman
authors.affiliation: Department of Psychiatry/Langley Porter Psychiatric Institute, Psychosomatic Medicine Division, UCSF Weill Institute for Neurosciences, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Bourgeois
keywords: aging; emergency department utilization; geriatric homelessness; hospital utilization