Perhaps end-of-life considerations for homeless elderly could be considered a topic of fictional creation, a sociomedical unicorn. Because, depending on one’s perspective, the curse or blessing of homelessness is the failure to even reach an age that is generally acknowledged as “geriatric”. Advance care planning is the process by which one decides what types of treatment one prefers at the end of life, but also who can speak on his or her behalf should the person become unable to speak for himself or herself. This chapter discusses advance care planning with aging homeless at end of life. It provides brief description on challenges in accessing healthcare for homeless aging, perceptions of dying of the aging homeless, and spiritual and religious consideration at end of life. The chapter then discusses palliative and hospice care delivery for the geriatric homeless. It also discusses innovative palliative care delivery models.
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Cardiovascular disease (CVD) remains the leading cause of death in older homeless people. Traditional CV risk factors, such as hypertension, diabetes, smoking, and hyperlipidemia, and nontraditional CV risk factors, such as substance abuse, psychological stress, and lack of diagnostic and preventative medical care, contribute to CVD in this population. Barriers to CV prevention and treatment in homeless individuals include their environment, lack of access to care, substance dependence, mental illness, food insecurity, and medication non-adherence. Healthcare models that provide Housing First and just-in-time care by non-judgmental multidisciplinary teams have been shown to improve the CV health of people who are homeless. CV health requires prevention, as well as prompt intervention, and close follow-up. CV healthcare practice adaptations for homeless clients include ascertaining living conditions, improvising the physical exam, scheduling longer clinic appointments with frequent follow-up, prioritization of the plan of care, and simplification of the medication regimen.
- Go to chapter: Infectious Diseases in Homeless Geriatrics Population: Part II: Bacterial Infections, Tuberculosis, and Arthropods Infestation
Infectious Diseases in Homeless Geriatrics Population: Part II: Bacterial Infections, Tuberculosis, and Arthropods Infestation
Homelessness is a rising healthcare problem. Secondary to poor living situations and limited access to healthcare services, homeless people are at increased risk for exposure to various communicable diseases, including viral and bacterial infections, tuberculosis, and arthropod carried diseases. This chapter briefly discusses infectious diseases such as bacterial infections, tuberculosis, and arthropods infestation in homeless geriatrics population. The bacterial infections covered in the chapter are urinary tract infections, bacterial pneumonia, and foot infections. The arthropods infestations include lice, scabies mites, bed bugs, delusional parasitosis. There are other causes of bites and lesions aside from lice, scabies mites, and bed bugs. Spiders, mosquitoes, ticks, fleas, and ants also pose risks for homeless people, particularly those who live outdoors. Homeless people can have a difficult time avoiding bites from mosquitoes and ticks, which can carry diseases.
Homelessness is a rising healthcare problem. Secondary to poor living situations and limited access to healthcare services, homeless people are at increased risk for exposure to various communicable diseases. The diseases found in the homeless population include viral infections, hepatitis A, hepatitis B, hepatitis C, HIV/AIDS, and influenza. Homelessness, on one hand, increases the prevalence of infectious diseases, and aging, on the other hand, makes the elderly more vulnerable to infections. Homelessness is associated with numerous behavioral, social, and environmental risks that expose persons to many communicable diseases, including viral infections, which may spread among the homeless, and aside from posing a threat to individuals’ health can lead to outbreaks that can become serious public health concerns. Homeless populations may be at higher risk for West Nile virus and other mosquito-borne diseases due to their increased exposure to the outdoors and their limited access to preventive measures.
Geriatric homelessness (GH) is a significant and growing social, political, economic, and humanistic issue throughout the United States. This chapter presents case studies that will highlight the GH in four urban areas and among veterans. It defines geriatric homelessness, outlines its general dimensions, explicates its two primary etiologies (loss of employment and the lack of affordable housing in the areas where most homeless persons are located), and gives examples of the diversity of the problem and attempts at solutions in four cities and among veterans. The case examples show that the solution to the medical and psychological issues in the GHP involves much more than traditional medical practices and therapies. The solutions, involving among others politics, economics, and housing, are those of communities and localities acting to positively affect the lives of individuals and families of all ages, particularly the growing population of GHPs in the United States.
Skin problems are one of the most common presenting complaints of homeless persons to emergency departments and community clinics, estimated at 20% of such visits. Adult homeless suffer the usual skin diseases common to nonhomeless adults, but in addition can suffer more frequent infections, dermatitis, and wounds related to their compromised living status. This chapter focuses on the diagnosis, treatment, and triage of common skin complaints in homeless adults. Hospital admission should be considered whenever fever, chills, tachycardia, hypotension, or severe or rapidly progressing infection or other admission criteria are present. Additionally, if outpatient treatment is unrealistic given limited social or logistical challenges, admission may be appropriate even without the aforementioned standards, in order to ensure appropriate critical treatments and resolution. The chapter provides case example for infestations, bites and infections, wounds, neoplasms, and rashes.
The ethical and legal issues that arise in the care of the geriatric homeless population are complex not only because they involve nuances unique to either population, but because the combination of being undomiciled and aged leads to significant unique vulnerability. The usual dilemmas in geriatrics of creating an acceptable process for informed consent, judging adequate decision-making capacity for treatment acceptance and refusal, determining appropriate substitute decision makers, preserving privacy and confidentiality, promoting advance care planning, and allocating healthcare resources are made more challenging in the homeless. Complicating factors include ongoing psychiatric comorbidities and serious medical illnesses, which change a patient’s mentation and cognitive capacities. Therefore, appropriate assessment and treatment in these complex cases no doubt requires input from an interprofessional team. This chapter presents a case with changing psychiatric, ethical, and legal issues to illustrate how such complex tensions arise and may be resolved in a homeless geriatric patient.
This chapter provides brief description on malnutrition and aging, and nutrition and homelessness. It discusses nutritional impact of substance abuse, and nutrition assessment and intervention. The chapter explores the impact that homelessness and food insecurity has on the nutritional status of older adults. Interventions must be tailored to accommodate the patient’s financial resources, medical conditions, and ultimately his or her own personal goals in order to be effective. Patients may be completely disengaged from nutrition education and focused on other priorities, which are essential for survival, that is, shelter and safety, thus making nutrition education the least effective intervention for that patient at that moment in time. Ideally, the homeless geriatric person would be monitored and re-evaluated; however, follow-up may be unrealistic. What does nutrition assessment look like in action? The chapter provides a case study to describe this question.
This book serves as the pillar for clinical care teams to improve health equity among homeless older adults. Interdisciplinary care teams are essential in complex homeless older population clinical practice, as all disciplines must work together to address medical, surgical, behavioral, nutritional, and social determinants of health. All clinicians who treat older adults, from the independent to the frail, should approach problem solving via an inclusive approach that includes social work, pharmacy, nursing, rehabilitation, administrative, and medicine inputs. The social determinants of health that contribute to the complexities of clinical care outcomes cannot be addressed within silos. The book reflects a holistic care model to assist clinicians in the complicated homeless population that is continuing to change in the instability of the homeless environment. The book is divided into 14 chapters. The chapters in are organized by problems most commonly faced by clinicians in servicing homeless populations: mental, social, medical, and surgical challenges. Chapter one presents definition and background of geriatric homelessness. Chapter two discusses chronic mental health issues (psychosis) in the geriatric homeless. Chapters three and four describe neurocognitive disorders, depression, and grief in the geriatric homeless population. The next two chapters explore ethical, legal, housing and social issues in the geriatric homeless. Chapters seven and eight discuss infectious diseases in homeless geriatrics population. Chapter nine is on cardiovascular disease in homeless older adults. Chapter 10 describes care of geriatric diabetic homeless patients. Chapter 11 discusses geriatric nutrition and homelessness. Chapter 12 presents barriers and applications of medication therapy management in the homeless population. Chapter 13 describes dermatologic conditions in the homeless population. Finally, the book addresses end-of-life considerations in homelessness and aging.
- Go to chapter: Barriers and Applications of Medication Therapy Management in the Homeless Population
Medication therapy management (MTM) remains a challenging endeavor to optimally implement in the homeless population. Working in various settings in collaboration with other health professionals, pharmacists are spearheading patient-centered efforts to optimize MTM and assist the homeless with attaining health insurance and continuity of care. In the case of MTM, homeless persons may face significant hardship in not only procuring and using effective drug therapy, but also in following-up with their providers and establishing provider–patient relationships that will help them to meet their target therapeutic goals. This chapter enumerates a review of the more common barriers to MTM in the homeless population, followed by a number of practical applications of MTM in optimizing the health of the homeless. In order to appreciate the value and role that stable MTM can offer the homeless, the chapter briefly discusses perspectives on homeless health and the concept of MTM.