Understanding the Phenomenon of Older Adult Homelessness in North America: A Qualitative Interpretive Meta-Synthesis

Background: Research demonstrates that homelessness among older adults will significantly increase in the coming decades due to population aging, a trend of first-time homelessness at mid-life, and continued economic vulnerability into old age without appropriate prevention and policy response. Despite evidence that older adult homelessness is steadily increasing, scant attention has been paid to this phenomenon by researchers and policymakers. Of the limited extant literature, the majority examines older adult homelessness quantitatively, but few studies contribute qualitatively. Even fewer provide a voice to individuals experiencing the phenomenon themselves. Thusly, the objective of this study was to generate a rich description of homelessness as told by older adults using a qualitative interpretive meta-synthesis (QIMS).

Method: A QIMS was chosen as the method for this study because of its ability to synthesize multiple qualitative studies to form a holistic, broad understanding of the phenomenon (Aguirre & Bolton, 2014). An exhaustive search yielded 144 potentially relevant studies. Eight of these studies met the inclusion criteria for further analyses. Data for the QIMS were provided by 150 individuals over the age of 40 from the United States and Canada. Data analysis occurred in stages, beginning with identification of original themes. Next, the first author immersed herself in the data, reading each quotation at a line-by-line level multiple times using an open-coding process in Atlas.ti(7). The next step involved iteratively creating themes at a higher level of abstraction (Pietkiewicz & Smith, 2014). The first author met multiple times with the second author and a methodological expert colleague to reach consensus on overarching themes and subthemes. After identification of the emergent themes, the authors recognized a deeper meaning that was not captured in the new overarching themes. The authors used phenomenological reduction to find a framework that most appropriately fit the data (Van Manen, 2011). Using this approach, the authors sifted the results through the lens of structural violence.

Results: Synthesis of the eight studies resulted in two subthemes that describe older adult homelessness: systemic failings and coping mechanisms and survival behaviors. Within systemic failings, the job market, housing costs, shelters and other helping systems, and healthcare were identified as contributing factors to first-time homelessness and barriers to exiting homelessness. Individuals also discussed mindsets and behaviors that enable them to cope with their situations.

Implications: Through immersion in the data, the authors noticed the consistency of experiences across geographical locations and the insight into the structural forces both producing and maintaining homelessness. Taken individually, each of the studies provides a unique glimpse into the phenomenon of older adult homelessness. Although some of the original texts briefly mentioned systemic failings, the majority focused heavily on individual factors. However, when analyzed as one unit, the synergistic understanding yielded a more comprehensive look into the structural forces driving inequality, contributing to and maintaining homelessness as a global phenomenon. This understanding is critical, given that ending homelessness is one of the identified grand challenges of social work. Micro and macro-level practice and policy recommendations are addressed.