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. 2022 Oct 1;182(10):1052-1060.
doi: 10.1001/jamainternmed.2022.3697.

Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study

Rebecca T Brown  1   2   3   4   5 , Jennifer L Evans  6 , Karen Valle  6   7 , David Guzman  6   7 , Yea-Hung Chen  8 , Margot B Kushel  6   7
Affiliations

Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study

Rebecca T Brown et al. JAMA Intern Med. .

Erratum in

  • Errors in Table 1.
    [No authors listed] [No authors listed] JAMA Intern Med. 2023 Feb 1;183(2):171. doi: 10.1001/jamainternmed.2022.5820. JAMA Intern Med. 2023. PMID: 36469339 Free PMC article. No abstract available.

Abstract

Importance: The population of homeless older adults is growing and experiences premature mortality. Little is known about factors associated with mortality among homeless older adults.

Objective: To identify the prevalence and factors associated with mortality in a cohort of homeless adults 50 years and older.

Design, setting, and participants: In this prospective cohort study (Health Outcomes in People Experiencing Homelessness in Older Middle Age [HOPE HOME]), 450 adults 50 years and older who were homeless at baseline were recruited via venue-based sampling in Oakland, California. Enrollment occurred in 2 phases, from July 2013 to June 2014 and from August 2017 to July 2018, and participants were interviewed at 6-month intervals.

Exposures: Baseline and time-varying characteristics, including sociodemographic factors, social support, housing status, incarceration history, chronic medical conditions, substance use, and mental health problems.

Main outcomes and measures: Mortality through December 31, 2021, based on state and local vital records information from contacts and death certificates. All-cause mortality rates were compared with those in the general population from 2014 to 2019 using age-specific standardized mortality ratios with 95% CIs.

Results: Of the 450 included participants, median (IQR) age at baseline was 58.1 (54.5-61.6) years, 107 (24%) were women, and 360 (80%) were Black. Over a median (IQR) follow-up of 55 (38-93) months, 117 (26%) participants died. Median (IQR) age at death was 64.6 (60.3-67.5) years. In multivariable analyses, characteristics associated with mortality included a first episode of homelessness at 50 years and older (adjusted hazard ratio [aHR], 1.62; 95% CI, 1.13-2.32), homelessness (aHR, 1.82; 95% CI, 1.23-2.68) or institutionalization (aHR, 6.36; 95% CI, 3.42-11.82) at any follow-up compared with being housed, fair or poor self-rated health (aHR, 1.64; 95% CI, 1.13-2.40), and diabetes (aHR, 1.55; 95% CI, 1.06-2.26). Demographic characteristics, substance use problems, and mental health problems were not independently associated. All-cause standardized mortality was 3.5 times higher (95% CI, 2.5-4.4) compared with adults in Oakland. The most common causes of death were heart disease (n = 17 [14.5%]), cancer (n = 17 [14.5%]), and drug overdose (n = 14 [12.0%]).

Conclusions and relevance: The cohort study found that premature mortality was common among homeless older adults and associated factors included late-life homelessness and ongoing homelessness. There is an urgent need for policy approaches to prevent and end homelessness among older adults in the US.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Kushel reported serving as a board member for Housing California, a nonprofit that advocates for affordable housing in California. No other disclosures were reported.

Figures

Figure.
Figure.. Age at Time of Death Among 117 Homeless Adults Who Died During Follow-up
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