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.

Through interviews of HOPE HOME participants who reported living with family or friends, this qualitative study from BHHI researchers found that intergenerational trauma significantly a...

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.

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.

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.

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.

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.

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.

In this qualitative study, UCSF BHHI researchers found that providing mobile testing, incentives, and trusted community members for outreach mitigated barriers to COVID-19 testing and v...

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.

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.

Homelessness is dynamic; some individuals cycle between homelessness and housing. BHHI examined the prevalence of and factors associated with exits from and returns to homelessness among adults aged 50 and older. With a median 4 years of follow-up, 80% of participants exited homelessness into housing. Having a permanent rental subsidy was associated with retaining housing.

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.

This UCSF study found that adults experiencing homelessness have a high risk of incarceration. The authors emphasize the need for targeted interventions addressing substance use, homele...

Older homeless-experienced adults are at higher risk of loneliness than general older adults, yet less is known about the factors contributing to loneliness for this group. Loneliness is associated with multiple adverse health and mental health outcomes. This study examines this gap in our knowledge.

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 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.

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.

In this qualitative study, UCSF BHHI researchers interviewed older unhoused adults to understand how structural determinants affect stays with family members among individuals experienc...

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.

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.

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 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.

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.

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.