Differences in Perceived Health, Mental Health, and Substance Use between Older and Younger Adults Experiencing Chronic Homelessness

Background and Purpose: This study examined the differences between younger (18-49 years) and older (50+ years) adults experiencing chronic homelessness. Few housing and service solutions for individuals experiencing chronic homelessness are tailored by age despite increased recognition that older and younger homeless adults experience unique age-related health and mental health challenges while homeless. Typical age-related service modifications, if they exist, include access to housing and emergency shelter that is ADA compliant in order to meet physical needs associated with aging.  The purpose of this study was to examine additional age-related differences that might guide improved service delivery in a Southeastern city seeking to end chronic homelessness.

Methods: The study is a cross-sectional examination of baseline participants in a larger prospective study of chronic homelessness. The sample includes 223 individuals who are on the chronic homeless registry, 49% (n=110) who are under the age of 50 and 51% (n=113) who are 50 and older.  The majority of the sample identified as Male (78%, n=173) and Black or African-American only (64%, n=143; White only 21%, n=46; Multiple races 10%, n=21). The mean age was 47.6 and participants had been homeless an average of 7.6 years. Participants were recruited from the chronic homeless registry using flyers and by local outreach and coordinated entry workers. Surveys included measures of residential history, quality of life, food security, and multiple subjective health and mental health measures.

Results:  Overall, study participants’ average perceived health and mental health scores were below the general U.S. population and the likelihood of PTSD was higher than the general population. The t test and chi square analyses indicated differences among older and younger participants across multiple measures. Younger adults experiencing chronic homelessness perceived better physical health and more power in decision-making than older adults, but reported more mental health symptoms and a greater likelihood of PTSD. Among the older and younger participants who used substances, participants reported using alcohol at similar rates during the last 30 days, but younger adults reported drinking to intoxication and using marijuana more often than did older adults.

Conclusions and Implications: Findings highlight the importance of age-modifications across various dimensions of health and mental health services to effectively meet the needs of all chronically homeless adults, including, but not limited to physical modifications to housing and shelter.  While substance use and trauma-informed services are important for both older and younger adults experiencing chronic homelessness, necessary variations within those services to address age-related differences deserve greater attention. Findings will be discussed in light of current local and national efforts to end chronic homelessness and the use of by-name registries and vulnerability assessments to identify and prioritize permanent supportive housing opportunities.