Cancer is a leading cause of death in older unhoused adults. In this retrospective cohort study, researchers assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. Researchers used a national sample of veterans with lung, colorectal, and breast cancer during the period of 2011-2020. Findings showed veterans who were unhoused before and for the twelve months after their diagnosis had 10–20 percent greater risk for all-cause mortality than veterans who were consistently housed, even after adjustment for multiple factors.

Cancer is a leading cause of death among older people experiencing homelessness. In this retrospective cohort study, researchers sought to characterize the diagnosis, treatment, surgical outcomes, and mortality by housing status of patients who receive care from the US Department of Veterans Affairs (VA) health system for colorectal, breast, or lung cancer. Researchers found that homelessness was associated with later stages at diagnosis for colorectal cancer.

Mobile crisis services for people experiencing distress related to mental health or substance use are expanding in the US. In this mixed method study protocol, researchers plan to conduct an interrupted time series analysis to quantitatively examine the impacts of the Street Crisis Response Team (SCRT) on people experiencing homelessness who utilize the services in San Francisco. Researchers also plan to analyze racial and ethnic disparities to understand the impact on health equity.

A study from UCSF Benioff Homelessness and Housing Initiative examined implementation of a rapid COVID-19 test and response model in congregate shelters in San Francisco. The pilot allowed for detection and isolation of cases among staff and residents. Researchers recommend frequent testing with rapid turnaround as an important public health intervention to improve accessibility and availability of testing, identification, and isolation of COVID-19 positive cases in shelters.

In this commentary of the study "Housing Status, Cancer Care, and Associated Outcomes Among US Veterans", Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, provides lessons from the Veterans Health Administration. In 2009, the VHA began a multipronged initiative designed to end and prevent homelessness among veterans, which led to a 45% reduction in veteran homelessness from 2009 to 2017. Dr. Raven writes, "The results of this study indicate that in addition to providing housing at comparatively high rates for unhoused veterans, the system’s initiative to prevent and end veteran homelessness has also likely helped reduce important disparities in oncologic care for this population."

 Traumatic injury is a major cause of morbidity for people experiencing homelessness (PEH), however, injury patterns and subsequent hospitalization among PEH have not been studied on a national scale. In this national retrospective observational cohort study, researchers evaluated whether differences in mechanisms of injury exist between PEH and housed trauma patients in North America and whether the lack of housing is associated with increased adjusted odds of hospital admission. Researchers found that injured PEH had a significantly adjusted greater odds of hospital admissions.

People living with HIV/AIDS (PLWHA) have an increased risk of experiencing homelessness. The underlying drivers of homelessness are structural, however individual factors such as mental health and substance use problems are also common drivers. People living with HIV/AIDS who experience homelessness are more likely to have uncontrolled viral load. Researchers from BHHI suggest integrating HIV treatment with mental health and substance use treatment.

Margot Kushel, MD, director of UCSF’s Benioff Housing and Homelessness Initiative, wrote an editorial in JAMA about a recent study on the negative health consequences of involuntary displacements on the lives of people experiencing homelessness. Dr. Kushel writes, "The question is not whether living in unsheltered settings is dangerous, but rather what is the role of forced displacements in addressing the harm caused by them."

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.

Alcohol use disorders (AUDs) are common among those experiencing homelessness. Managed alcohol programs (MAPs) are an evidence-based solution for helping people with AUD experiencing homelessness. Researchers examined and evaluated MAPs in Canada and California. They found that MAPs have successes and stabilization effects.

Traumatic injury is a leading cause of hospitalization among people experiencing homelessness. In this retrospective cohort study of the American College of Surgeons Trauma Quality Programs (TQP) researchers evaluated whether homelessness was associated with increased morbidity and length of stay (LOS) after hospitalization for traumatic injury. Researchers found that challenges in providing safe discharge to people experiencing homelessness after injury may lead to prolonged LOS.

This UCSF study examined deaths among people experiencing homelessness in San Francisco from 2016 to 2018. Although heart disease and cancer are the first and second causes of death for California’s general population, the leading causes of homeless deaths were acute intoxication (unintended overdose) and trauma (including homicide and suicide rates over triple that of the US general population). The authors advocate that these differences in cause-specific mortality should inform death prevention efforts within the homeless population differently than the general population.

This study from UCSF BHHI researchers examined deaths among people experiencing homelessness in San Francisco during the first year of the COVID-19 pandemic. They found 82% of 331 deaths were associated with drug overdose, not COVID-19 infection. Traumatic injury, including homicide and suicide, was the second most common cause of death. This research highlights a need for strategies that address both homelessness and drug use, including housing, evidence-based treatment of opioid addiction, and overdose prevention programs.

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.

Tobacco use is common in people who experience homelessness; however, research in homeless and unstably housed (HUH) women is sparse. Researchers found that the most common reason for tobacco use was to reduce stress and anxiety. The findings suggest that tailored counseling and healthcare interactions that include smoking cessation efforts and address food insecurity during treatment.

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.

Unhoused patients have worse surgical outcomes than the general population, resulting in premature mortality. Researchers conducted 26 semi-structured interviews of clinicians who care for patients with surgical disease. The researchers identified 5 themes, including, but not limited to: patients and clinicians face multiple challenges meeting preoperative requirements; although surgeons do not make major operative decisions based on housing status, some take it into consideration for minor care decisions; clinicians perceive that unhoused patients have negative postoperative experiences in the hospital.

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.