“We remember the pain”: a qualitative study of intergenerational trauma among older adults experiencing homelessness in the HOPE HOME study

ABSTRACT

Rates of homelessness among adults aged 50 and over are rising. Common strategies for exiting homelessness rely on social and family support. However, intergenerational trauma may disrupt these social support networks and contribute to homelessness. Understanding the impact of intergenerational trauma on living with family or friends may give insight into addressing homelessness among older adults. We purposefully sampled 46 adults who reported living with family or friends from the HOPE HOME study cohort (350 community-recruited adults, ≥50 years and experiencing homelessness in Oakland, California) and 19 family/friends who had hosted the participants in their living spaces. We conducted independent, semi-structured interviews and used grounded theory methodologies to analyze data. We identified four major themes from the interviews: (1) Intergenerational trauma was common and made it difficult to stay with family or friends; (2) Participants and hosts sought to protect future generations from intergenerational trauma; (3) Relationships endured despite intergenerational trauma; and (4) social structures exacerbated the impact of intergenerational trauma and played a significant role in perpetuating homelessness. Trauma-informed policies that confront the structures that propagate or exacerbate intergenerational trauma may mitigate their impact and facilitate housing for older adults.

KEYWORDS:

• trauma
• aging
• homelessness
• qualitative

Acknowledgements

The authors thank the FAH study participants and the HOPE HOME Community Advisory Board members.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. National Institute on Aging [grant numbers R01AG050630 (MK, KK, JW, PO), R01AG041860 (MK, KK, JW, PO), and K24AG046372 (MK)] as well as the Health Resources and Services Administration [grant number T32HP19025 (AH)].

Notes on contributors

Anita S. Hargrave

Anita S. Hargrave, MD, is a National Clinician Scholar Program (NCSP) Fellow at the University of California, San Francisco and Internal Medicine Physician at the Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG). Her research focuses on addressing the impact of interpersonal violence on health and health equity.

Cheyenne M. Garcia

Cheyenne Garcia, BA, is a research analyst with the UCSF Center for Vulnerable Populations and the Benioff Homelessness and Housing Initiative. She focuses on informing policies to address the housing crisis. Her other research interests include transgenerational transmission of trauma, parenting ethnotheories, and attachment.

Marguerita Lightfoot

Marguerita Lightfoot, PhD, is the Associate Dean for Research at the OHSU-PSU School of Public Health. Her research focuses on improving the health and well-being of adolescents and young adults, as well as the development of culturally competent, efficacious interventions to reduce acquisition and transmission of HIV among populations disproportionately burdened by the epidemic.

Margaret A. Handley

Margaret A. Handley, PhD, MPH, is a public heath-trained epidemiologist in the Departments of Epidemiology and Biostatistics and the Center for Vulnerable Populations, at the University of California San Francisco, Zuckerberg San Francisco General Hospital. She co-Directs the UCSF PRISE Center, Partnerships in Research in Implementation Science for Equity. Dr. Handley’s research focuses on bridging the fields of primary care, public health, and health communication for improving health outcomes and equity in healthcare access.

John Weeks

John Weeks is a Clinical Research Coordinator for the HOPE HOME Study in the UCSF Center for Vulnerable Populations. His work has focused on HIV prevention among MSM populations and homelessness in San Francisco and Oakland.

Pamela Olsen

Pamela Olsen, MA, has a Master's Degree in Gerontology from San Francisco State University (SFSU) and has worked for years with vulnerable individuals as a criminal and legal investigator. She has also been an ombudsperson for individuals in assisted living facilities in San Francisco. She worked on the HOPE HOME project, researching the aging homeless in Oakland.

Kelly R. Knight

Kelly R. Knight, PhD, is a Professor and the Vice-Chair of the Department of Humanities and Social Sciences at the University of California San Francisco (UCSF). Her research interests include the social construction and experience of addiction; Co-morbidity (HIV, substance abuse, mental illness), homelessness, and US urban health; Chronic non-cancer pain, clinical uncertainty, and scientific evidence; Post-traumatic stress disorder (PTSD), bi-polar disorder, and the US welfare state; Gender, reproduction, motherhood and citizenship.

Margot B. Kushel

Margot B. Kushel, MD, is a Professor of Medicine in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) and the Director of the UCSF Center for Vulnerable Populations. Dr. Kushel’s research focuses on reducing the burden of homelessness on health through examining efforts to prevent and end homelessness, as well as mitigating the effects of housing instability on health care outcomes.