title: Homeless Individuals Approaching the End of Life: Symptoms and Attitudes.
abstract: Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL).
  
  
  
  This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences.
  
  
  
  Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer "no" to the question "Would you be surprised if this patient were not alive in one year?" Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies.
  
  
  
  Participants (n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders (n = 18; 90%) and psychiatric diagnoses (n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal (n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little (n = 11; 55%) or too much (n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups (P < 0.01 for each comparison).
  
  
  
  Homeless individuals may experience a high frequency of pain and other symptoms as they approach the EOL. Care for such individuals may require a tailored approach.
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, USA. Electronic address: mltobey@partners.org.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tobey
authors.affiliation: Division of Rheumatology, New York University Langone Medical Center, New York, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Manasson
authors.affiliation: Division of Rheumatology, New York University Langone Medical Center, New York, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Decarlo
authors.affiliation: New York University Langone Medical Center, New York, USA.
authors.forename: Katrina
authors.initials: K
authors.lastname: Ciraldo-Maryniuk
authors.affiliation: New York University Langone Medical Center, New York, USA; Department of Family Medicine, Boston University, Boston, USA.
authors.forename: Jessie M
authors.initials: JM
authors.lastname: Gaeta
authors.affiliation: Boston Health Care for the Homeless Program, Boston, USA; and Division of Palliative Care, Massachusetts General Hospital, Boston, USA.
authors.forename: Erica
authors.initials: E
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D013727:Terminal Care / Q000523:psychology*; D035502:Trust; D014481:United States
keywords: Homeless persons; end-of-life care; palliative care; patient-centered care; respite care; vulnerable patients