HOPE HOME: All Related Resources

Loneliness is often more common in older adults and those who face structural vulnerabilities, including those who experience homelessness. In the United States, 48% of single homeless adults are 50 and older. There is a limited information about loneliness among older adults who have experienced homelessness. This study used qualitative data collected as part of a longitudinal mixed-methods study, Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME). The study aimed to examine the intersection between social isolation, functional and cognitive impairment, and use of supportive services among a cohort of older adults experiencing homelessness in Oakland, California. Researchers found that homeless-experienced older adults with cognitive or functional impairments exhibited diverse loneliness experiences.

Half of people experiencing homelessness are older than 50, and almost half of older homeless adults became homeless for the first time after they turned 50. This webinar is about the causes and consequences of homelessness in late life. Margot Kushel, MD, and other BHHI presenters will discuss findings from the Health Outcomes of People Experiencing Homelessness in Older Middle Age (HOPE HOME) project—a longitudinal cohort study following older adults experiencing homelessness in Oakland, CA, and the California Statewide Study of People Experiencing Homelessness (CASPEH)—the largest representative study of homelessness in the United States since the mid-1990s.

Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults. This exploratory study examined the factors associated with poor sleep quality in a cohort of older adults in Oakland, California. Researchers found that participants had higher prevalence of poor sleep and worse Pittsburgh Sleep Quality Index (PSQI) scores than in studies of housed adults 20 years older.

Little is known how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. Researchers examined the perceptions and use of telehealth, sampling from a larger longitudinal study on homeless-experienced adults in Oakland, CA. They found that the participants experienced challenges accessing the necessary technologies for telehealth.

In this cohort study, UCSF BHHI researchers found that most older homeless-experienced adults needed caregiving assistance and few received such assistance. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term care needs due to untreated disabilities.

In this long-term study of 450 homeless adults age 50 and older, BHHI researchers examined how factors like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected participants' risk of dying. They found that 26% of the participants died within a few years of being enrolled, and people who first became homeless at age 50 or older were about 60% more likely to die than those who had become homeless earlier in life, and those who remained homeless were about 80% more likely to die than those who were able to return to housing. These findings illustrate an urgent need for policy approaches to prevent and end homelessness among older adults in the United States and suggest that addressing older adults’ barriers to health care and high rates of institutionalization may prevent premature mortality.

The homeless population in the United States is aging, however, there is limited studies on the neurologic etiologies of cognitive impairment in this population. Researchers observed a wide range of focal neurological deficits in the study participants, most notably deficits in cranial nerve function, motor function, coordination, and peripheral sensory functions. This study lays the foundation for the development of a longitudinal study of neurocognitive health among unhoused older adults in San Francisco.

Recently the demographic characteristics of people experiencing individual homelessness have changed; more individuals over the age of 50 are experiencing homelessness. BHHI researchers examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with family or friends. Researchers found barriers to stay such as feelings of shame and concerns about burdening the hosts. Findings suggest that family members and friends may play an important role in supporting older adults experiencing homelessness.

The homeless population is aging and adults who experience homelessness for the first time in older age are more likely to progress to chronic homelessness. To prevent or delay homelessness, many people live temporarily live with family or friends. In this qualitative study of homeless older adults, researchers conducted 46 semi-structured interviews. They found that structural barriers to family and friends providing housing for temporary or permanent exits from homelessness included housing regulations, geographic and transportation challenges, and environments inconducive to older adults.

The homeless population is aging and people experiencing homelessness are at a heightened risk of experiencing physical and sexual victimization. This study examined whether homelessness is independently associated with experiencing physical or sexual abuse. Researchers found that older homeless adults experience high rates of victimization.

Older homeless-experienced adults have low rates of advance care planning (ACP) engagement. In this cross-sectional qualitative study, researchers examined potential barriers and solutions to ACP engagement. Researchers found that participants believed that ACP is important, but acknowledge the multiple barriers to engagement. Potential solutions include capitalizing on opportunities outside health care setting and focusing on the period after housing and tailoring content.

The proportion of single homeless adults over the age of 50 is increasing. In this longitudinal cohort study, researchers examined the prevalence of and risk of falling in a cohort of older homeless adults. Researchers interviewed participants every 6 months for 3 years. They found a high prevalence of falls. Participants reported a prevalence of falls higher than older adults with a mean age of 78 in the general population. Researchers recommended identifying people at high risk of falls reducing unsheltered homelessness.

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness. Researchers aimed to understand the relationship between race and the experience of homelessness for older adults. They developed a theoretical model of the way experiences with overt and structural racism may lead to and perpetuate homelessness for older Black adults. Researchers recommend that efforts aimed at ending homelessness target the effects of structural racism with polices.

The homeless population has a higher prevalence of mental health and substance use problems than the general population. Researchers aimed to examine the prevalence of and factors associated with unmet needs for mental health and substance use treatment in older homeless adults. They used logistic regression to examine factors associated with unmet treatment needs. Researchers found that older homeless adults have a high prevalence of unmet behavioral health treatment needs and need targeted services.

Difficulty performing activities of daily living (“functional impairment”) is common in homeless adults aged 50 and older. Homeless adults develop aging-related conditions earlier than individuals in the general population, including difficulty with basic activities of daily living (ADLs) that are essential for independence. Researchers conducted a prospective cohort study to assess functional trajectories based on self-reported difficulty performing 5 activities of daily living. They found functional impairment improved in some homeless adults, it persisted or worsened in many others.

A guest column by Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, and Kevin Prindiville, JD, looks at the rise in homelessness among people older than 50: “With rising housing costs, fewer pensions, and a fraying safety net, many older adults are one crisis away from losing the roof over their head.”

The US homeless population is aging. Older adults and those living in poverty are at a high risk of food insecurity. Researchers conducted a cross-sectional analysis of baseline data from a population-based study of 350 homeless adults aged ≥50. They found older homeless adults experience a high prevalence of food insecurity. To alleviate food insecurity in this population, targeted interventions must address specific risk groups.

The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. This study aimed to describe the access to and use of mobile phones, computers, and the Internet among a cohort of 350 homeless adults over the age of 50 years. Researchers found that participants with phones used them for social support and communication with healthcare providers; however, few had annual phone contracts.

People experiencing homelessness have inadequate resources for regular dental hygiene and a higher prevalence of risk for tooth loss, including smoking and substance use. This study aimed to describe the prevalence of and factors associated with oral health measures in a sample of older homeless adults in Oakland, CA. Researchers conducted a cross-sectional analysis of data from a population-based study of 350 homeless adults aged ≥50. They found that tooth loss and oral pain are highly prevalent in older homeless adults.

Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. The study aimed to characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults. Researchers conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. They found that homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering.

Older homeless-experienced adults have low engagement in advance care planning (ACP) despite high morbidity and mortality. Researchers conducted a cross-sectional analysis of a cohort of 350 homeless-experienced adults aged 50 and older in Oakland, California. They assessed the prevalence of potential surrogate decision-makers, ACP contemplation, discussions, and ACP documentation (surrogate designation, advance directives). Researchers found a low prevalence of engagement in a full range of ACP behaviors, including contemplation, discussions, and formal ACP documentation.

Homeless adults in their 50s and 60s have a similar prevalence of geriatric conditions, including functional and cognitive impairment, as adults in their 70s and 80s in the general population. Researchers aimed to describe the prevalence of symptoms among older homeless-experienced adults, analyze factors associated with moderate–high physical symptom burden, and identify symptom clusters. They conducted a cross-sectional analysis within longitudinal cohort study. Researchers found a high prevalence of symptomatology across multiple domains. They found that symptom domains clustered together: those with higher physical symptomatology had a high prevalence of other symptom domains.

The prevalence of tobacco use among populations experiencing homelessness is between 60% and 80%. In this qualitative study, researchers examined attitudes toward tobacco control policies among older African American homeless-experienced smokers. Researchers identified seven major themes from their in-depth semistructured interviews. They found that older African American homeless-experienced smokers face significant barriers to smoking cessation.

Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. In this cohort study, researchers interviewed homeless adults aged 50 and older to determine the prevalence of common geriatric conditions and if the prevalence of these conditions differs across living environments. Researchers found geriatric conditions were common among older homeless adults living in diverse environments.

Researchers evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. They conducted structured interviews and neuropsychological testing with participants. Older homeless adults displayed a prevalence of cognitive impairment 3–4 times higher than has been observed in general population adults aged 70 and older. Future research will be helpful in clarifying whether treatment of alcohol misuse leads to improvements in cognitive function and whether specific treatment strategies are more effective in this population.

Little is known about chronic pain in older adults experiencing homelessness. In this cross-section, population-based study, researchers interviewed 350 homeless individuals aged 50 years and older to assess factors associated with chronic moderate to severe pain. Overall, 46.8% reported chronic moderate to severe pain. Researchers suggest clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.

The prevalence of substance use decreases as individuals age, but older adults now have a higher prevalence of substance use than older adults did 10 years ago. People experiencing homelessness have a higher prevalence of substance use disorders compared to the general population. In this cohort study, researchers examined the prevalence of and factors associated with substance use in a population of homeless individuals aged 50 and older. They found a high prevalence of substance use and an association between psychiatric hospitalization and depression with substance use. Researchers also recommend targeted treatment programs and geriatric substance use workforce development.

Researchers examined whether childhood adversity is associated with depressive symptoms, suicide attempts, or psychiatric hospitalization among older homeless adults. Using population-based sampling methods, the study enrolled 350 homeless adults aged 50 and older in Oakland, California. They found that childhood adversities are associated with poor mental health outcomes among older homeless adults. Researchers recommend screening for childhood adversities should be undertaken by all providers who care for older homeless adults.

The median age of single homeless adults is over 50. Individuals who are homeless visit emergency departments (EDs) at higher rates than the general population. Researchers described the use of and factors associated with ED use in a sample of homeless adults 50 and older. They found that a sample of adults aged 50 and older who were experiencing homelessness at study entry had higher rates of ED use in the prior 6 months than the general US age-matched population. Within the sample, ED use rates varied based on individuals’ residential histories, suggesting that individuals’ ED use is related to exposure to homelessness.

Little is known about pathways to homelessness among older adults. In this study, researchers interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported current health and functional status, including recent mental health and substance use problems. Researchers found that the life course experiences and current health and functional status of individuals with first homelessness before age 50 differed in key ways from those whose first homelessness occurred later.

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. Researchers administered structured interviews including assessments of health, history of homelessness, social support, and life course. They found that compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Further research on the newly homeless individuals and cohabiters in this cohort may elucidate more clearly the trajectories of these different phenotypes of homelessness.

Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. In this longitudinal cohort study, researchers examine smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. Researchers found tobacco use in older homeless adults and rates of quit attempts were similar to that observed in the general population, but successful quitting was lower.