Factors associated with mortality among homeless elderly in California

1. Premature mortality was common amongst homeless older adults in the United States.

2. Factors contributing to premature mortality amongst homeless adults included heart disease, cancer, and drug overdose. 

Evidence Rating Level: 2 (Good) 

Homeless individuals have been known to experience more accelerated aging, premature onset of chronic diseases, impairments in cognition and function, as well as mortality. With the increased overall age of the homeless population in the United States, further research discussing factors contributing to their mortality is vital. This prospective cohort study examined 450 homeless adults older than 50 years of age to assess prevalence, causes, and associated factors of mortality. Participants were interviewed at baseline and follow-up interviews were conducted every six months. The results showed that a total of 26% of participants died through the study timeline and median age at death was 64.6 years. As such, an increased risk of mortality was associated with homelessness over the age of 50 years (aHR 1.62, 95%CI 1.13-2.32). After death certificates of the decedents were analyzed, the most common causes of mortality were found to be heart disease, cancer, and drug overdose. In conclusion, this cohort study confirms that premature mortality is common among homeless older adults. Given these disparities that do exist among this population in the United States as confirmed by this present study, further initiatives to prevent and end the growing homelessness crisis is crucial, especially considering the early mortality in this group. However, this study still has several limitations. For instance, given the small number of deaths that occurred in this study, there may have been a lack in power to detect clear factors associated with mortality. Nevertheless, as premature mortality is likely very common in older homeless adults, there is an urgent need for new policies to address the homelessness endemic in the United States.  

Click to read the study in JAMA Internal Medicine

Image: PD

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