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...

California passed the Community Assistance, Recovery, and Empowerment (CARE) Act in 2022 to provide behavioral health and housing services to individuals with psychotic spectrum and schizophrenia disorders who are deemed unable to care for themselves. This policy brief from the Benioff Homelessness and Housing Initiative at UCSF and the California Policy Lab uses anonymized data to estimate how many San Franciscans in a database of individuals who have contact with the urgent and emergent care system may be eligible for referral to CARE Court and describe their service needs.

Cancer is the leading cause of mortality for people experiencing homelessness (PEH). However, not much is known about cancer-related surgical outcomes among PEH. This retrospective cohort study aimed to characterize access to care among PEH, evaluate postoperative outcomes, and assess costs associated with surgery for malignancy among PEH. Researchers found that PEH were less likely to undergo surgery for malignancy at cancer centers than hose who are housed. People experiencing homelessness also had a higher risk of requiring unplanned surgery.

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.

High users of the health care system use a disproportionate amount of health services yet have poorer health outcomes. This study aimed to examine natural trends in emergency department visits among high users of health and social services and assess whether the trends differed during the COVID-19 pandemic. In this retrospective cohort study, researchers found that there was a decrease in emergency department visits. Further research is needed to elucidate COVID-19 pandemic specific factors associated with a decrease in emergency department visits.

Unhoused patients have worse outcomes and higher health care utilization compared to their housed counterparts. Previous research has primarily focused on physical and behavioral health. This retrospective cohort study investigated the association between housing status and the nature of surgical care provided, health care utilization, and operational outcomes. Researchers found that unhoused patients commonly underwent emergent operations and had more complex hospitalizations.

Research from BHHI in collaboration with the San Francisco Department of Public Health and UC Berkeley School of Public Health showed how shelter-in-place emergency housing during the C...

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.

This study from BHHI researchers describes five distinct subgroups of the highest users of the health care system in San Francisco with differential comorbidities, health care needs, and social determinants of health, spanning from patients with medical comorbidities solely using medical services to patients grappling with housing insecurity, incarceration, substance use disorder, and mental health comorbidities. Frequent users of the health care system are not a homogenous population as previously thought. This study sheds new light on how to help the most vulnerable patients and inform clinicians and care coordination teams on making sure patients get the care they need the most. 

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.

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...

In a cohort of over 100,000 patients who received care from the Department of Veterans Affairs (VA) health system, those experiencing homelessness were more likely to be diagnosed with stage IV colorectal cancer compared with those who had housing. The patients who experienced homelessness also had longer hospital stays for all the cancer types studied. However, the findings differed across healthcare settings. In a commentary accompanying the study, Maria C. Raven, MD, MPH, associate Professor and Chief of Emergency Medicine at UCSF, said "Reducing healthcare disparities for people experiencing homelessness is essential, and the [VA] can serve as an example of what it takes to do so."