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

Approximately half of the homeless population is aged 50 or older. Homeless adults in their 50s and 60s have a similar prevalence of geriatric conditions, including functional and cognitive impairment, as adults in their 70s and 80s in the general population. The majority of homeless adults over 50 have two or more chronic health conditions. Thus, homeless adults can be considered “older” at age 50. Symptoms, the self-reported negative perceptions that individuals experience in relation to disease, are prevalent and a common reason for seeking care. There are four dimensions of symptoms: physical, psychological, social (e.g., loneliness), and existential (those relating to the meaning, purpose, or value of life, e.g., regret and dignity). The Theory of Symptom Management (TSM) suggests that contextual factors, such as an individual’s socioeconomic status, environmental factors, and personal- and health-related factors, affect the experience of symptoms. In the general population, increased age, being a woman, and living in poverty are associated with increased symptom burden. Symptoms have been associated with adverse social and health outcomes including lower quality of life, functional decline, and increased risk of hospitalization or death. The literature on health and homelessness focuses on healthcare utilization and health-related behaviors. There is limited literature on health status focusing on chronic diseases and, more recently, geriatric conditions. Health-related quality of life, to which symptoms are an important contributor, remains understudied. While there are promising advances in treating symptoms in older adults, these have not been translated to settings in which people experiencing homelessness receive care. With the aging of the homeless population, there is a heightened need to understand and address symptomatology. To inform interventions among homeless adults, we describe the prevalence and severity of symptoms in a sample of older adults who currently or recently experienced homelessness. We analyze whether there are associations between sociodemographic characteristics, life conditions, health conditions, health-related behaviors, and other symptom domains, and moderate to severe physical symptoms. Our approach facilitates the identification of modifiable factors for interventions targeted at reducing physical symptom burden. Using cluster analysis, we analyze whether symptom type and severity cluster with one another.