Pathways to Homelessness among Older Homeless Adults: Results from the HOPE HOME Study

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.

Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial

“…A life‐course perspective on homelessness may provide additional explanation for our findings. There is increasing recognition that a large proportion of older homeless adults first became homeless in old age (Brown et al ., ; Crane et al ., ; Shinn et al ., ). Consistent with this finding, our study found that older homeless adults first experienced homelessness at an older age than their younger counterparts.…”

“…Cohen's model of aging and homelessness proposes that risk factors for homelessness such as low income and poor social support (Cohen, ) can accumulate over the life course. A triggering event later in life, such as loss of employment or death of a spouse (Brown et al ., ; Crane et al ., ), can precipitate homelessness in people who have lived in stable housing for most of their lives.…”

Factors Associated with Substance use in Older Homeless Adults: Results from the HOPE HOME Study

“…42, 43 Adults who become homeless earlier in life tend to have more early life adverse experiences such as mental health, imprisonment, and substance use. 44 It is possible that the association between suspension or expulsion from school and greater severity illicit drug and alcohol use is a reflection of the impact of early life experiences on the development of substance use later in life.…”

Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study

“…This outreach approach expanded on prior methods (Burnam and Koegel, 1988) to include homeless encampments and recycling centers to ensure inclusion of unsheltered adults. We recruited individuals from all overnight homeless shelters in Oakland that served single adults, all free and low-cost meal programs that served homeless persons ≥3 prepared meals a week, a recycling center, and places where unsheltered people stay overnight (Brown et al, 2016a; Lee et al, 2016a). Individuals were eligible to participate if they spoke English, were homeless as defined by the federal Homeless Emergency Assistance and Rapid Transitions to Housing (HEARTH) Act (2010), and were aged ≥50.…”