Factors associated with substance use in older homeless adults: Results from the HOPE HOME study

ABSTRACT

Background: The median age of the single adult homeless population is 50 and rising. Although the prevalence of substance use decreases as individuals age, older adults now have a higher prevalence of substance use than older adults did 10 years ago. Homeless individuals have a higher prevalence of substance use disorders than the general population. However, little is known about substance use in older homeless adults. Methods: The objective of the study was to examine prevalence of and factors associated with substance use in a population-based sample (N = 350) of homeless individuals aged 50 and older in Oakland, California. Dependent variables included moderate or greater severity illicit drug symptoms (Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) score >3) and moderate or greater alcohol symptoms (Alcohol Use Disorders Identification Test (AUDIT) score >7). Independent variables included demographics, mental health problems, and negative life course events such as physical and sexual abuse, school expulsion, and onset of homelessness. Results: Almost two thirds of participants, 64.6%, had moderate or greater severity symptoms for at least 1 illicit drug; 25.8% had moderate or greater severity alcohol symptoms. History of psychiatric hospitalization was associated with moderate or greater illicit drug symptoms (adjusted odds ratio [AOR] = 1.9, 1.0–3.6). The presence of major depressive symptoms was associated with moderate or greater severity alcohol symptoms (AOR = 1.8, 1.1–3.0). Conclusions: In this sample of older homeless adults, substance use is common. There is a need for substance use treatment programs, integrated with mental health services, which are targeted towards the needs of older homeless adults.

KEYWORDS:

• Aging
• homeless persons
• substance-related disorders

Acknowledgments

The authors gratefully acknowledge their colleagues Angela Allen, Pamela Olsen, Nina Fiellin, Tauni Marin, and Kenneth Perez for their invaluable contributions to the HOPE HOME study. The authors also thank the staff at St. Mary's Center and the HOPE HOME Community Advisory Board for their guidance and partnership. This study was presented as an oral presentation at the Society for General Internal Medicine 38th Annual Meeting on April 24, 2015, in Toronto, Canada. The authors declare that they have no conflicts of interest.

Funding

This work was funded by the National Institute on Aging (NIA) at the National Institutes of Health (NIH) (R01AG041860 [Kushel, Ponath, Guzman, Tieu] and K24AG046372 [Kushel]). Emily Hurstak is funded by a Ruth L. Kirschstein National Research Service Award (T32HP19025). The funding sources had no role in the preparation, review, or approval of the manuscript. M. B. Kushel is a member of the leadership board of Everyone Home, which seeks to end homelessness in Alameda County, CA.

Author contributions

Drs. Spinelli and Kushel had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Spinelli, Guzman, and Kushel. Acquisition of data: Kushel and Ponath. Statistical analysis: Guzman. Analysis and interpretation of data: Spinelli, Ponath, Tieu, Guzman, and Kushel. Drafting of the manuscript: Spinelli. Critical revision of the manuscript for important intellectual content: Spinelli, Ponath, Tieu, Guzman, and Kushel.