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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.
Patanwala M1, Tieu L2,3, Ponath C2, Guzman D2,3, Ritchie CS4, Kushel M5,6.
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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