A Study of the Deaths of Persons who are Homeless in Ottawa - A Social and Health Investigation (original) (raw)
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Carrying out a social autopsy of deaths of persons who are homeless
Evaluation and Program Planning, 2006
Social autopsy methodology has been useful in uncovering patterns leading to untimely deaths in many different contexts. Although patterns of early deaths have often been detected among individuals who are homeless, social autopsies are particularly difficult to carry out in this population. This paper provides a template for carrying out a social autopsy of persons who died while homeless. The logistical, ethical, and methodological challenges associated with implementing this methodology are discussed with suggested responses. In addition, this article aims to provide procedures and lessons learned for researchers embarking on this type of work. The described procedures are based on an investigation intended to develop a social autopsy methodology to investigate early mortality among homeless persons. q
Experiences With and Attitudes Toward Death and Dying Among Homeless Persons
Journal of General Internal Medicine, 2007
BACKGROUND: Homeless persons face many barriers to health care, have few resources, and experience high death rates. They live lives of disenfranchisement and neglect. Few studies have explored their experiences and attitudes toward death and dying. Unfortunately, studies done in other populations may not apply to homeless persons. Exploring these experiences and attitudes may provide insight into life, health care, and end-of-life (EOL) concerns of this population. OBJECTIVE: To explore the experiences and attitudes toward death and dying among homeless persons. DESIGN: Qualitative study utilizing focus groups. PARTICIPANTS: Fifty-three homeless persons recruited from homeless service agencies. MEASUREMENTS: In-depth interviews, which were audiotaped and transcribed. RESULTS: We present seven themes, some of which are previously unreported. Homeless persons described many significant experiences with death and dying, and many participants suffered losses while very young. These encounters influenced participants' attitudes toward risks and risky behavior: e.g., for some, these experiences provided justification for high-risk behaviors and influenced their behaviors while living on the streets. For others, they may be associated with their homelessness. Finally, these experiences informed their attitudes toward death and dying as well as EOL care; homeless persons believe that care will be poor at the EOL. CONCLUSIONS: Findings from this study have implications for addressing social services, health promotion, prevention, and EOL care for homeless persons, as well as for others who are poor and disenfranchised.
Risk of death among homeless women: a cohort study and review of the literature.
H omelessness is an important problem in the United States, 1,2 Canada 3 and the United Kingdom. Earlier studies have documented the high burden of illness among homeless people due to mental illness and addictions, 5 medical conditions, 6-8 tuberculosis and HIV infection, and traumatic injuries. 12 These illnesses, in conjunction with severe poverty and often inadequate access to health care, lead to high mortality rates among homeless people. Previous studies have focused on excess mortality observed among homeless people relative to their counterparts in the general population. In Philadelphia, the mortality rate among homeless adults was 3.5 times higher than the rate in the general population. 14 In a study of homeless people in Boston, mortality rates among men were 5.9, 3.0 and 1.6 times higher than those in the general population for people 18-24, 25-44 and 45-64 years of age respectively. 15 A study of people using homeless shelters in New York found ageadjusted death rates 2 to 3 times higher than those in the city's general population. Among men using homeless shelters in Toronto, mortality rates were 8.3, 3.7 and 2.3 times higher than rates among men in the general population aged 18-24, 25-44 and 45-64 years respectively. Although a significant proportion of homeless people are women, 1 relatively little attention has been focused on patterns of mortality in this subgroup. Among homeless people, single men, single women and women accompanied by children tend to have different health problems. For example, the prevalence of substance abuse is lower among homeless single women than among homeless single men, but the rate of major depression is higher. 18,19 Such differences may have an effect on mortality rates. In this study, we focus on homeless single women, who tend to have more health problems than homeless women accompanied by children. In the general population, mortality rates among younger women are one-third to one-half those among younger men. 21 Low socioeconomic status is strongly associated with shorter life expectancy, but within every socioeconomic stratum women have a longer life expectancy than men do. 22,23 Whether this survival advantage is attenuated or lost altogether among homeless women is an important question, because the underlying mechanisms (e.g., addictions leading to drug overdose, or depression leading to suicide) might be amenable to targeted intervention. We therefore conducted this study to determine whether homeless women lose the survival advantage associated with being female. Our first objective was to determine mortality rates among women who use homeless shelters in Toronto. Our second objective was to analyze published data on mortality rates among homeless women compared with those among women in the general population and among homeless men.
Background: Homeless populations have complex and diverse end-of-life care needs. However, they typically die outside of the end-of-life care system. To date, few studies have explored barriers to the end-of-life care system for homeless populations. This qualitative study involving health and social services professionals from across Canada sought to identify barriers to the end-of-life care system for homeless populations and generate recommendations to improve their access to end-of-life care. Methods: Semi-structured qualitative interviews were conducted with 54 health and social services professionals involved in end-of-life care services delivery to homeless persons in six Canadian cities (Halifax, Hamilton, Ottawa, Thunder Bay, Toronto and Winnipeg). Participants included health administrators, physicians, nurses, social workers, harm reduction specialists, and outreach workers. Interviews were audio-recorded, transcribed verbatim and analysed thematically. Results: Participants identified key barriers to end-of-life care services for homeless persons, including: (1) insufficient availability of end-of-life care services; (2) exclusionary operating procedures; and, (3) poor continuity of care. Participants identified recommendations that they felt had the potential to minimize these barriers, including: (1) adopting low-threshold strategies (e.g. flexible behavioural policies and harm reduction strategies); (2) linking with population-specific health and social care providers (e.g. emergency shelters); and, (3) strengthening population-specific training. Conclusions: Homeless persons may be underserved by the end-of-life care system as a result of barriers that they face to accessing end-of-life care services. Changes in the rules and regulations that reflect the health needs and circumstances of homeless persons and measures to improve continuity of care have the potential to increase equity in the end-of-life care system for this underserved population.
Unnatural death: a major but largely preventable cause-of-death among homeless people?
European Journal of Public Health, 2018
Background: We aimed to assess the contribution of specific causes-of-death to excess mortality of homeless persons and to identify differences in cause-specific mortality rates after vs. before implementing social policy measures. Methods: We conducted a register based 10-year follow-up study of homeless adults in Rotterdam and calculated the proportion of deaths by cause-of-death in this cohort in the period 2001-2010. We estimated causespecific mortality among the homeless compared to the general population with Standardized Mortality Ratios. We calculated Hazard Ratios adjusted for age and sex to compare mortality rates by cause-of-death among the homeless in the period after (2006-2010) vs. before (2001-2005) implementing social policy measures. Results: Our cohort consisted of 2130 homeless persons with a mean age of 40, 3 years. Unnatural death, cardiovascular disease and cancer were the main causes of death. Compared to the general population of Rotterdam, the homeless had an excess risk of death for all causes. The largest mortality differences with Rotterdam citizens were observed for unnatural death (SMR 14.8, CI 11.5-18.7), infectious diseases (SMR 10.0, CI 5.2-17.5) and psychiatric disorders (SMR 7.7, CI 4.0-13.5). Mortality due to intentional injuries (suicide and homicide) differed significantly between the two study periods (HR 0.45, CI 0.20-0.97). Conclusions: Reducing unnatural death should be a target in social policies aimed at improving the health of the homeless. We generated the hypothesis that social policies aimed at housing, work and improved contact with health care could be accompanied by less suicides and homicides within this vulnerable group.
Causes of Death Among an Urban Homeless Population Considered by the Medical Examiner
Journal of Social Work in End of Life Palliative Care, 2012
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Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period
JAMA internal medicine, 2013
Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time. We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, through December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort with rates in the 2003-2008 Massachusetts population and a 1988-1993 cohort of homeless adults in Boston using standardized rate ratios with 95% confidence intervals. A total of 1302 deaths occurred during 90 450 person-years of observation. Drug overdose (n = 219), cancer (n = 206), and heart disease (n = 203) were the major causes of death. Drug overdose accounted for one-third of deaths among adults...
2013
but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time. Methods: We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, through December 31, 2008. Deaths were identified through probabilistic linkage to the Massachusetts death occurrence files. We compared mortality rates in this cohort with rates in the 2003-2008 Massachusetts population and a 1988-1993 cohort of homeless adults in Boston using standardized rate ratios with 95 % confidence intervals. Results: A total of 1302 deaths occurred during 90 450