Title: Factors Associated with Loneliness Among Older Adults Who Experienced Homelessness: Results from the HOPE HOME Study

Background and Purpose

Older adults with experiences of homelessness are at an increased risk of loneliness, which is linked to adverse physical and mental health outcomes. While previous research has identified general risk factors for loneliness in older adults, there is limited understanding of how these factors interact among those who have experienced homelessness. Understanding these relationships is critical to developing targeted interventions that address both the psychological and structural determinants of loneliness. This study aims to examine the relationships between trauma, mental and physical health, social support, substance use, housing stability, and loneliness among older adults who were homeless at the time of study entry.

Methods

This study used data from the Health Outcomes in People Experiencing Homelessness in Older Middle agE (HOPE HOME) study, a longitudinal cohort study conducted in Oakland, California. Participants were eligible if they were: (1) homeless at study enrollment, (2) English-speaking, (3) age 50 and older in 2013-2014 or 53 and older in 2017-2018, and (4) able to provide informed consent. We interviewed participants at baseline and every six months regardless of their housing status. In this analysis, we included interview data between 2015 and 2023. We measured loneliness using the UCLA Loneliness 3-item Scale. We examined key latent independent variables, including self-reported experiences of trauma, mental health status, physical health and functional status, social support, housing stability, and substance use. We used Structural Equation Modeling (SEM) to assess both direct and indirect pathways linking these factors to loneliness.

Results

Our analytic sample consisted of 385 participants who completed 2099 assessments. The majority of participants were men (74.8%), Black (82.1%), and not partnered (87.5%). At the first loneliness interview, 41.8% remained homeless, and 39.2% met the criteria for loneliness. Poor mental health and a lack of social support were associated with loneliness. Poor physical health and functional status had an indirect effect on increased loneliness through worsening mental health status. Experiences of trauma had an indirect effect on increased loneliness through worsening mental health status. The Shelter-In-Place (SIP) mandate was temporarily associated with decreased loneliness. We found no association between regaining housing and decreased loneliness.

Conclusions and Implications

In a longitudinal study of older adults, homeless at study entry, we found that mental health had direct impacts on loneliness, and other factors (i.e., trauma, physical health and functional status) contributed to increased loneliness through their negative effects on mental health. While stable housing is an important factor in overall well-being, it alone is not sufficient to mitigate loneliness. The findings suggest the need for comprehensive interventions that extend beyond providing housing alone to include mental health services, trauma-informed care, and opportunities for meaningful social engagement to reduce loneliness among older adults with lived experiences of homelessness. The unexpected relationship between the SIP period and decreased loneliness could reflect homeless-specific policy decisions during this time (i.e., SIP hotels), a sense of connection to larger struggle, or other factors that deserve future research.