title: Factors associated with substance use in older homeless adults: Results from the HOPE HOME study.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Spinelli
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ponath
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Tieu
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: Emily E
authors.initials: EE
authors.lastname: Hurstak
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: a Division of General Internal Medicine , University of California, San Francisco, San Francisco General Hospital , San Francisco , California , USA.
authors.forename: Margot
authors.initials: M
authors.lastname: Kushel
mesh_terms: D000368:Aged; D001213:Asian / Q000523:psychology*; D002140:California / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology*; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D044465:White People / Q000523:psychology*
keywords: Aging; homeless persons; substance-related disorders