Factors Associated with Loneliness Among Older Adults Who Experienced Homelessness: Results from the HOPE HOME Study.

Abstract

Older homeless-experienced adults are at higher risk of loneliness than general older adults. Loneliness is associated with multiple adverse health and mental health outcomes. Less is known about factors contributing to loneliness among older adults who experience homelessness. This study aims to examine the relationship between relevant factors and loneliness. We used data collected from January 2015 to February 2023 from the Health Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study, an ongoing longitudinal cohort study of older adults, homeless at study entry, conducted in Oakland, CA. We used structural equation modeling (SEM) to investigate the relationships between trauma, mental health status, physical health and functional status, housing factors, social support, and substance use and loneliness. Our analytic sample consisted of 385 participants who completed 2099 assessments. The majority of participants were men (74.8%), Black (82.1%), and not partnered (87.5%). At the first loneliness interview, 41.8% remained homeless, and 39.2% met the criteria for loneliness. Poor mental health and a lack of social support were associated with loneliness. Poor physical health and functional status had an indirect effect on increased loneliness through worsening mental health status. Experiences of trauma had an indirect effect on increased loneliness through worsening mental health status. The Shelter-In-Place mandate was associated with decreased loneliness. We found no association between regaining housing and decreased loneliness. In a longitudinal study of older adults, homeless at study entry, we found that mental health had direct impacts on loneliness, and other factors (i.e., trauma, physical health, and functional status) contributed to increased loneliness through their negative effects on mental health. Regaining housing was not associated with a decrease in loneliness. These findings highlight the need for interventions beyond housing, including mental healthcare, trauma-informed support, and social engagement opportunities.