Journal article
Identifying and Addressing Housing Insecurity in Older Patients: Trends, Referrals, and Inequities in a California Medical System
The Gerontologist, v 65(5), gnaf027
09 Apr 2025
PMID: 40222811
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Housing insecurity is rising among older adults, especially for racially minoritized people. Few studies have evaluated whether healthcare institutions are meeting that challenge. Using data from a large California medical system, we examined how often older patients are (A) identified as housing insecure and then (B) referred to social services, as well as inequities in those rates.
We analyzed electronic health records (2013-2022) for 119,127 older adults (55+) receiving primary or emergency care. We used a natural language processing model to identify housing insecurity and social services referrals/connections from unstructured notes, with referrals also captured via structured data. Trends in identification were compared to eviction and homelessness trends in the general population. Racial inequities in referrals were evaluated using logistic regression.
0.6% of encounters (n = 6,253) screened positive for housing insecurity. Positive screening trends were nonlinear, with initial increases followed by declines to baseline (roughly tracking regional eviction trends). Only 7% of patients identified as housing insecure were referred to social services, and connections were more likely in primary than emergency care (odds ratio [OR] = 2.04, 95% confidence interval [95% CI]: 1.41-2.96). Asian patients had lower odds of referral than non-Hispanic White patients (OR = 0.51, 95% CI: 0.28-0.95).
We identified urgent unmet needs for housing intervention among older patients. Healthcare systems must do more to ensure older patients, especially racially minoritized older adults, are screened for housing insecurity and connected to housing services.
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Details
- Title
- Identifying and Addressing Housing Insecurity in Older Patients: Trends, Referrals, and Inequities in a California Medical System
- Creators
- Erin L Ferguson - University of California, San FranciscoShivani Mehta - University of California, San FranciscoSilvia Miramontes - University of California, San FranciscoMinhyuk Choi - University of California, San FranciscoYe Ji Kim - Boston UniversityTanisha G Hill-Jarrett - University of California, San FranciscoNicolas Cevallos - University of California, San FranciscoYulin Yang - University of California, San FranciscoScott C Zimmerman - University of California, San FranciscoRuijia Chen - Boston UniversityMin Hee Kim - University of California, San FranciscoKendra D Sims - Boston UniversityGabriel L Schwartz (Corresponding Author) - University of California, San Francisco
- Publication Details
- The Gerontologist, v 65(5), gnaf027
- Publisher
- Oxford University Press
- Number of pages
- 10
- Grant note
- T32AG049663-06A1 / NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Drexel FIRST (Center for Firefighter Injury Research and Safety Trends); Urban Health Collaborative; Health Management and Policy
- Web of Science ID
- WOS:001465359700001
- Scopus ID
- 2-s2.0-105002678629
- Other Identifier
- 991022048364404721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Gerontology