Opioid use disorder, pain, and cognitive impairment in older adults who have experienced homelessness.

BACKGROUND AND OBJECTIVES

The population of older adults with lived experience of homelessness in the United States is growing. Homelessness is associated with accelerated aging and opioid misuse. Older adults who have experienced homelessness suffer from greater functional impairment than nonhomeless older adults. Opioid misuse may catalyze functional impairment in this population, yet little is known about the prevalence of opioid use disorder (OUD) among currently and formerly homeless older adults. We report findings about the prevalence of OUD and functionality that we hope will spur future research about longevity and OUD in this population.

RESEARCH DESIGN AND METHODS

Using a secondary analysis of data collected in New York City through electronic medical records, we examined 253 patients who met three inclusion criteria: (a) aged 50 years and older, (b) history of homelessness, and (c) received community-based medical services. We summarize the prevalence of OUD in our cohort and present descriptive statistics about pain and cognitive function for a small subset measured by the Pain Enjoyment of Life and General Activity (PEG) and Mini-Cog scales.

RESULTS

Twelve percent ( = 31) had OUD diagnoses (age range = 50-81; mean age = 65; median age = 65; female = 11; and receiving agonist therapy = 5). Of those, 18 completed Mini-Cog; two showed clinically important cognitive impairment; 14 completed PEG; and eight reported moderate to severe pain.

DISCUSSION AND IMPLICATIONS

Our report is among the first to describe OUD among older adults who have experienced homelessness. Currently and formerly homeless older adults with OUD are younger, on average, and more likely to be female, than those without OUD. They are more likely to report pain but less likely to exhibit cognitive impairment. Possible explanations for these observations include care engagement, untreated pain, and a survivor effect wherein older adults with OUD who survive homelessness may have traits that protect them from cognitive decline and fatal overdose.