Kelseanne Breder

Abstract

  Background and Objectives The population of older adults with lived experience of homelessness in the United States is growing. Homelessness is associated with accelerated aging and opioid misuse. Older adults who have experienced homelessness suffer from greater functional impairment than nonhomeless older adults. Opioid misuse may catalyze functional impairment in this population, yet little is known about the prevalence of opioid use disorder (OUD) among currently and formerly homeless older adults. We report findings about the prevalence of OUD and functionality that we hope will spur future research about longevity and OUD in this population. Research Design and Methods Using a secondary analysis of data collected in New York City through electronic medical records, we examined 253 patients who met three inclusion criteria: (a) aged 50 years and older, (b) history of homelessness, and (c) received community-based medical services. We summarize the prevalence of OUD in our cohort and present descriptive statistics about pain and cognitive function for a small subset measured by the Pain Enjoyment of Life and General Activity (PEG) and Mini-Cog scales. Results Twelve percent (n = 31) had OUD diagnoses (age range = 50–81; mean age = 65; median age = 65; female = 11; and receiving agonist therapy = 5). Of those, 18 completed Mini-Cog; two showed clinically important cognitive impairment; 14 completed PEG; and eight reported moderate to severe pain. Discussion and Implications Our report is among the first to describe OUD among older adults who have experienced homelessness. Currently and formerly homeless older adults with OUD are younger, on average, and more likely to be female, than those without OUD. They are more likely to report pain but less likely to exhibit cognitive impairment. Possible explanations for these observations include care engagement, untreated pain, and a survivor effect wherein older adults with OUD who survive homelessness may have traits that protect them from cognitive decline and fatal overdose. Keywords: unhoused, health disparities, addiction

Abstract

~

Abstract

~

Abstract

Sexual and gender minority (LGBT) adults experience heightened levels of social discrimination and minority stress throughout their lives because of their minority identities. LGBT older adults are at particularly increased risk for minority stress as they are more likely to live alone and more likely to be estranged from their families of origin. To cope with minority stress, LGBT older adults have developed “chosen families” or social networks composed of non-biological relatives who care for one another as if they are family. The LGBT chosen family is a resilience strategy that has not been examined thoroughly by a theoretical framework. The purpose of this paper is to apply the Convoy Model of Social Relations as a framework for examining the LGBT chosen family experience. The paper identifies points of convergence between the model and LGBT chosen families, as well as points of departure. Modifications to the model are proposed.  

Abstract

Transgender and gender diverse (TGD) adults experience significant burdens of disease andhealth disparities compared to their cisgender peers. Stigma functions as a fundamental cause of health disparity in TGD communities. Stigma can be tempered by gender-affirming care (GAC), wherein TGD adults receive care that validates their gender identity. There is little evidence focusing on health outcomes associated with delivery of integrated GAC.This integrative review explores the extant evidence on the relationship between integratedGAC and health outcomes in TGD adults in the United States.A comprehensive search of 4 electronic databases was conducted in May 2022. Includedstudies were peer reviewed, conducted in the US from 2013 to the present, and describedintegrated GAC delivery for TGD adults ages 18 and older. After screening 3328 records andreviewing 135 full text articles, 15 articles were included in this review. Articles were critically appraised, and data extraction and analysis using constant comparison was used to identify themes and relationships across studies. Synthesis suggested GAC relates to three distinct areas of TGD adult health: physical health, mental health, and health services outcomes. GAC was associated with better overall health and improvements in HIV-related outcomes; significant decreases in mental health symptoms and suicidality; and increases in utilization, engagement, and care retention.There is moderate evidence that GAC delivery is associated with positive health outcomes for TGD adults. This integrative review provides empirical and theoretical support for integrated GAC delivery as an approach to improve health and address stigma-related barriers to care.

Abstract

~

Abstract

Invited speaker at Brooklyn, Queens, Long Island Area Health Education Center.

Abstract

Invited speaker to deliver lecture at Hunter School of Nursing

Abstract

Invited speaker at Center for Urban Community Services grand rounds

Abstract

Invited speaker at NYU Grossman School of Medicine.