Journal Article

Loneliness among homeless-experienced older adults with cognitive or functional impairments: qualitative findings from the HOPE HOME study

Knight, Kelly R., Yuan, Yeqing, Weeks, John, Olsen, Pamela, King, Stephen, Kushel, Margot

2024

Overview

Background Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences. Methods We purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis. Results Twenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants’ loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: (1) “lonely– distressed”, characterized by physical impairment and severe isolation; (2) “lonely– rather be isolated”, reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; (3) “lonely– transient”, as a result of aging, acceptance and grieving; and (4) “not lonely”– characterized by stability and connection despite having experienced homelessness. Conclusions Loneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Activities of daily living / Adults / Aged / Aging / Analysis / Biostatistics / Cognition / Cognition disorders in old age / Cognitive ability / Cohort analysis / Consent / Content analysis / Data analysis / Demographic aspects / Environmental Health / Epidemiology / Experience / Grief / Health aspects / Homeless / Homeless people / Homeless persons / Homelessness / Humans / Ill-Housed Persons / Impairment / Interviews / Loneliness / Loneliness - psychology / Loneliness and Social Isolation / Longitudinal Studies / Male / Marginality / Marginalized groups / Medicine / Medicine & Public Health / Mental health / Mobility / Older adults / Older people / Patient outcomes / Pattern recognition / Perceived social support / Physical disabilities / Physically disabled persons / Population aging / Public Health / Qualitative analysis / Qualitative research / Social aspects / Social factors / Social interactions / Social isolation / Social Isolation - psychology / Social networks / Social support / Trauma / Typology / Vaccine