Cited by 71Homelessness and Social IssuesFrailty in Older AdultsChronic Disease Management Strategies

Factors associated with geriatric syndromes in older homeless adults

Open access
Brown, Rebecca T., Kiely, Dan K., Bharel, Monica, Mitchell, Susan L.·2013·Journal of Health Care for the Poor and Underserved

Abstract

Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients.

Integrity signals

Registry

Crossref · 10.1353/hpu.2013.0077

Cites

51 of 51 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 15 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In older homeless adults, having less than a high school education is associated with a higher total number of geriatric syndromes.

    “A higher total number of geriatric syndromes was associated with having less than a high school education”
    • Also stated in: § Discussion · plain
      “Lower educational level was associated with a higher total number of geriatric syndromes among the homeless subjects”
    Quote in the paperSubstantial claim
  • Findingown data

    In older homeless adults, difficulty performing one or more ADLs is associated with a higher total number of geriatric syndromes.

    “A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more ADLs.”
    Quote in the paperSubstantial claim
  • Findingown data

    In bivariate ordinal logistic regression, one or more clinic visits in the past year is significantly associated with a higher total number of geriatric syndromes.

    “In bivariate ordinal logistic regression analyses, the following factors were significantly associated with a higher total number of geriatric syndromes: less than a high school education, one or more clinic visits in the past year, diabetes mellitus, hypertension, arthritis, alcohol use problems, drug use problems, and ADL impairment.”
    Quote in the paperNot a substantial claim
  • Findingown data

    In older homeless adults, alcohol use problems are associated with a higher total number of geriatric syndromes.

    “alcohol and drug use problems) were strongly associated with a higher total number of geriatric syndromes”
    Quote in the paperSubstantial claim
  • Findingown data

    In older homeless adults, arthritis is associated with a higher total number of geriatric syndromes.

    “diabetes and arthritis were associated with a higher total number of geriatric syndromes in the homeless cohort”
    Quote in the paperSubstantial claim
  • May combine two claims. 9
  • Classified as probably not a substantial claim. 9
  • May combine two claims.

    Findingown data

    Among the six geriatric syndromes, hearing impairment and urinary incontinence are least likely to be associated with one or more additional syndromes, while MMSE impairment, TMT-B impairment, depression, and frailty are most likely.

    “Among the six syndromes, hearing impairment and urinary incontinence were the least likely to be associated with one or more additional syndromes, while MMSE impairment, TMT-B impairment, depression, and frailty were most likely to be associated with one or more additional syndromes.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Findingown data

    The proportion of homeless adults with one geriatric syndrome who had one or more additional syndromes ranged from 88.2% to 98.9%, which is higher than the 48.7% to 78.7% range in the general population.

    “while the proportion of subjects in the general population with one geriatric syndrome who had one or more additional syndromes ranged from 48.7% to 78.7%,7 the proportion in homeless adults was much higher, ranging from 88.2% to 98.9%.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Findingcitation

    Compared to homeless adults age 50 and older in previous cohorts, rates of functional impairment, cognitive impairment, depression, hearing impairment, and visual impairment in this cohort were generally similar to those reported previously.

    “rates of functional impairment,35 cognitive impairment,36 depression,37 hearing36 and visual impairment38 were generally similar to those reported previously.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Study design and conductcitation

    Half of the subjects were recruited during winter months, when only 6% of single homeless adults in Boston stay on the street.

    “However, half of the subjects in this study were recruited during winter months, when only 6% of single homeless adults in Boston stay on the street.54”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Among 387 eligible individuals, 250 (64.6%) were recruited.

    “Among the 387 eligible individuals, 250 (64.6%) subjects were recruited.”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    This study confirms current knowledge about factors associated with geriatric syndromes in the general older population while revealing how these syndromes present uniquely in older homeless adults.

    “This study confirms current knowledge about factors associated with geriatric syndromes in the general older population, while revealing how these syndromes present uniquely in older homeless adults.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Study design and conductown data

    Eligible clients who declined to participate did not differ significantly from those enrolled by observed race/ethnicity, but were older and likelier to be men.

    “Eligible clients who declined to participate did not differ significantly from those enrolled by observed race/ethnicity, but were older (mean age 59.5 years, p=.002) and likelier to be men (89.8%, p=.02).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Arthritis is associated with falls in community-dwelling older adults.

    “and arthritis to be associated with falls.42”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Rubenstein LZ Falls in older people: Epidemiology, risk factors and strategies for prevention Age Ageing 2006 9 35 Suppl 2 ii37 41 16926202

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Unmeasured confounders may partially account for the observed associations.

    “While unmeasured confounders may partially account for the observed associations, our results are consistent with those of studies conducted in the general population.41–44,47–53”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    Recruiting from shelters could either overestimate or underestimate geriatric syndromes.

    “Recruiting from shelters could either overestimate geriatric syndromes (if more functional homeless adults do not access shelters), or could underestimate syndromes (if frailer individuals are unable to seek shelter).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the general older population, geriatric syndromes are thought to result from an accumulation of deficits that occurs with aging.

    “In the general older population, geriatric syndromes are thought to result from an accumulation of deficits that occurs with aging.5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Inouye SK Studenski S Tinetti ME Geriatric syndromes: Clinical, research, and policy implications of a core geriatric concept J Am Geriatr Soc 2007 5 55 5 780 91 17493201 PMC2409147

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Lower educational level is associated with cognitive impairment in the general population.

    “Lower educational level was associated with a higher total number of geriatric syndromes among the homeless subjects, and is known to be associated with cognitive impairment in the general population.39,40”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [39] Escobar JI Burnam A Karno M Use of the Mini-Mental State Examination (MMSE) in a community population of mixed ethnicity: cultural and linguistic artifacts J Nerv Ment Dis 1986 10 174 10 607 14 3760851

      Not checked in the free run.

    • cites [40] Razani J Burciaga J Madore M Effects of acculturation on tests of attention and information processing in an ethnically diverse group Arch Clin Neuropsychol 2007 3 22 3 333 41 17298874

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Alcohol misuse is associated with geriatric syndromes in community-dwelling older adults.

    “Similar relationships between alcohol misuse and geriatric syndromes have been noted in community-dwelling older adults,47–53”
    Quote in the paperNot a substantial claim0 of 7 sources checked
    • cites [47] Saunders PA Copeland JR Dewey ME Heavy drinking as a risk factor for depression and dementia in elderly men: Findings from the Liverpool longitudinal community study Br J Psychiatry 1991 8 159 213 6 1773236

      Not checked in the free run.

    • cites [48] Fratiglioni L Ahlbom A Viitanen M Risk factors for late-onset Alzheimer’s disease: A population-based, case-control study Ann Neurol 1993 3 33 3 258 66 8498809

      Not checked in the free run.

    • cites [49] Malmivaara A Heliovaara M Knekt P Risk factors for injurious falls leading to hospitalization or death in a cohort of 19,500 adults Am J Epidemiol 1993 9 15 138 6 384 94 8213744

      Not checked in the free run.

    • cites [50] Cherpitel CJ Tam T Midanik L Alcohol and non-fatal injury in the U.S. general population: A risk function analysis Accid Anal Prev 1995 10 27 5 651 61 8579696

      Not checked in the free run.

    • cites [51] Mukamal KJ Mittleman MA Longstreth WT Jr Self-reported alcohol consumption and falls in older adults: Cross-sectional and longitudinal analyses of the Cardiovascular Health Study J Am Geriatr Soc 2004 7 52 7 1174 9 15209658

      Not checked in the free run.

    • cites [52] Cawthon PM Harrison SL Barrett-Connor E Alcohol intake and its relationship with bone mineral density, falls, and fracture risk in older men J Am Geriatr Soc 2006 11 54 11 1649 57 17087690

      Not checked in the free run.

    • cites [53] Kessler RC The epidemiology of dual diagnosis Biol Psychiatry 2004 56 730 737 15556117

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Recruitment of subjects was limited to shelters, and therefore does not capture individuals who do not access these organizations.

    “Recruitment of subjects was limited to shelters, and therefore does not capture individuals who do not access these organizations.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Study design and conductreasoning

    The study reports associations between subject characteristics and geriatric syndromes, but cannot infer causality due to the cross-sectional design.

    “Finally, we report associations between subject characteristics and geriatric syndromes, but cannot infer causality due to the study’s cross-sectional design.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Diabetes is associated with a higher prevalence of geriatric syndromes in community-dwelling older adults.

    “consistent with studies of community-dwelling older adults that show diabetes to be associated with a higher prevalence of geriatric syndromes41”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [41] Cigolle CT Lee PG Langa KM Lee YY Tian Z Blaum CS Geriatric conditions develop in middle-aged adults with diabetes J Gen Intern Med 2011 3 26 3 272 9 Epub 2010 Sep 29 20878496 PMC3043187

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Systematic random sampling was used to select shelter clients from bed lists or meal lines.

    “Systematic random sampling was used to select shelter clients from bed lists or meal lines.”
    Quote in the paperNot a substantial claim
17 of 17
  • The paper relies on this without support.

    Most of the geriatric syndromes included in the study have screening tests that require 5 minutes or less to administer.

    “Most of the syndromes included in this study have screening tests that require 5 minutes or less to administer.”
  • The paper relies on this without support.

    Diabetes, arthritis, substance use, and ADL impairment are preventable or treatable conditions.

    “Several factors associated with geriatric syndromes are preventable or treatable, including diabetes, arthritis, substance use, and ADL impairment.”
  • The paper relies on this without support.

    The relationship of illicit drug use to geriatric syndromes has not been examined in the general population.

    “though the relationship of illicit drug use to geriatric syndromes has not been examined in the general population.”
3 of 3

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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Incorrect percentage for subjects with four geriatric syndromes

    Minor

    The reported count of 33 out of 250 subjects is 13.2%, not 12.2%.

    Reported 12.2 · recomputed 13.2

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Authors
Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L.
Affiliations
  • San Francisco VA Medical Center (US)
  • Hebrew SeniorLife (US)
  • Boston Medical Center (US)
  • Beth Israel Deaconess Medical Center (US)
Venue
Journal of Health Care for the Poor and Underserved
Publisher
Project MUSE
Published
2013-05
Volume
24
Issue
2
Pages
456-468
ISSN
  • 1049-2089 (ISSN-L)
  • 1548-6869
OpenAlex
W2083963422
Cited by
71
References
51
Citations by year
2026: 4 · 2025: 6 · 2024: 7 · 2023: 4 · 2022: 7 · 2021: 5 · 2020: 12 · 2019: 8 · 2018: 2 · 2017: 5 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 2
FWCI
6.61
Type
journal article
Language
en
Open access
Locations
  • Journal of Health Care for the Poor and Underserved (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Project Muse (Johns Hopkins University) (submittedVersion)
Funders
  • National Institutes of Health
  • National Institute on Aging (T32AG023480, K24AG033640, T32AG000212)
Topics
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
  • Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Keywords
geriatric syndromes, risk factors, falls, cognitive impairment, frailty, major depressive disorder, sensory impairment, urinary incontinence, educational attainment, comorbidities, diabetes mellitus, arthritis, alcohol and drug use, activities of daily living, geriatric screening
MeSH terms
Accidental Falls, Activities of Daily Living, Aged, Chronic Disease, Cognition Disorders, Major Depressive Disorder, Female, Health Status, Ill-Housed Persons, Humans, Male, Middle Aged, Risk Factors, Socioeconomic Factors, Syndrome, Urinary Incontinence, Geriatric Assessment, Substance-Related Disorders

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