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J Gen Intern Med. 2018 May;33(5):635-643. doi: 10.1007/s11606-017-4229-1. Epub 2017 Nov 28.

Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort.

Author information

1
UCSF School of Medicine, San Francisco, CA, USA.
2
UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
3
UCSF Center for Vulnerable Populations, San Francisco, CA, USA.
4
UCSF Division of Geriatrics, Department of Medicine, San Francisco, CA, USA.
5
UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA. margot.kushel@ucsf.edu.
6
UCSF Center for Vulnerable Populations, San Francisco, CA, USA. margot.kushel@ucsf.edu.

Abstract

BACKGROUND:

The homeless population in the United States is aging. Aging-associated comorbidities are associated with increased symptoms.

OBJECTIVE:

To describe the prevalence of symptoms among older homeless-experienced adults, analyze factors associated with moderate-high physical symptom burden, and identify symptom clusters.

DESIGN:

Cross-sectional analysis within longitudinal cohort study.

PARTICIPANTS:

Using population-based sampling from shelters, meal programs, encampments, and a recycling center in Oakland, CA, we recruited homeless adults aged ≥ 50 for a longitudinal cohort. This study includes participants who participated in the 18-month follow-up visit.

MAIN MEASURES:

We assessed physical symptoms using the Patient Health Questionnaire-15 (PHQ-15); psychological symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D), Primary Care PTSD Screen (PC-PTSD), and psychiatric section of the Addiction Severity Index (ASI); loneliness using the Three-Item Loneliness Scale; and regret using a six-item regret scale.

KEY RESULTS:

Two hundred eighty-three participants (75.6% men and 82.3% African-Americans) completed symptoms interviews. Over a third (34.0%) had moderate-high physical symptom burden. The most prevalent physical symptoms were joint pain, fatigue, back pain, and sleep trouble. Over half (57.6%) had psychological symptoms; 39.6% exhibited loneliness and 26.5% had high regret. In a multivariate model, being a woman (AOR 2.54, 95% CI 1.28-5.03), childhood abuse (AOR 1.88, 95% CI 1.00-3.50), cannabis use (AOR 2.59, 95% CI 1.38-4.89), multimorbidity (AOR 2.50, 95% CI 1.36-4.58), anxiety (AOR 4.30, 95% CI 2.24-8.26), hallucinations (AOR 3.77, 95% CI 1.36-10.43), and loneliness (AOR 2.32, 95% CI 1.26-4.28) were associated with moderate-high physical symptom burden. We identified four symptom clusters: minimal overall (n = 129), moderate overall (n = 68), high physical and high psychological (n = 67), and high physical and low psychological (n = 17).

CONCLUSIONS:

Older homeless-experienced adults exhibit a high prevalence of symptoms across multiple dimensions. To reduce suffering, clinicians should recognize the interaction between symptoms and address multiple symptom dimensions.

KEYWORDS:

aging; homelessness; symptoms; vulnerable populations

PMID:
29185174
PMCID:
PMC5910332
[Available on 2019-05-01]
DOI:
10.1007/s11606-017-4229-1

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