Mortality and causes of death among homeless in Finland: a 10-year follow-up study

Stenius-Ayoade, Agnes; Haaramo, Peija; Kautiainen, Hannu; Gissler, Mika; Wahlbeck, Kristian; Eriksson, Johan G.

doi:10.1136/jech-2017-209166

Cited by 29 publications

(19 citation statements)

References 28 publications

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“…Our study confirms previous findings that compared to the general population, homeless people die younger 1 – 11 and have complex comorbidities and a high symptom burden at the end of life. 19 – 22 , 24 , 34 – 37 Although the end of life was recognised for three-quarters of the homeless persons in our study, it was difficult to specifically predict prognoses and identify palliative care needs: whereas some patients revived prodigiously, others deteriorated rapidly once admitted to the shelter-based nursing care setting.…”

Section: Discussionsupporting

confidence: 91%

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Dongen

Klop²,

Veer

et al. 2020

Palliat Med

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Background: Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. Aim: To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. Design: A retrospective record study using both quantitative and qualitative analysis methods. Setting/participants: Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. Results: Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0–1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient–professional communication and medical-pharmacological alleviation of suffering. Conclusions: End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.

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Section: Discussionsupporting

confidence: 91%

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Dongen

Klop²,

Veer

et al. 2020

Palliat Med

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“…There is no information relating to the morbidity and mortality amongst the homeless in South Africa. Several studies have shown mortality and morbidity rates to be higher in the homeless [13][14][15]. Homelessness itself is an independent risk factor for mortality for certain conditions, however mortality rates were higher in the homeless in those with substance abuse disorders and infectious diseases [16].…”

Section: Introductionmentioning

confidence: 99%

Volunteering, health and the homeless – the cost of establishing a student-run primary healthcare clinic serving the inner-city homeless in South Africa

Johnston

McInerney

Miot

2020

BMC Health Serv Res

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Background: Those who are homeless are more prone to communicable, respiratory and cardiovascular diseases and are less likely to access healthcare services. In South Africa there are no specific public healthcare services tailored to the needs of these communities, particularly if they are immigrants. Trinity Health Services is a studentrun inner-city clinic providing free healthcare to the homeless of Johannesburg, South Africa. The clinic operates two nights per month and provides treatment for mainly acute conditions. The purpose of this study was to determine the costs of establishing and operating a student-run clinic for an indigent population. Methods: This costing analysis used a mixed-methods approach combining an ingredients-based and top-down methodology. The costs, capital and recurrent, pertaining to the establishment and operating of the clinic as well as the cost of treatment per patient were identified and quantified from 1st January 2016-31st December 2017. Results: The capital costs incurred in establishing the clinic were calculated to be £10,968.57 (ZAR 214157.08) and included building alterations, equipment purchased, installations, furniture, application for a pharmacy license, consumables and medications. The recurrent costs per annum were estimated at £17,730.72 (ZAR 346185.54) and comprised of overheads and maintenance, rental, personnel, pharmacy license, consumables and medication. The cost of treatment per patient, included medication dispensed and consumables used in the consultation, was estimated at £3.54 (ZAR 69.05) per visit. Conclusions: This study summarised the costs of establishing and operating a student-run clinic providing pertinent information essential to the sustainability of the service. It also provides a model for costs associated with free clinics in faith-based and university settings.

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“…Additionally, they face specific challenges and barriers to accessing healthcare, often resulting in high rates of acute care use (Fazel et al, ). Furthermore, homelessness has shown to be an independent risk factor for mortality, with average ages of mortality varying roughly between 50 and 65 years in different studies in Western, high‐income countries (Baggett et al, ; Henwood, Byrne, & Scriber, ; Morrison, ; Nielsen et al, ; Stenius‐Ayoade et al, ). Therefore, at these generally still considered middle ages, homeless people are already classified as old (Fazel et al, ).…”

Section: Introductionmentioning

confidence: 99%

“…A similar demographic trend has been observed in the Netherlands: among homeless people receiving help from Dutch social relief facilities, the proportion of people older than 50 gradually increased, from 19% in 2009 to 26% in 2015 (Federation of Shelters, ). While the excess mortality among younger homeless people mainly results from external causes, such as injury and poisoning, older homeless people mainly die from chronic medical conditions, such as respiratory and cardiovascular diseases (Baggett et al, ; Stenius‐Ayoade et al, ). These findings suggest that differences between older and younger homeless people might also be present for other clinically relevant health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Self‐reported health, healthcare service use and health‐related needs: A comparison of older and younger homeless people

Dongen

Straaten

Wolf³

et al. 2019

Health Soc Care Community

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The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.

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Mortality and causes of death among homeless in Finland: a 10-year follow-up study

Abstract: Homelessness is associated with a fivefold mortality compared with the controls, and especially homeless aged ≤50 years have an increased risk of death. Being homeless eliminates the protective effects of marriage, employment and education on mortality risk.

Cited by 29 publications

References 28 publications

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study

Volunteering, health and the homeless – the cost of establishing a student-run primary healthcare clinic serving the inner-city homeless in South Africa

Self‐reported health, healthcare service use and health‐related needs: A comparison of older and younger homeless people

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