Homeless Individuals Approaching the End of Life: Symptoms and Attitudes

Abstract Context Over a million individuals in the United States experience homelessness annually and homeless individuals die at a higher rate than domiciled peers. Homeless individuals often have unique experiences at the end of life (EOL). Objectives This study examined the symptoms experienced by homeless individuals nearing the EOL and explored social background, attitudes, and experiences. Methods Investigators conducted surveys of homeless individuals approaching the EOL at a medical respite home. Eligibility required a serious medical condition and for the patient's medical provider to answer “no” to the question “Would you be surprised if this patient were not alive in one year?” Interviews explored symptoms using the Memorial Symptom Assessment Survey. Symptoms were compared with those of relevant comparator groups in other studies. Results Participants ( n = 20) were young to face the EOL (median age = 58) and suffered high rates of substance use disorders ( n = 18; 90%) and psychiatric diagnoses ( n = 16; 80%). Symptom frequency was high, especially as regarded pain and psychological symptoms. Previous experience with death among family and peers was universal ( n = 20; 100%). Mistrust of others' decisions about the EOL was common, as was concern about receiving too little ( n = 11; 55%) or too much ( n = 8; 40%) care at the EOL. The frequency of symptoms was higher than in three comparator studies and those studies' subgroups ( P