Characteristics and Factors Associated With Pain in Older Homeless Individuals: Results From the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) Study

  • John C. Landefeld
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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  • Christine Miaskowski
    Department of Physiological Nursing, University of California, San Francisco, California
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  • Lina Tieu
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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  • Claudia Ponath
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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  • Christopher T. Lee
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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  • David Guzman
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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  • Margot Kushel
    Address reprint requests to Margot Kushel, MD, UCSF Division of General Internal Medicine at ZSFG, UCSF Box 1364, 1001 Potrero Ave, Bldg 10, W13, San Francisco, CA 94143.
    Division of General Internal Medicine, University of California, San Francisco, California

    Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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      • Half of older homeless adults reported chronic moderate to severe pain.
      • Older homeless adults experienced moderate to severe pain for a median of 5 years.
      • Chronic pain was associated with arthritis, post-traumatic stress disorder, and abuse.


      Individuals experiencing homelessness in the United States are aging; little is known about chronic pain in this population. In a cross-sectional, population-based study, we interviewed 350 homeless individuals aged 50 years and older to describe pain experienced by older persons experiencing homelessness and to assess factors associated with chronic moderate to severe pain, defined as pain lasting ≥3 months, with a past week average severity score of 5 to 10 (scale 0–10). The median age of participants was 58 years. Participants were predominantly African American (79.6%) and male (77.3%). Overall, 46.8% reported chronic moderate to severe pain. Almost half of participants reported a diagnosis of arthritis (44.3%) and one-third reported symptoms consistent with post-traumatic stress disorder (PTSD; 32.8%). Three-quarters (75.3%) endorsed a personal history of abuse. In multivariate analyses, PTSD (adjusted odds ratio [AOR]: 2.2, 95% confidence interval [CI], 1.4–3.7), arthritis (AOR: 4.8, 95% CI, 3.0–7.8), and history of experiencing abuse (AOR: 2.4, 95% CI, 1.3–4.3) were associated with chronic moderate to severe pain. HIV status, diabetes, depressive symptoms, and substance use were not associated with pain. Clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.


      This article describes the prevalence and factors associated with chronic pain in older homeless adults. Almost half report chronic pain, which was associated with PTSD, arthritis, and personal history of abuse. Clinicians should address chronic pain, trauma, and the associated mental health conditions in this high-risk population.

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