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J Pain Symptom Manage. 2018 Aug;56(2):195-204. doi: 10.1016/j.jpainsymman.2018.05.011. Epub 2018 May 19.

'The Thing that Really Gets Me Is the Future': Symptomatology in Older Homeless Adults in the HOPE HOME Study.

Author information

1
University of California Berkeley - University of California San Francisco Joint Medical Program, Berkeley, California, USA.
2
University of California San Francisco School of Medicine, San Francisco, California, USA.
3
General Division of General Internal Medicine, University of California San Francisco/Zuckerberg San Francisco, San Francisco, California, USA; University of California San Francisco Center for Vulnerable Populations, San Francisco, California, USA.
4
University of California Berkeley - University of California San Francisco Joint Medical Program, Berkeley, California, USA; University of California Berkeley School of Public Health, Berkeley, California, USA.
5
General Division of General Internal Medicine, University of California San Francisco/Zuckerberg San Francisco, San Francisco, California, USA; University of California San Francisco Center for Vulnerable Populations, San Francisco, California, USA. Electronic address: margot.kushel@ucsf.edu.

Abstract

CONTEXT:

The homeless population is aging. Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. Little is known about symptom experience among older homeless adults.

OBJECTIVES:

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.

METHODS:

We 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. We analyzed data between June 2016 and December 2017 using thematic analysis.

RESULTS:

We found four main themes: 1) nonphysical symptoms are interwoven with, and as distressing as, physical symptoms; 2) individuals attribute symptoms to childhood abuse, manual labor, the conditions of homelessness, and aging; 3) symptoms interfere with daily functioning, causing negative changes in personality, energy, and motivation; and 4) individuals cope with symptoms through religion, social support, and substance use.

CONCLUSION:

Homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering. Health systems that care for homeless patients should adapt palliative care practices using a stepwise approach. Homeless shelters should adopt policies and modifications that increase privacy and autonomy while promoting community building. Housing interventions should promote community building. All who work with people experiencing homelessness should avoid stigmatizing language and recognize homeless individuals' sources of strength and coping.

KEYWORDS:

Symptoms; homelessness; older adults

PMID:
29783004
PMCID:
PMC6050110
[Available on 2019-08-01]
DOI:
10.1016/j.jpainsymman.2018.05.011

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