Individuals experiencing homelessness in the United States are aging; little is known about chronic pain in this population. In a cross-sectional, population-based study, we interviewed 350 homeless individuals aged 50 and older to describe pain experienced by older persons experiencing homelessness and to assess factors associated with chronic moderate to severe pain, defined as pain lasting ≥3 months, with a past week average severity score of 5–10 (scale 0–10). The median age of participants was 58 years. Participants were predominantly African American (79.6%) and male (77.3%). Overall, 46.8% reported chronic moderate to severe pain. Almost half of participants reported a diagnosis of arthritis (44.3%) and one-third reported symptoms consistent with post-traumatic stress disorder (PTSD, 32.8%). Three-quarters (75.3%) endorsed a personal history of abuse. In multivariate analyses, PTSD (AOR: 2.2, CI 1.4–3.7), arthritis (AOR: 4.8, CI 3.0–7.8), and history of experiencing abuse (AOR: 2.4, CI 1.3–4.3) were associated with chronic moderate to severe pain. HIV status, diabetes, depressive symptoms, and substance use were not associated with pain. Clinicians should consider the management of associated mental health conditions and the sequelae of experiencing abuse in the treatment of chronic pain in older adults experiencing homelessness.

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Advance care planning involves communicating your values, goals, and preferences about what kind of medical care you would like to receive if you become ill. When you are seriously ill, you may not be able to make decisions about medical care. Other people sometimes need to make these decisions for you. These decisions can be preferences about the types, location, or intensity of treatment that you would want to receive. Talking with your loved ones about your values and wishes, and documenting them in an advance directive will provide others with guidance to make the best decision for you. A good place to start the conversation is to describe what in life is most important to you. For some people, this is being physically able to do things that they enjoy. For others, this is being mentally alert enough to spend time with family. Although this may feel uncomfortable, many family and friends say they wish their loved ones had spoken with them earlier about their wishes.