Accelerated Aging Among Older Adults in Permanent Supportive Housing

Background: Nearly half of those experiencing chronic homelessness (i.e. long-term homelessness with a disabling condition) are aged 50+; research has found age-related health problems in this population occur an average of 20 years earlier than among housed persons. Moreover, when people experience homelessness we consider them to be “older adults” at 50-55 years, while the age cutoff of older adults is higher in other populations (62-65 years) (Garibaldi, Conde-Martel, & O'Toole (2005). However, little is known about aging-related health and illness among formerly-homeless persons now living in permanent supportive housing (PSH), which is recognized as an evidence-based solution to homelessness. Such knowledge is key for designing interventions to improve health and wellness and enable PSH tenants to successfully age in place. Given the relationship between homelessness and early onset of age-related health problems, we hypothesized  that longer tenure in PSH will have a protective effect against early onset of geriatric conditions (cognitive decline, urinary incontinence, frailty, falls, activities of daily living (ADLs), instrumental activities of daily living (IADLs), and depression).

Methods: 237 adults aged 45+ (recruited from two PSH providers in Los Angeles) completed interviews assessing age-related health conditions. 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.  Descriptive analyses of health status were conducted.  Additionally, regression analyses were conducted exploring the association of housing tenure with overall health and frailty in this population. Stata (v14) was used for analyses.

Results: Participants were 63% male, 60% African American, and averaged 58 years of age, 5 years living in PSH, and 8 years of lifetime homelessness. Participants reported difficulty in instrumental activities of daily living (48%), activities of daily living (50%), walking (49%), balance (48%), past-year falls (55%), and frailty (46%) at rates much higher than a general population comparison sample aged 70+. Even the youngest adults in this study -- those aged 45-49 - experienced frailty at 4x the rate of the older comparison sample.  Regression analyses examined the association between housing tenure and health, geriatric syndromes (ADL impairment, IADL impairment, frailty, falls in prior year, cognitive impairment (as measured by both the MMSE and TMT-B) and depression, controlling for age, gender, and education; there were no statistically significant relationships found.

Conclusions: These findings support previous research that homeless adults experience accelerated aging, and extend these findings to the large and vulnerable population of older adults living in PSH. However, contrary to our hypothesis, having lived for a longer time in PSH was not associated with a lower prevalence of geriatric conditions.  Moreover, age and tenure in PSH offer little protection from the flattening nature of chronic homelessness. Currently, PSH lacks embedded services that are intended to address ADL/IADL impairments and other geriatric syndromes. In order to help improve wellbeing and aging in place while medical containing costs, PSH design and interventions must account for early onset of aging related health conditions.