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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 5/2018

01-05-2018

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

Authors: M. Patanwala, BA, L. Tieu, MPH, C. Ponath, MA, D. Guzman, MSPH, C. S. Ritchie, MD, MSPH, Margot Kushel, MD

Published in: Journal of General Internal Medicine | Issue 5/2018

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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.
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Metadata
Title
Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort
Authors
M. Patanwala, BA
L. Tieu, MPH
C. Ponath, MA
D. Guzman, MSPH
C. S. Ritchie, MD, MSPH
Margot Kushel, MD
Publication date
01-05-2018
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 5/2018
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-017-4229-1

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