Abstract
Abstract only
Introduction:
People over age 50 comprise 30% of people experiencing homelessness (PEH) in the United States and are predicted to increase exponentially in the next ten years. Few studies have documented PEH hypertension (HTN) prevalence, and treatment protocols rarely test their efficacy specifically when treating older PEH. The few geriatric PEH HTN studies that have been conducted are based out of homeless shelters, with even less known about the HTN rates of people experiencing unsheltered homelessness (PEUH) who constitute one-third of PEH nationally. Our objective is to assess prevalence of elevated blood pressure (BP) and HTN treatment rates among geriatric PEUH presenting at a free clinic in Miami-Dade County.
Methods:
Clinical information and BP measurements of 105 PEUH over 50 were documented as part of care by a street outreach medical team. Clinical information was recorded in a REDCap electronic database. De-identified data was compared to the Centers for Disease Control National Health and Nutrition Examination Survey 2017-2019 pre-pandemic cohort (CDC NHANES) and analyzed in R studio version 4.3.2.
Results:
PEUH were at significantly increased relative risk (RR) for Stage 1 HTN (RR 3.97, Confidence Interval (CI) 2.68-5.89, p<0.0001) when compared to age- matched NHANES dataset. After 10-year age cohort stratification the small PEH sample size (N=11) lacked enough power to reach significance. PEUH were also found to be at significantly increased risk of Stage 2 HTN (RR 6.17, CI 4.93-7.73, p<0.0001). Here findings remained significant after 10-year age cohort stratification (N=41). NHANES reports medication use by 20-year age groups: 50.8% of people aged 40-59, and 49.4% of people over 60 with diagnosed HTN were on BP control medication. PEUH were at significantly increased risk of untreated HTN (RR 1.67, CI 1.50-1.87, p<0.0001). Only 15.9% were prescribed medication.
Conclusion:
Increased risk of elevated BP and untreated HTN among geriatric PEUH likely reflect barriers of access to chronic disease management. There are likely also unidentified confounding factors preventing proper care for this vulnerable population. Further investigation should critically assess gaps in the care to devise protocols for improving treatment outcomes.