ObjectivesThis study describes the proportion of emergency department (ED) returns within 7 days due to adverse events, defined as adverse outcomes related to healthcare received.DesignProspective cohort study.SettingWe used an electronically triggered adverse event surveillance system at a tertiary care ED from May to June 2010 to examine ED returns within 7 days of index visit.ParticipantsOne of three trained nurses determined whether the visit was related to index emergency care. For such records, one of three trained emergency physicians conducted adverse event determinations.Main outcome measureWe determined adverse event type and severity and analysed the data with descriptive statistics, χ2 tests and logistic regression.ResultsOf 13 495 index ED visits, 923 (6.8%) were followed by ED returns within 7 days. The median age of all patients was 47 years and 52.8% were women. After nursing review, 211 cases required physician review. Of these, 53 visits were adverse events (positive predictive value (PPV)=5.7%, 95% CI 4.4% to 7.4%) and 30 (56.6%) were preventable. Common adverse event types involved management, diagnostic or medication issues. We observed one potentially preventable death and 58.5% of adverse events resulting in transient disability. The PPV of a modified trigger with a cut-off of return within 72 h, resulting in admission was 11.9% (95% CI 6.8% to 18.9%).ConclusionsOur electronic trigger efficiently identified adverse events among 12% of patients with ED returns within 72 h, requiring hospital admission. Given the high degree of preventability of the identified adverse events, this trigger also holds promise as a performance measurement tool.

RÉSUMÉLe sans-abrisme chez les personnes âgées est une préoccupation croissante à travers le Canada et devrait augmenter avec le changement démographique (Crane & Warnes, 2010 ; Culhane, Métraux, Byrne, Stino, et Bainbridge, 2013 ). Pourtant, les connaissances actuelles, les politiques et les pratiques concernant le sans-abrisme ont tendance largement de se concentrer sur des populations plus jeunes. De même, la recherche et les politiques sur le vieillissement en général négligent le sans-abrisme. Les réponses au problème de sans-abrisme chez les personnes âgées doivent répondre aux besoins complexes liés à la santé, la sécurité du revenu et le logement. Basé sur un examen exhaustif de la littérature, cet article présente les domaines de recherche afi n d'éclairer les politiques, les stratégies et les services pour les divers groupes des aînés sans-abri. Nous clarifi ons les intersections du vieillissement et du sans-abrisme; examinons les statistiques pertinentes, y compris la prévalence estimée; discutons des voies et des variations de l'expérience; et determinons les lacunes dans les connaissances. Nous concluons par un appel à un programme de recherche inclusive qui aidera à créér des politiques et des pratiques visant à réduire et fi nalement à éliminer le sans-abrisme chez les personnes âgées au Canada. ABSTRACTHomelessness among older people is a growing concern across Canada and is expected to rise with demographic change (Crane & Warnes, 2010 ;Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013 ). Yet current knowledge, policies, and practices on homelessness largely focus on younger populations. Likewise, research and policies on aging typically overlook homelessness. Responses to homelessness among older people must address complex needs related to health, income security, and housing. Based on a comprehensive literature review, this article outlines the existing and needed research with regards to homelessness among older people. We clarify the intersections of aging and homelessness; review the relevant statistics, including estimated prevalence; discuss pathways and variations in experience; and identify gaps in knowledge. We conclude with a call for an inclusive research agenda that will help build policies and practices to reduce and ultimately to eliminate homelessness among older people in Canada. Based on a comprehensive literature review, this article sets the stage for a research agenda that will inform national and provincial strategies; policies in housing, health, and social care; and community services for Canada's older homeless population. After a brief comment on homelessness in Canada, we clarify the intersections of aging and homelessness and sketch out the existing knowledge that can be used to counter homelessness. Drawing on international and Canadian research, we review terminology, defi nitions, and distinctions in the literature; available statistics and the estimated prevalence of homelessness in Canada; pathways into homelessness in later life; and examples of heterogeneous ...

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Homelessness among older people in Canada is both a growing concern, and an emerging field of study. This article reports thematic results of qualitative interviews with 40 people aged 46 to 75, carried out as part of a mixed-methods study of older people who are homeless in Montreal, Quebec, Canada. Our participants included people with histories of homelessness (n = 14) and persons new to homelessness in later life (n = 26). Interviews focused on experiences at the intersections of aging and homelessness including social relationships, the challenges of living on the streets and in shelters in later life, and the future. This article outlines the 5 main themes that capture the experience of homelessness for our participants: age exacerbates worries; exclusion and isolation; managing significant challenges; shifting needs and realities; and resilience, strength, and hope. Together, these findings underscore the need for specific programs geared to the unique needs of older people who are homeless.

The “hard times” resulting from the 2008 Great Recession represent an opportunity to re-examine the theoretical framework for how families use economic resources to manage stress. M. Sherraden's (1991) theory of assets and H. I. McCubbin and J. Patterson's (1983) family adjustment and adaptation response model informed this study of how assets relate to family demands among 839 low-income families. Structural equation modeling found that assets were directly related to a reduced sense of family demands and that assets were indirectly related to demands via economically stressful events. Findings suggest that social welfare policies that promote assets among low-income families may positively influence family relations. Future family research would benefit from measuring assets as economic resources and testing how assets affect family functioning