Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort
Type of Spiritual Experience
A description of the experience
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.
Patanwala M1, Tieu L2,3, Ponath C2, Guzman D2,3, Ritchie CS4, Kushel M5,6.
The homeless population in the United States is aging. Aging-associated comorbidities are associated with increased symptoms.
To describe the prevalence of symptoms among older homeless-experienced adults, analyze factors associated with moderate-high physical symptom burden, and identify symptom clusters.
Cross-sectional analysis within longitudinal cohort study.
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.
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.
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,
- 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).
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.
aging; homelessness; symptoms; vulnerable populations
The source of the experiencePubMed
Concepts, symbols and science items
Activities and commonsteps
Bone and skeletal disease
Loneliness and isolation
Physical abuse and beating
Sleep deprivation, insomnia and mental exhaustion