Timothy E Chung1, Agnes Gozdzik1, Luis I Palma Lazgare1, Matthew J To1, Tim Aubry2, James Frankish3, Stephen W Hwang1,4, Vicky Stergiopoulos1,5,6. 1. Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 2. School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Ontario, Canada. 3. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 4. Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 5. Centre for Addiction and Mental Health, Toronto, Ontario, Canada. 6. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: This study compares the effect of Housing First on older (≥50 years old) and younger (18-49 years old) homeless adults with mental illness participating in At Home/Chez Soi, a 24-month multisite randomized controlled trial of Housing First. METHOD: At Home/Chez Soi, participants (n = 2148) were randomized to receive rent supplements with intensive case management or assertive community treatment, based on their need level for mental health services, or usual care in their respective communities. A subgroup analysis compared older (n = 470) and younger (n = 1678) homeless participants across baseline characteristics and 24-month outcomes including housing stability (primary outcome), generic and condition-specific quality of life, community functioning, physical and mental health status, mental health symptom severity, psychological community integration, recovery, and substance use (secondary outcomes). RESULTS: At 24 months, Housing First significantly improved the percentage of days stably housed among older (+43.9%, 95% confidence interval [CI]: 38.4% to 49.5%) and younger homeless adults (+39.7%, 95% CI: 36.8% to 42.6%), compared with usual care, with no significant differences between age groups (difference of differences = +4.2%, 95% CI: -2.1% to 10.5%, p = 0.188). Improvements from baseline to 24 months in mental health and condition-specific quality of life were significantly greater among older homeless adults than among younger homeless adults. CONCLUSION:Housing First significantly improved housing stability among older and younger homeless adults with mental illness, resulting in superior mental health and quality of life outcomes in older homeless adults compared with younger homeless adults at 24 months.
RCT Entities:
OBJECTIVE: This study compares the effect of Housing First on older (≥50 years old) and younger (18-49 years old) homeless adults with mental illness participating in At Home/Chez Soi, a 24-month multisite randomized controlled trial of Housing First. METHOD: At Home/Chez Soi, participants (n = 2148) were randomized to receive rent supplements with intensive case management or assertive community treatment, based on their need level for mental health services, or usual care in their respective communities. A subgroup analysis compared older (n = 470) and younger (n = 1678) homeless participants across baseline characteristics and 24-month outcomes including housing stability (primary outcome), generic and condition-specific quality of life, community functioning, physical and mental health status, mental health symptom severity, psychological community integration, recovery, and substance use (secondary outcomes). RESULTS: At 24 months, Housing First significantly improved the percentage of days stably housed among older (+43.9%, 95% confidence interval [CI]: 38.4% to 49.5%) and younger homeless adults (+39.7%, 95% CI: 36.8% to 42.6%), compared with usual care, with no significant differences between age groups (difference of differences = +4.2%, 95% CI: -2.1% to 10.5%, p = 0.188). Improvements from baseline to 24 months in mental health and condition-specific quality of life were significantly greater among older homeless adults than among younger homeless adults. CONCLUSION: Housing First significantly improved housing stability among older and younger homeless adults with mental illness, resulting in superior mental health and quality of life outcomes in older homeless adults compared with younger homeless adults at 24 months.