• Wagahta Semere, Lauren Kaplan, Karen Valle, David Guzman, Claire Ramsey, Cheyenne Garcia, and Margot Kushel.
• Division of General Internal Medicine, University of California, San Francisco (UCSF) and Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA. wagahta.semere@ucsf.edu.
• J Gen Intern Med. 2022 Nov 1; 37 (14): 361136193611-3619.

BackgroundThe homeless population is aging, with early onset of cognitive and functional impairments. It is unclear whether older homeless adults receive caregiving assistance that could prevent long-term disability.ObjectiveWe describe characteristics of older homeless-experienced adults with caregiving need and determine factors associated with having unmet need.Design And ParticipantsCross-sectional analysis of a longitudinal study, Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME), examining health, life course events, and functional status among older homeless-experienced (i.e., currently and recently homeless) adults. We recruited 350 homeless adults (July 2013-June 2014) and an additional 100 (August 2017 to July 2018) in Oakland, California; this study includes 303 participants who completed caregiving interviews.MeasurementsWe defined caregiving need as difficulty with activities of daily living (ADLs), instrumental activities of daily living (IADLs), falls, Short Physical Performance Battery (SPPB) score < 10, or Modified Mini-Mental State (3MS) exam impairment. We defined unmet need as having caregiving need and reporting not receiving caregiving assistance in the last 6 months. Using logistic regression, we analyzed associations between respondent characteristics and unmet caregiving need.ResultsAmong 303 participants, the mean age was 61.3 ± 5.0 years; 73% were men and 82% were Black. Eighty-one percent had caregiving needs, and in 82% of those, their caregiving needs were unmet. Better self-rated health (AOR 2.13, CI [1.02-4.46], p = 0.04) and being a man (AOR 2.30, CI [1.12-4.69], p = 0.02) were associated with higher odds of unmet need. Moderate or high-risk substance use (AOR 0.47, CI [0.23, 0.94], p = 0.03) was associated with lower odds of unmet need.ConclusionsOlder homeless-experienced adults have high prevalence of unmet caregiving need. Interventions that increase caregiving access for homeless-experienced individuals may help avoid poor health outcomes and costly long-term-care needs due to untreated disabilities.© 2022. The Author(s) under exclusive licence to Society of General Internal Medicine.

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