Estimating the Rates of Undiagnosed Prediabetes and Diabetes Among People Experiencing Homelessness

OBJECTIVES

The rising prevalence of type 2 diabetes (T2D) in Canada poses a significant health challenge. Despite the convenience of screening for diabetes with glycated hemoglobin concentration, people experiencing homelessness (PEH) often face barriers to accessing diabetes screening, potentially leading to underdiagnosis. In this study, we aim to assess the prevalence of undiagnosed diabetes among PEH in Calgary, Alberta, and contribute insights for planning healthcare services and public health initiatives.

METHODS

Four screening clinics were held, and participants were recruited through posters and word of mouth. Participants underwent point-of-care glycated hemoglobin (A1C) testing using the Siemens DCA Vantage point-of-care analyzer. Descriptive statistics were used to identify the proportions of prediabetes and diabetes, whereas CanRisk survey scores were used to identify the pre-test probability of diabetes.

RESULTS

The mean age of participants (n=102) was 47.6 years, and the self-reported causes of homelessness among the participants were diverse, including: housing and financial issues (n=53), interpersonal and family issues (n=35), and health or corrections-related factors (n=27). The average A1C was 5.60% (standard deviation 0.57%), with 5 values in the diabetes range and 12 in the prediabetes range, for a total of 17 participants found to have previously undiagnosed dysglycemia.

CONCLUSIONS

The high rate of undiagnosed prediabetes and diabetes among people experiencing homelessness reflects at least what is already seen in the general population in Canada. More resources are required to reduce the barriers to screening for diabetes among this population.

Canadian Health Care Providers' Perspectives on Working with Older Homeless Adults in Outreach Settings

Service providers have a unique understanding of older homeless adults' challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client-provider relationship as an essential building block to HCPs' work; (b) progression of care that acknowledges the "whole person"; (c) collaboration as integral to providers' work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.

Later-Life Homelessness as Disenfranchised Grief

ABSTRACTAlthough interest on older homelessness is gaining momentum, little research has considered the experiences of first-time homelessness from the perspective of older adults themselves. This constructivist grounded-theory study addresses this gap by exploring how societal perceptions of homelessness and aging shape access to housing, services, and perceptions of self for 15 older adults residing in emergency homeless shelters in Montreal, (Quebec, Canada). Findings revealed that homelessness evoked a grief response characterized by shock, despair, anger, and in some cases, relief. Connecting and receiving support from other shelter residents and staff helped participants to acknowledge and grieve their losses. However, difficult shelter conditions, the stigma associated with aging and homelessness, and not having their grief recognized or validated served to disenfranchise grief experiences. Conceptualizing later-life homelessness as disenfranchised grief contributes to the aging and homelessness literature while providing new avenues for understanding and validating the experiences of a growing population of vulnerable older adults.