Tenants Aging in Place: Exploring Unmet Needs

Background: Currently, more than 280,000 Americans are living in Permanent Supportive Housing (PSH), which has been recognized as the “clear solution” to chronic homelessness by the U.S. federal government. The population of homeless adults aged 50 or older, whose functional age is significantly older than its chronological age, constitutes nearly half of those who are chronically homeless. As more Americans move into PSH, there is increasing need to address factors that prevent residents from aging in place. Guided by a disablement framework that positions the ability to age in place as a matter of fit between person and environment, the study used a mix-method design to investigate prevalence of early onset of a number of health conditions and tenant perspectives on healthy aging.

 

Methods: We recruited a representative sample of adults aged 45 years old and above who are currently living in PSH (N=203). Surveys were administered collecting self-reported health, age-related health conditions, nutrition, substance use, and mental health. Additionally, physical examinations of mobility (walk test), grip strength, vision, and cognitive ability were administered by trained interviewers.  In-depth qualitative interviews were conducted at a subsequent interview with a purposive subsample of 50 tenants representing variation in health and time spent in supportive housing. Descriptive analyses of health status were conducted using Stata (v14) while qualitative thematic analysis was conducted using Dedoose.

Results: The average age of our sample was nearly 57 years; with participants having lived in housing an average of 3 years and the average length of lifetime literal homelessness experience is more than 9 years. This sample reported abnormally high rates of chronic physical health conditions (eg. Hypertension (60%), Asthma (22%), Arthritis (38%), Emphysema, chronic bronchitis, or chronic obstructive pulmonary disease (12%), and Diabetes (17%)) and chronic mental health conditions (specifically depression, with 92% reporting a lifetime depression diagnosis). Food insecurity was reported by 63% of participants. Impairment in instrumental activities of daily living/activities of daily living (IADL/ADL) or vision, past-year falls, and poor self-rated mobility are all reported by around half of participants. Around 1/3^rd reported urine incontinence, and 29% hearing loss. The mini-mental state examination (MMSE) identified cognitive impairment in 12% of participants.  Thematic analysis of interviews showed two unifying themes (i.e., geospatial safety concerns, negative provider perceptions).  Additionally, dividing themes emerged (i.e. healthy living and social engagement/disengagement).   

Conclusions & implications:  These findings from the study support the claim that those who experience chronic homelessness are physically and mentally significantly more aged than their non-homeless peers.  Moreover, in this study the age limited was lowered by five years and there was still and significant early onset geriatrics conditions found. Thematic analysis showed that PSH residents do not feel fully supported to address these conditions by staff and are often left to navigate the aging process without support.  Aging in place in PSH, must have increased attention in the coming years to allow for health aging and decreased medical costs from this population.