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We describe use of and factors associated with <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use in a sample of homeless adults 50 and older.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We recruited 350 participants who were homeless and 50 or older in Oakland, California. We interviewed participants about residential history in the prior 6\u00a0months, health status, health\u2010related behaviors, and health services use and assessed cognition and mobility. Our primary outcome was the number of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visits in the prior 6\u00a0months based on medical record review. We used negative binomial regression to examine factors associated with <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 6\u00a0months prior to enrollment, 46.3% of participants spent the majority of their time unsheltered; 25.1% cycled through multiple institutions including shelters, hospitals, and jails; 16.3% primarily stayed with family or friends; and 12.3% had become homeless recently after spending much of the prior 6 months housed. Half (49.7%) of participants made at least one <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visit in the past 6\u00a0months; 6.6% of participants accounted for 49.9% of all visits. Most (71.8%) identified a regular non\u2010<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> source of healthcare; 7.3% of visits resulted in hospitalization. In multivariate models, study participants who used multiple institutions (incidence rate ratio [<jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>]\u00a0=\u00a02.27; 95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0=\u00a01.08 to 4.77) and who were unsheltered (<jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>\u00a0=\u00a02.29; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.17 to 4.48) had higher <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use rates than participants who had been housed for most of the prior 6\u00a0months. In addition, having health insurance\/coverage (<jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>\u00a0=\u00a02.6; <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.5 to 4.4), a history of psychiatric hospitalization (<jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>\u00a0=\u00a01.80; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.09 to 2.99), and severe pain (<jats:styled-content style=\"fixed-case\">IRR<\/jats:styled-content>\u00a0=\u00a01.72; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.07 to 2.76) were associated with higher <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> visit rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>A sample of adults aged 50 and older who were homeless at study entry had higher rates of <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use in the prior 6\u00a0months than the general U.S. age\u2010matched population. Within the sample, <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use rates varied based on individuals\u2019 residential histories, suggesting that individuals\u2019 <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> use is related to exposure to homelessness.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13070","type":"journal-article","created":{"date-parts":[[2016,8,13]],"date-time":"2016-08-13T07:22:40Z","timestamp":1471072960000},"page":"63-74","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":36,"title":["Emergency Department Use in a Cohort of Older Homeless Adults: Results From the <scp>HOPE HOME<\/scp> Study"],"prefix":"10.1111","volume":"24","author":[{"given":"Maria C.","family":"Raven","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of California at San Francisco San Francisco CA"},{"name":"Philip R. 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