Transcript Chronically Medically Ill Homeless Women

Chronically Medically Ill
Homeless Women:
Characteristics at Baseline
Romina Kee MD, MPH
Collaborative Research Unit
John H. Stroger Hospital
CRU
A Personal Story
JC is a 40 year old African-American
woman diagnosed with AIDS and enrolled
into our study after a hospitalization for
pneumonia. She has 3 children ages 12 to
18 who have been placed into adoption and
with whom she has no contact. Her mother
is deceased and her father is currently in
prison.
A Personal Story
Homeless for the last 2 years she is
dependent on crack cocaine and alcohol
with 3 failed attempts at residential
treatment. Her recent stay at a local
women’s shelter came to an end when she
was barred for exchange sex and drug
activity. Despite multiple incarcerations she
has continued participating in the study.
Background
• Homelessness rates have increased over the
last 2 decades
• Chronic medical illness among the
homeless is common (30-45%)
• Medical hospitalization rates are 4-5X of
general population
• Psychiatric hospitalization rates are 2X
higher
Background
• Female heads of households who are
homeless found to have increasing rates
physical health limitations, major
depressive illness and Post Traumatic Stress
Disorder*
• Limited data on medical health status of
hospitalized homeless women
*Weinreb LF et al., AJPH 2006 Aug: 96 (8)
Study Goal
To describe the baseline physical and mental
health syndromes in homeless women
hospitalized for a chronic medical illness
(CMI)
Methods
• Sub-study of a longitudinal randomized
clinical trial evaluating the effect of
providing housing and comprehensive case
management to the homeless with CMIs
• Recruited from 3 Chicago hospitals (public,
private, VA)
Methods
•
•
•
•
•
One of 15 qualifying CMIs
Unstable Housing 30 days prior
Able to self-care
No dependents requiring housing
English or Spanish speaking
• Face to face interview
ACTG-SF 21, Prime-MD PHQ, ASI
Demographics (N = 99)
Mean Age
African-American
White/Other
Latino
High School or greater
Never Married
Currently Married
% or Mean , SD
43, 9.7
81
16
2
53
52
5
Demographics (N = 99)
Children - yes
Children - number
% or Mean, SD
80
2.7, 2.3
Lived 30 days prior enrollment
family/friends
shelter
street
institution
treatment facility
65
24
38
37
4
18, 11
17, 12
18, 9
7, 7
14, 14
Health Status
%
CMI
single
two
Hypertension
HIV
Pulmonary Disease
Diabetes
69
22
43
34
27
10
Self-Rated Health Status
fair-poor
79
Mental Health
%
Somatoform disorder
56
Anxiety syndrome
45 (37/82)
Depression
major
16
other
23
Suicidal Ideation
36
Substance Use
%
Alcohol Abuse
13
Use past 30 days
%
Alcohol
Mean Days, SD
50
5, 9
Alcohol-Intoxication 35
3,7
Heroin
32
4, 10
Cocaine
47
6, 10
Women compared to Men
Women %
Children - Yes
80
Hypertension
43
Somatoform
57
Alcohol abuse
13
Men %
68
31
43
87
Lived 30 days prior to enrollment
Family/friends 66
45
Institution
38
55
p value
.010
.013
.022
.006
.000
.022
Conclusions
This cohort of homeless women had
• multiple CMIs
• poor self-rated health status
• substantial and recent alcohol, drug use
• high rates of suicidal ideation, anxiety and
depressive symptoms
• frequently lived street or shelter prior to admission
Conclusions
Specific service needs may include
• Medical case management
• Mental Health Crisis Intervention
• Substance abuse screening & referral for
treatment
A Quote
What advice would you give to help provide
better services?
“Be sure to deal with people on an individual
basis and try not to generalize…..”
TT, Age 46
Acknowledgements
• Participants
• Research Assistants &
Coordinator
• Arturo Bendixen
(AIDS Foundation)
• Dr. David Buchanan
(Co-Investigator)
• Dr. Laura Sadowski
(PI, Co-Chair CRU)