Homelessness and aging

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Homelessness and aging is a largely neglected topic in the literature. [1] There is a widespread assumption that aged homeless people are rare, [2] but this is not true. Japan, Australia and the United Kingdom show increases in their populations of aging homelessness. Increased Elderly adults who straddle the poverty line are at greater risk of falling into pathways of homelessness. When a homeless person enters their later years, or becomes homeless for the first time in older age, health issues can become difficult to address and compound as age progresses. [3]

Research

Research in the older homeless population varies in age classification. The experiences that accompany homelessness, especially in the older population, require a lower age cut off point than is typically used for the older housed population. [4] A specific age for which is considered elderly homeless varies in research, however, there is a general consensus that those older homeless that are between the ages of 50 and 65 years are at greater risks. Those between the ages of 50 and 65 are at greater risks because they fall between viable working age and governmental safety nets. This age group typically experiences poor physical health, poor nutrition and severe living conditions that put them in a greater risk category than those who are younger than 50 and older than 65 years of age. [5] Studies consider this age group of the elderly homeless too old to benefit from employment services and too young for social safety net benefits. [6]

A University of California study has followed 350 participants in Oakland since 2013. Their conclusions were that the majority had worked in low-paid low-skill occupations. 80% were African American. They were at greater risk of homelessness because they spent over 50% of their income on rent. [7] Most were sicker to begin with and therefore spent more on medication. Once homeless, they died at a rate four to five times what would be expected in the general population, from the same causes as do other people – heart disease and cancer – but they do so 20 to 30 years earlier. [8] [9]

A 2013 report commissioned by the Australian Government found that while general homelessness had increased by 3% since 2011, for those over 55 it had increased by 14%, despite Australia having a comprehensive social safety net. [10] The main reasons were Financial difficulties (22%) Domestic and family violence (15%) Housing crisis (14%). [11]

The differences between the housed and homeless living conditions are significant to life expectancy of the older population. Under the conditions of homelessness, it is typical for those 50 and older to resemble similar health conditions to those of a 70 year old housed person. [12] Homelessness has been found to be a factor in dramatically shortening a person's life expectancy. Premature death is most often the result of the combination of acute and chronic medical conditions aggravated by situations of homelessness. [13]

The health of the elderly homeless population is often neglected until the severity of an illness requires emergency room treatment. Economic factors create pathways to homelessness for an increasing population of elderly. [14] The elderly homeless face difficulties that compound with age such as lack of a permanent place to receive health care services, medicine, and medical equipment [15]

Health factors

Older adults who are faced with living on the streets are more at risk for developing chronic and debilitating diseases such as diabetes, heart and related respiratory diseases, and others as a result of premature aging. [16] The effects of premature aging can cause older adults who are homeless to have developed earlier illness in their life than they previously would. Often these individuals are saddled with limited or no access to proper healthcare and are faced with a cycle of living on the streets, being institutionalized or even jailed. [16] As a result of the fluctuating economy, many older adults are finding themselves at risk of homelessness. [17] A group that was once able to live off of savings, retirements, or pensions are finding it increasingly harder to do so. Individuals aged 50–64 have little to no savings and as a result of the Great Recession of 2008 many saw a loss in the value of their property. [18] [19]

Risk factors

Those who are most at risk for homelessness are those who are currently or have lived in poverty in the past. [20] The reasons for homelessness can be characterized into three groups: those who lack stable, social relationships and are "predisposed to personal vulnerabilities", those who lack access to affordable housing, and those who can not afford or receive proper healthcare. [21] Those who do not have strong familial relationships with kids or other family members and do not have strong friend relationships are more at risk of becoming homelessness than those that do. [22]

Resources in the community

To assist with the growing homeless elderly population in the United States there has been several programs initiated. The U.S. Department of Housing and Urban Development (HUD) in 2008 began to provide permanent housing for those who were living on the street and showed proof of disability (mental, physical) and an inability to find affordable housing. [23] Many local and national organizations such as the Hearth Outreach Program (located in Boston), the National Coalition for homelessness, the National Alliance to End Homelessness, Justice in Aging and others, seek ways to raise money and improve the lives of the elderly living in homelessness. [24]

Related Research Articles

Geriatrics Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a specialty that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of elderly people. Rather, this decision is determined by the individual patient's needs and the availability of a specialist. It is important to note the difference between geriatrics, the care of aged people and gerontology, which is the study of the aging process itself. The term geriatrics comes from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". However, geriatrics is sometimes called medical gerontology.

Homelessness in the United States Human condition

Homelessness in the United States refers to the issue of homelessness, a condition wherein people lack "a fixed, regular, and adequate nighttime residence" as defined by The McKinney–Vento Homeless Assistance Act. Point-in-time single night counts prepared by shelter providers differ greatly from federal government accounts. In 2014, approximately 1.5 million sheltered homeless people were counted. The federal government statistics are prepared by the United States Department of Housing and Urban Development's Annual Homeless Assessment Report; as of 2018, HUD reported there were roughly 553,000 homeless people in the United States on a given night, or 0.17% of the population. Annual federal HUD reports contradict private state and local reports where homelessness is shown to have increased each year since 2014 across several major American cities, with 40 percent increases noted in 2017 and in 2019. In January 2018 the federal government statistics gave comprehensive encompassing nationwide statistics, with a total number of 552,830 individuals, of which 358,363 (65%) were sheltered in provided housing, while some 194,467 (35%) were unsheltered.

Elderly care Care serving the needs and requirements of senior citizens

Elderly care, or simply eldercare, serves the needs and requirements of senior citizens. It encompasses assisted living, adult daycare, long-term care, nursing homes, hospice care, and home care. Because of the wide variety of elderly care needs and cultural perspectives on the elderly, it includes a broad range of practices and institutions. For example, government-run elderly care is seldom used in many Asian countries, where younger generations often care for the elderly.

Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives, and is an active "community services and funding" stream across the United States. It was developed by different professional academics and US governmental departments that supported housing. Supportive housing is widely believed to work well for those who face the most complex challenges—individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance use disorders, mental health, HIV/AIDS, chronic illness, diverse disabilities or other serious challenges to stable housing.

Long-term care Services for the elderly or those with chronic illness or disability

Long-term care (LTC) is a variety of services which help meet both the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. Long term care is focused on individualized and coordinated services that promote independence, maximize patients' quality of life, and meet patients' needs over a period of time.

So Others Might Eat

So Others Might Eat (SOME) is a nonprofit organization that provides services to assist those dealing with poverty and homelessness in Washington, D.C. The organization provides affordable housing, job training, counseling and other healthcare services, and daily needs such as food and clothing to the poor and homeless. It spends the largest portion of its annual budget on affordable housing, with a majority of its residents recovering from addiction. SOME describes its mission as helping "our vulnerable neighbors in Washington, DC, break the cycle of homelessness through our comprehensive and transformative services".

A naturally occurring retirement community is a community that has a large proportion of residents over 60 but was not specifically planned or designed to meet the needs of seniors living independently in their homes.

Housing First is a policy that offers permanent housing as quickly as possible to homeless people, and other supportive services afterward. It was popularized starting in the 1990s, and in the following decades became government policy in the United States and various other countries.

Program of All-inclusive Care for the Elderly (PACE) are programs within the United States that provide comprehensive health services for individuals age 55 and over who are sufficiently frail to be categorized as "nursing home eligible" by their state's Medicaid program. The ultimate goal of PACE programs is to keep eligible older adults out of nursing homes and within their communities for as long as possible. Services include primary and specialty medical care, nursing, nutrition, social services, therapies, pharmaceuticals, day health center services, home care, health-related transportation, minor modification to the home to accommodate disabilities, and anything else the program determines is medically necessary to maximize a member's health. If you or a loved one are eligible for nursing home level care but prefer to continue living at home, a PACE program can provide expansive health care and social opportunities during the day while you retain the comfort and familiarity of your home outside of day hours.

Gerontological nursing Specialty of nursing pertaining to older adults

Gerontological nursing is the specialty of nursing pertaining to older adults. Gerontological nurses work in collaboration with older adults, their families, and communities to support healthy aging, maximum functioning, and quality of life. The term gerontological nursing, which replaced the term geriatric nursing in the 1970s, is seen as being more consistent with the specialty's broader focus on health and wellness, in addition to illness.

Homelessness State of having no home or permanent place of residence

Homelessness or houselessness – also known as a state of being unhoused or unsheltered – is the condition of lacking stable, safe, and adequate housing. The definition of homelessness differs from country to country, with some countries yet to have any definition in place. People can be categorized as homeless if they are:

Geriatric trauma Medical condition

Geriatric trauma refers to a traumatic injury that occurs to an elderly person. People around the world are living longer than ever. In developed and underdeveloped countries, the pace of population aging is increasing. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. While this trend presents opportunities for productivity and additional experiences, it also comes with its own set of challenges for health systems. More so than ever, elderly populations are presenting to the Emergency Department following traumatic injury. In addition, given advances in the management of chronic illnesses, more elderly adults are living active lifestyles and are at risk of traumatic injury. In the United States, this population accounts for 14% of all traumatic injuries, of which a majority are just mainly from falls.

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

Homelessness and mental health

In a study in Western societies, homeless people have a higher prevalence of mental illness when compared to the general population. They also are more likely to suffer from alcoholism and drug dependency. It is estimated that 20–25% of homeless people, compared with 6% of the non-homeless, have severe mental illness. Others estimate that up to one-third of the homeless suffer from mental illness. In January 2015, the most extensive survey ever undertaken found 564,708 people were homeless on a given night in the United States. Depending on the age group in question, and how homelessness is defined, the consensus estimate as of 2014 was that, at minimum, 25% of the American homeless—140,000 individuals—were seriously mentally ill at any given point in time. 45% percent of the homeless—250,000 individuals—had any mental illness. More would be labeled homeless if these were annual counts rather than point-in-time counts. Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system. Majority of the homeless population do not have a mental illness. Although there is no correlation between homelessness and mental health, those who are dealing with homelessness are struggling with psychological and emotional distress. The Substance Abuse and Mental Health Services Administration conducted a study and found that in 2010, 26.2 percent of sheltered homeless people had a severe mental illness.

Food preferences in older adults and seniors takes into consideration how people's experiences change with aging, that is how taste, diet (nutrition) and food choice change. Primarily, this occurs when most people approach the age of 70 or older. Influencing variables can include: social and cultural environment, male or female sex and personal habits as well as physical and mental health. Scientific studies attempting to explain why people like or dislike certain foods have been performed to better understand these factors.

Homeless veterans are persons who have served in the armed forces who are homeless or living without access to secure and appropriate accommodation.

Elder rights are the rights of older adults, who in various countries are not recognized as a constitutionally protected class yet face discrimination across many aspects of society due to their age.

Tea and toast syndrome is a form of malnutrition commonly experienced by elderly people who are unable to prepare meals and tend to themselves. Their diets often dwindle to tea and toast resulting in a deficiency of vitamins and other nutrients. The syndrome often manifests itself as hyponatremia, a low concentration of the electrolyte sodium in the bloodstream, due to the lack of salt in the diet. Hyponatremia can lead to various neurological problems ranging from headaches and a decreased ability to think, to seizures and coma in the most severe cases.

Serious mental illness (SMI) is characterized as any mental health condition that seriously impairs anywhere from one to several significant life activities including day to day functioning. Common diagnoses associated with SMI include bipolar disorder, psychotic disorders, post-traumatic stress disorder, and major depressive disorder. People experiencing SMI experience symptoms that can prevent them from having successful experiences that contribute to a good quality of life, due to social, physical, and psychological limitations of their illnesses. In 2017, there was a 4.5% prevalence rate of U.S. adults diagnosed with SMI, the highest percentage being the young adult population. In 2017, 66.7% of the 4.5% diagnosed adults sought out mental health care services.

COVID-19 and homelessness

Homeless individuals are more likely to contract COVID-19 than those with permanent housing access. This is due to the environments that homeless people live in, which often suffer overcrowding and/or a lack of access to adequate sanitation. Homeless individuals are also more likely to suffer underlying health conditions, which increases the risk of death caused by COVID-19. The closure of public facilities has negatively impacted the homeless population, as reduced access to toilet facilities and support services has affected their hygiene and mental health respectively. Initiatives have been introduced by governments and at local levels in attempts to reduce the impact on the homeless.

References

  1. ↑ Cohen, Carl I. "Aging and homelessness." The Gerontologist 39, no. 1 (1999): 5-15.
  2. ↑ Cohen, Carl I., Jay Sokolovsky, and Maureen Crane. "Aging, homelessness and the law." In Aging: Caring for Our Elders, pp. 219-235. Springer Netherlands, 2001.
  3. ↑ Grenier, Amanda; Barken, Rachel; Sussman, Tamara; Rothwell, David; Bourgeois-Guérin, Valérie; Lavoie, Jean-Pierre (March 2016). "A Literature Review of Homelessness and Aging: Suggestions for a Policy and Practice-Relevant Research Agenda". Canadian Journal on Aging. 35 (1): 28–41. doi: 10.1017/S0714980815000616 . ISSN   1710-1107. PMID   26782092.
  4. ↑ Tompsett, Carolyn J.; Fowler, Patrick J.; Toro, Paul A. (2009). "Age differences among homeless individuals: adolescence through adulthood". Journal of Prevention & Intervention in the Community. 37 (2): 86–99. doi:10.1080/10852350902735551. ISSN   1085-2352. PMC   2774834 . PMID   19363770.
  5. ↑ Kirkman, M. Sue; Briscoe, Vanessa Jones; Clark, Nathaniel; Florez, Hermes; Haas, Linda B.; Halter, Jeffrey B.; Huang, Elbert S.; Korytkowski, Mary T.; Munshi, Medha N.; Odegard, Peggy Soule; Pratley, Richard E. (2012-12-01). "Diabetes in Older Adults". Diabetes Care. 35 (12): 2650–2664. doi: 10.2337/dc12-1801 . ISSN   0149-5992. PMC   3507610 . PMID   23100048.
  6. ↑ People, Institute of Medicine (US) Committee on Health Care for Homeless (1988). Summary and Recommendations. National Academies Press (US).
  7. ↑ People, Institute of Medicine (US) Committee on Health Care for Homeless (1988). Who Are the Homeless?. National Academies Press (US).
  8. ↑ "How the homeless population is changing: it's older and sicker" . Retrieved 7 January 2017.
  9. ↑ "Heart Health and Aging". National Institute on Aging. Retrieved 2021-01-15.
  10. ↑ "Homelessness and homelessness services". Australian Institute of Health and Welfare. Retrieved 2021-01-15.
  11. ↑ "Specialist homelessness services 2012–2013" . Retrieved 7 January 2017.
  12. ↑ People, Institute of Medicine (US) Committee on Health Care for Homeless (1988). Health Problems of Homeless People. National Academies Press (US).
  13. ↑ Fazel, Seena; Geddes, John R; Kushel, Margot (2014-10-25). "The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations". Lancet. 384 (9953): 1529–1540. doi:10.1016/S0140-6736(14)61132-6. ISSN   0140-6736. PMC   4520328 . PMID   25390578.
  14. ↑ Stafford, Amanda; Wood, Lisa (December 2017). "Tackling Health Disparities for People Who Are Homeless? Start with Social Determinants". International Journal of Environmental Research and Public Health. 14 (12): 1535. doi:10.3390/ijerph14121535. ISSN   1661-7827. PMC   5750953 . PMID   29292758.
  15. ↑ People, Institute of Medicine (US) Committee on Health Care for Homeless (1988). Health Care Services for Homeless People. National Academies Press (US).
  16. 1 2 Sorrell, Jeanne M. (2016). "Aging on the Street: Homeless Older Adults in America". Journal of Psychosocial Nursing and Mental Health Services. 54 (9): 25–29. doi:10.3928/02793695-20160817-04. PMID   27576225.
  17. ↑ Jaul, Efraim; Barron, Jeremy (2017-12-11). "Age-Related Diseases and Clinical and Public Health Implications for the 85 Years Old and Over Population". Frontiers in Public Health. 5: 335. doi:10.3389/fpubh.2017.00335. ISSN   2296-2565. PMC   5732407 . PMID   29312916.
  18. ↑ Goldberg, J., Lang, K., & Barrington, V. (2016, April). How to Prevent and End Homelessness Among Older Adults. Retrieved February 25, 2018.
  19. ↑ Population, Institute of Medicine (US) Committee on the Long-Run Macroeconomic Effects of the Aging U. S. (2012-12-10). Saving and Retirement Security. National Academies Press (US).
  20. ↑ Brown, R. T., Lori Thomas, M., Cutler, D. F., & Hinderlie, M. (2013). Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 21(1), 126-135.
  21. ↑ Brown, R. T., Lori Thomas, M., Cutler, D. F., & Hinderlie, M. (2013). Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 21(1), 126-135.
  22. ↑ Brown, R. T., Lori Thomas, M., Cutler, D. F., & Hinderlie, M. (2013). Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 21(1), 126-135.
  23. ↑ Brown, R. T., Lori Thomas, M., Cutler, D. F., & Hinderlie, M. (2013). Meeting the Housing and Care Needs of Older Homeless Adults: A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 21(1), 126-135.
  24. ↑ National Academies of Sciences, Engineering; Division, Health and Medicine; Practice, Board on Population Health and Public Health; Affairs, Policy and Global; Program, Science and Technology for Sustainability; Individuals, Committee on an Evaluation of Permanent Supportive Housing Programs for Homeless (2018-07-11). The History of Homelessness in the United States. National Academies Press (US).{{cite book}}: |first4= has generic name (help)
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