• Ilana Garcia-Grossman, Lauren Kaplan, Karen Valle, David Guzman, Brie Williams, and Margot Kushel.
• Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
• J Gen Intern Med. 2022 Apr 1; 37 (5): 108810961088-1096.

BackgroundIn the US, the median age of adults experiencing homelessness and incarceration is increasing. Little is known about risk factors for incarceration among older adults experiencing homelessness. To develop targeted interventions, there is a need to understand their risk factors for incarceration.ObjectiveTo examine the prevalence and risk factors associated with incarceration in a cohort of older adults experiencing homelessness.DesignProspective, longitudinal cohort study with interviews every 6 months for a median of 5.8 years.ParticipantsWe recruited adults ≥50 years old and homeless at baseline (n=433) via population-based sampling.Main MeasuresOur dependent variable was incident incarceration, defined as one night in jail or prison per 6-month follow-up period after study enrollment. Independent variables included socioeconomic status, social, health, housing, and prior criminal justice involvement.Key ResultsParticipants had a median age of 58 years and were predominantly men (75%) and Black (80%). Seventy percent had at least one chronic medical condition, 12% reported heavy drinking, and 38% endorsed moderate-severe use of cocaine, 8% of amphetamines, and 7% of opioids. At baseline, 84% reported a lifetime history of jail stays; 37% reported prior prison stays. During follow-up, 23% spent time in jail or prison. In multivariable models, factors associated with a higher risk of incarceration included the following: having 6 or more confidants (HR=2.13, 95% CI=1.2-3.7, p=0.007), remaining homeless (HR=1.72, 95% CI=1.1-2.8, p=0.02), heavy drinking (HR=2.05, 95% CI=1.4-3.0, p<0.001), moderate-severe amphetamine use (HR=1.89, 95% CI=1.2-3.0, p=0.006), and being on probation (HR=3.61, 95% CI=2.4-5.4, p<0.001) or parole (HR=3.02, 95% CI=1.5-5.9, p=0.001).ConclusionsOlder adults experiencing homelessness have a high risk of incarceration. There is a need for targeted interventions addressing substance use, homelessness, and reforming parole and probation in order to abate the high ongoing risk of incarceration among older adults experiencing homelessness.© 2021. Society of General Internal Medicine.

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