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Erschienen in:
28.11.2017
Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort
Erschienen in: Journal of General Internal Medicine | Ausgabe 5/2018
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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.