Faculty Bibliography

BACKGROUND AND OBJECTIVES/UNASSIGNED:The population of older adults with lived experience of homelessness in the United States is growing. Homelessness is associated with accelerated aging and opioid misuse. Older adults who have experienced homelessness suffer from greater functional impairment than nonhomeless older adults. Opioid misuse may catalyze functional impairment in this population, yet little is known about the prevalence of opioid use disorder (OUD) among currently and formerly homeless older adults. We report findings about the prevalence of OUD and functionality that we hope will spur future research about longevity and OUD in this population. RESEARCH DESIGN AND METHODS/UNASSIGNED:Using a secondary analysis of data collected in New York City through electronic medical records, we examined 253 patients who met three inclusion criteria: (a) aged 50 years and older, (b) history of homelessness, and (c) received community-based medical services. We summarize the prevalence of OUD in our cohort and present descriptive statistics about pain and cognitive function for a small subset measured by the Pain Enjoyment of Life and General Activity (PEG) and Mini-Cog scales. RESULTS/UNASSIGNED: = 31) had OUD diagnoses (age range = 50-81; mean age = 65; median age = 65; female = 11; and receiving agonist therapy = 5). Of those, 18 completed Mini-Cog; two showed clinically important cognitive impairment; 14 completed PEG; and eight reported moderate to severe pain. DISCUSSION AND IMPLICATIONS/UNASSIGNED:Our report is among the first to describe OUD among older adults who have experienced homelessness. Currently and formerly homeless older adults with OUD are younger, on average, and more likely to be female, than those without OUD. They are more likely to report pain but less likely to exhibit cognitive impairment. Possible explanations for these observations include care engagement, untreated pain, and a survivor effect wherein older adults with OUD who survive homelessness may have traits that protect them from cognitive decline and fatal overdose.

We report results of a workforce initiative to increase functional screenings for older adults with lived experiences of homelessness. Thirty-four healthcare practitioners screened 253 patients ages 50 years + using a battery of screening tools aligned with the 4 Ms. Using secondary analyses, we describe practitioners' participation in the workforce initiative, patients' functional scores, and a qualitative analysis of "what matters" to patients. Many practitioners did not complete all screenings. Among patient respondents, 6% reported moderate to severe ADL impairment; 24% scored positive cognitive impairment; 32% reported being unable to walk 250 feet; 46% reported moderate to severe pain. Resilience strategies developed during homelessness "matter." Few participants reported impaired ADL performance, which may reflect levels of independence needed to survive homelessness or to maintain services while homelessness. Findings suggest a need for additional workforce training to increase functional screenings for older adults in this population.