• Judith A Hahn, Margot B Kushel, David R Bangsberg, Elise Riley, and Andrew R Moss.
• Epi-Center, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94143-1372, USA. jhahn@epi-center.ucsf.edu
• J Gen Intern Med. 2006 Jul 1; 21 (7): 775778775-8.

BackgroundHomelessness is associated with high rates of health and substance use problems.ObjectiveTo examine trends in the age, housing, health status, health service utilization, and drug use of the homeless population over a 14-year period.DesignSerial cross-sectional.ParticipantsWe studied 3,534 literally homeless adults recruited at service providers in San Francisco in 4 waves: 1990-1994, 1996-1998, 1999-2000, and 2003.MeasurementsAge, time homeless, self-reported chronic conditions, hospital and emergency department utilization, and drug and alcohol use.ResultsThe median age of the homeless increased from 37 to 46 over the study waves, at a rate of 0.66 years per calendar year (P<.01). The median total time homeless increased from 12 to 39.5 months (P<.01). Emergency department visits, hospital admissions, and chronic health conditions increased.ConclusionsThe homeless population is aging by about two thirds of a year every calendar year, consistent with trends in several other cities. It is likely that the homeless are static, aging population cohort. The aging trends suggest that chronic conditions will become increasingly prominent for homeless health services. This will present challenges to traditional approaches to screening, prevention, and treatment of chronic diseases in an aging homeless population.

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