Abstract
Little is known about pathways to homelessness among older adults. We identified life course experiences associated with earlier versus later onset of homelessness in older homeless adults and examined current health and functional status by age at first homelessness. We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling. Participants reported age at first episode of adult homelessness and their life experiences during 3 time periods: childhood (<18 years), young adulthood (ages 18–25), and middle adulthood (ages 26–49). We used a structured modeling approach to identify experiences associated with first adult homelessness before age 50 versus at age 50 or older. Participants reported current health and functional status, including recent mental health and substance use problems. Older homeless adults who first became homeless before 50 had more adverse life experiences (i.e., mental health and substance use problems, imprisonment) and lower attainment of adult milestones (i.e., marriage, full-time employment) compared to individuals with later onset. After multivariable adjustment, adverse experiences were independently associated with experiencing a first episode of homelessness before age 50. Individuals who first became homeless before age 50 had higher prevalence of recent mental health and substance use problems and more difficulty performing instrumental activities of daily living. Life course experiences and current vulnerabilities of older homeless adults with first homelessness before age 50 differed from those with later onset of homelessness. Prevention and service interventions should be adapted to meet different needs.
Highlights
Over the past 25 years, the average age of single adults experiencing homelessness has increased [1]
We further examined the prevalence of current vulnerabilities in the cohort, including mental health and substance use problems, and hypothesized that individuals with earlier onset of homelessness would have higher rates of current vulnerabilities compared to those with later onset of homelessness
To assess differences in current vulnerabilities according to onset of homelessness, we examined measures of incarceration, current health status, mental health status, substance use, functional status, and cognitive status
Summary
Over the past 25 years, the average age of single adults experiencing homelessness has increased [1]. Approximately half of single homeless adults are aged 50 and older [2], compared to 11% in 1990 [1]. Due to the premature development of multiple health concerns in homeless adults, researchers have considered homeless adults to be “older” at age 50 [3,7,8]. There has been a growing call to develop strategies to prevent and end homelessness among older adults [9,10], as increasing numbers of older adults face severe housing cost burden, defined as spending 50% or more of household income on housing costs [11]
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