{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T11:34:19Z","timestamp":1792755259058,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2022,10,1]]},"abstract":"\n Importance<\/jats:title>\n The population of homeless older adults is growing and experiences premature mortality. Little is known about factors associated with mortality among homeless older adults.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify the prevalence and factors associated with mortality in a cohort of homeless adults 50 years and older.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Baseline and time-varying characteristics, including sociodemographic factors, social support, housing status, incarceration history, chronic medical conditions, substance use, and mental health problems.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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\u2009=\u200917 [14.5%]), cancer (n\u2009=\u200917 [14.5%]), and drug overdose (n\u2009=\u200914 [12.0%]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2022.3697","type":"journal-article","created":{"date-parts":[[2022,8,29]],"date-time":"2022-08-29T11:32:38Z","timestamp":1661772758000},"page":"1052","source":"Crossref","is-referenced-by-count":68,"title":["Factors Associated With Mortality Among Homeless Older Adults in California"],"prefix":"10.1001","volume":"182","author":[{"given":"Rebecca T.","family":"Brown","sequence":"first","affiliation":[{"name":"Division of Geriatrics, Department of Medicine, University of California, San Francisco"},{"name":"Division of Geriatric Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia"},{"name":"Geriatrics and Extended Care, Corporal Michael J. 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