The long-term goal of this study is to determine, in homeless adults aged 50 and over, the key life events and precipitants of homelessness and how these are associated with the prevalence, severity, trajectory and consequences of geriatric conditions in order to guide prevention, healthcare, social service and housing interventions. The average age of homeless adults in the United States has risen dramatically in the last 20 years; while only 11% of the homeless population was age 50 and older in 1990, half is now. Little is known about the life trajectories that lead to late-life homelessness or the role of agin-related conditions in poor outcomes. Policies and programs directed at preventing and ameliorating homelessness were designed before the age distribution changed and do not address aging issues. Homeless adults experience premature aging and are not able to make compensatory changes in their environment, suggesting that geriatric conditions may be a substantial factor in poor outcomes. Little is known about the characteristics or consequences of geriatric conditions in this population; these data are needed to design and implement effective policies and programs. The proposed study will address this gap by assembling and following a cohort of 350 homeless adults age 50 and older in order to address the following aims: 1) To identify key life events and precipitants of homelessness 2) To determine the prevalence, severity and trajectory of geriatric conditions and their association with life course events and 3 To examine predictors (including life course events and geriatric conditions) of acute health care utilization (Emergency Department visits and hospitalizations). Participants will be recruited from emergency shelters, subsidized food programs, and homeless encampments in Oakland, CA using a multi- stage probability sampling design. Participants will be followed for 3 years, with a baseline study visit and 6 semi-annual follow-up visits for structured interviews. Subsamples will undergo in-depth interviews to explore key events and precipitants. Study visits will take place at St. Mary's Center, a multiservice community-based center for older homeless adults. Trained research assistants, working under the close supervision of the study investigators and a neuropsychologist, will administer clinical assessments and structured interviews using validated instruments to assess life course events preceding homelessness, geriatric conditions (functional and cognitive impairments), behavioral health (mental health and alcohol and illicit substance use), physical health (chronic diseases), and acute healthcare utilization (Emergency Department visits, inpatient hospitalizations). We will gather mortality data through death record registries. An Advisory Board of community and policy leaders with extensive expertise with homeless programs and policies will work with the study team to guide study development and help translate the findings into practice and policy changes. Study findings will ultimately contribute to the development of clinical, programmatic and policy recommendations to prevent and ameliorate the effects of homelessness among older adults.

Public Health Relevance

The proposed study will identify the key life events and precipitants of homelessness as well as the prevalence, severity and consequences of geriatric conditions among homeless adults aged 50 and older. While half of homeless adults are aged 50 or older, there is little data on life trajectories or aging-related conditions in this populatin. The results of this study will provide an evidence-base to guide policies and programs to prevent late-life homelessness and ameliorate poor outcomes in older homeless adults.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG041860-04
Application #
8870260
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Patmios, Georgeanne E
Project Start
2012-09-30
Project End
2016-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
4
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94118
Bazari, Adam; Patanwala, Maria; Kaplan, Lauren M et al. (2018) 'The Thing that Really Gets Me Is the Future': Symptomatology in Older Homeless Adults in the HOPE HOME Study. J Pain Symptom Manage 56:195-204
Sudore, Rebecca L; Cuervo, Isabel Arellano; Tieu, Lina et al. (2018) Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study. J Am Geriatr Soc 66:1068-1074
Tong, M; Tieu, L; Lee, C T et al. (2018) Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study. J Public Health (Oxf) :
Vijayaraghavan, Maya; Olsen, Pamela; Weeks, John et al. (2018) Older African American Homeless-Experienced Smokers' Attitudes Toward Tobacco Control Policies-Results from the HOPE HOME Study. Am J Health Promot 32:381-391
Patanwala, M; Tieu, L; Ponath, C et al. (2018) Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort. J Gen Intern Med 33:635-643
Freitas, Daniel J; Kaplan, Lauren M; Tieu, Lina et al. (2018) Oral health and access to dental care among older homeless adults: results from the HOPE HOME study. J Public Health Dent :
Lee, Chuan Mei; Mangurian, Christina; Tieu, Lina et al. (2017) Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study. Am J Geriatr Psychiatry 25:107-117
Brown, Rebecca T; Hemati, Kaveh; Riley, Elise D et al. (2017) Geriatric Conditions in a Population-Based Sample of Older Homeless Adults. Gerontologist 57:757-766
Raven, Maria C; Tieu, Lina; Lee, Christopher T et al. (2017) Emergency Department Use in a Cohort of Older Homeless Adults: Results From the HOPE HOME Study. Acad Emerg Med 24:63-74
Hurstak, Emily; Johnson, Julene K; Tieu, Lina et al. (2017) Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study. Drug Alcohol Depend 178:562-570

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