# Aging Among the Homeless:  Social Isolation, Function and Institutional Care

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $608,199

## Abstract

Project Summary/Abstract
The long term goal of this proposal is to reduce the need for institutional care and identify optimal housing
options in older adults with an experience of homelessness. The proposal seeks to renew AG041860, “Aging
among the homeless: geriatric conditions, health and health care outcomes” also known as the Health
Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study. HOPE HOME
recruited and followed a cohort of 350 homeless adults aged 50 and older. Approximately half of all homeless
adults are age 50 or older; the aging of the homeless population is expected to continue. In HOPE HOME,
despite a median age of 58, we found a prevalence and severity of geriatric conditions, including functional,
mobility and cognitive impairments, similar to that of community-living adults in their 70s. Participants had a
high prevalence of behavioral health problems, social isolation, and narrow social networks. We found high
rates of acute healthcare utilization and institutional care, including frequent stays in nursing homes. The
majority of older adults will require assistance with activities of daily living (long-term services and support
(LTSS)); most will receive this support from unpaid caregivers within their social network. Medicaid will pay for
services but homeless older adults face numerous barriers to receiving LTSS, whether paid or unpaid. These
barriers may increase their risk for costly and avoidable care and nursing home utilization. Therefore, we
propose to extend the HOPE HOME study in order to examine 1) the prevalence of, and association between,
perceived social isolation, social support, functional and cognitive impairments, and health care utilization; 2)
the need for, use of, and barriers to home and community-based long-term services and supports; and 3) rates
of and risk factors for nursing home placement and mortality. We propose to recruit an additional 80
participants to HOPE HOME to replace those who have died or been lost to follow-up, and to follow the cohort
for three years, with six semi-annual visits for structured interviews and clinical assessments. We will recruit a
sub-sample of study participants and a sample of key informants for in-depth qualitative interviews to
understand the barriers to receiving LTSS, strategies to overcome those barriers, and optimal housing options
that allow older homeless adults to avoid unnecessary health care utilization and institutional care. Study visits
will take place at St. Mary's Center, a multiservice community-based center for older homeless adults. Trained
research assistants, working under the supervision of study investigators, will administer clinical assessments
and structured interviews to assess key variables. A Community Advisory Board, made up of community and
policy leaders in homelessness and study participants, will work with the study team to guide study
development and translate the findings into practice and policy ch...

## Key facts

- **NIH application ID:** 10179260
- **Project number:** 5R01AG041860-10
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Margot B Kushel
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $608,199
- **Award type:** 5
- **Project period:** 2012-09-30 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10179260

## Citation

> US National Institutes of Health, RePORTER application 10179260, Aging Among the Homeless:  Social Isolation, Function and Institutional Care (5R01AG041860-10). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10179260. Licensed CC0.

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