Breder Kelseanne, Yu Van
Rory Meyers College of Nursing, New York University, New York, New York, United States.
Center for Urban Community Services, New York, New York, United States.
Innov Aging. 2025 Jul 4;9(7):igaf075. doi: 10.1093/geroni/igaf075. eCollection 2025 Jul.
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.
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.
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.
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.
美国有过无家可归经历的老年人数量正在增加。无家可归与加速衰老和阿片类药物滥用有关。有过无家可归经历的老年人比无家可归的老年人功能障碍更严重。阿片类药物滥用可能会促使该人群出现功能障碍，但目前对于当前和曾经无家可归的老年人中阿片类药物使用障碍（OUD）的患病率知之甚少。我们报告了关于OUD患病率和功能状况的研究结果，希望能激发对该人群中长寿与OUD的未来研究。
通过对在纽约市通过电子病历收集的数据进行二次分析，我们检查了253名符合三项纳入标准的患者：（a）年龄在50岁及以上，（b）有无家可归史，（c）接受过社区医疗服务。我们总结了队列中OUD的患病率，并给出了通过生活愉悦与日常活动疼痛量表（PEG）和简易认知量表测量的一小部分患者的疼痛和认知功能的描述性统计数据。
12%（n = 31）被诊断为患有OUD（年龄范围 = 50 - 81岁；平均年龄 = 65岁；中位数年龄 = 65岁；女性 = 11名；接受激动剂治疗 = 5名）。其中，18人完成了简易认知量表测试；2人表现出具有临床意义的认知障碍；14人完成了PEG量表测试；8人报告有中度至重度疼痛。
我们的报告是首批描述有过无家可归经历的老年人中OUD情况的报告之一。与没有OUD的老年人相比，当前和曾经无家可归且患有OUD的老年人平均年龄更小，女性比例更高。他们更有可能报告疼痛，但出现认知障碍的可能性较小。这些观察结果的可能解释包括医疗参与、未治疗的疼痛以及一种幸存者效应，即无家可归后存活下来的患有OUD的老年人可能具有保护他们免受认知衰退和致命过量用药影响的特质。
