Self‐reported health, healthcare service use and health‐related needs: A comparison of older and younger homeless people

Abstract

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.

Well-Being without a Roof: Examining Well-Being among Unhoused Individuals Using Mixed Methods and Propensity Score Matching

“…Additionally, although findings are mixed as to the degree of vulnerability, the risks of homelessness associated with health and well-being may be greater for people of color than for white people, especially for women [ 33 ]. Age also plays a role in the experience of homelessness: older age among unhoused individuals has been associated with worse physical health and more limited social support [ 31 , 34 ]. Thus, the demographics of a homeless individual may influence their experience of homelessness and how they report their well-being.…”

Homeless persons' experiences of health‐ and social care: A systematic integrative review

“…Homelessness is an increasing problem worldwide (EU, ; US, ), and previous research highlights that persons experiencing homelessness are disproportionately affected by physical and mental illness, substance abuse and long‐term burden of chronic diseases compared to housed persons (van Dongen et al, ; Lebrun‐Harris et al, ; Lewer et al, ). Homeless populations, that is, individuals without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non‐permanent situation (US, ), face huge health inequities across a wide range of health conditions (Aldridge et al, ).…”

“…Persons experiencing homelessness are three times more likely to report chronic diseases with asthma, COPD, epilepsy and heart problems being prevalent (Lewer et al, ). Older persons (>50) experiencing homelessness have multiple health problems that remain unaddressed by healthcare services, often lack social support and do not explicitly express their own healthcare needs (van Dongen et al, ), resulting in higher use of acute care. The excess mortality associated with considerable social exclusion, such as homelessness, is extreme (Aldridge et al, ; Fazel, Geddes, & Kushel, ; Slockers, Nusselder, Rietjens, & van Beeck, ), that is, the mortality rate is nearly eight times higher than the average for men and 12 times higher for women (Aldridge et al, ), with an average age for death at 52 years.…”

“…The origins of homelessness are multi-faceted, both on individual and structural levels, for example the ageing population (van Dongen et al, 2019;Fazel et al, 2014), changes in the housing market with shifts in family structures (NBHW, 2017), migration (EU, 2013), rising costs for housing (NBHW, 2017) and poor health (van Dongen et al, 2019;Fazel et al, 2014;Lewer et al, 2019). A growing body of research concludes that homelessness is associated with heavy costs for society with regards to public health, social and legal services (Basu, Kee, Buchanan, & Sadowski, 2012;Fuehrlein et al, 2015;Larimer et al, 2009;Mitchell, Leon, Byrne, Lin, & Bharel, 2017;Suh et al, 2016).…”

“…There have been studies on experiences and needs of persons experiencing homelessness over the years, but these have not been systematically compiled and synthesised. Against this background, the aim of this review was to investigate the body of knowledge about experiences and needs of health-and social care for persons experiencing homelessness, as well as human and economic costs related to perceived barriers to reach the care needed United Nations, UN, (2015). The following research questions guided the review:…”