Matthew Tobey1, Julia Manasson2, Kristen Decarlo2, Katrina Ciraldo-Maryniuk3, Jessie M Gaeta4, Erica Wilson5. 1. Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA. Electronic address: mltobey@partners.org. 2. Division of Rheumatology, New York University Langone Medical Center, New York, USA. 3. New York University Langone Medical Center, New York, USA. 4. New York University Langone Medical Center, New York, USA; Department of Family Medicine, Boston University, Boston, USA. 5. Boston Health Care for the Homeless Program, Boston, USA; and Division of Palliative Care, Massachusetts General Hospital, Boston, USA.
Abstract
CONTEXT: Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). OBJECTIVES: This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. METHODS: Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. RESULTS: Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P < 0.01 for each comparison). CONCLUSION: Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach.
CONTEXT: Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). OBJECTIVES: This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. METHODS: Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. RESULTS:Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P < 0.01 for each comparison). CONCLUSION: Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach.
Authors: Adam Bazari; Maria Patanwala; Lauren M Kaplan; Colette L Auerswald; Margot B Kushel Journal: J Pain Symptom Manage Date: 2018-05-19 Impact factor: 3.612
Authors: Sophie I van Dongen; Hanna T Klop; Bregje D Onwuteaka-Philipsen; Anke Je de Veer; Marcel T Slockers; Igor R van Laere; Agnes van der Heide; Judith Ac Rietjens Journal: Palliat Med Date: 2020-07-30 Impact factor: 4.762
Authors: Caroline Shulman; Briony F Hudson; Joseph Low; Nigel Hewett; Julian Daley; Peter Kennedy; Sarah Davis; Niamh Brophy; Diana Howard; Bella Vivat; Patrick Stone Journal: Palliat Med Date: 2017-07-03 Impact factor: 4.762
Authors: Hanna T Klop; Anke J E de Veer; Sophie I van Dongen; Anneke L Francke; Judith A C Rietjens; Bregje D Onwuteaka-Philipsen Journal: BMC Palliat Care Date: 2018-04-24 Impact factor: 3.234
Authors: Anke J E de Veer; Barbara Stringer; Berno van Meijel; Renate Verkaik; Anneke L Francke Journal: BMC Palliat Care Date: 2018-10-24 Impact factor: 3.234