Homelessness Among Older Adults: Risk Factors and Resiliency in a Cultural Competency Framework

• Background and Purpose: Homelessness is an issue of social justice in the United States because it leaves people vulnerable, unsafe, and ill, while not having their basic needs for food and shelter met. Because older adults, in Latino and African American communities, tend to remain in family kinship systems long-term they are likely to be represented among the 50% of homeless individuals in America that are older than age 50. This creates serious challenges for how cities, governments, and health care providers will care for them. Poverty is often a primary risk factor, with women of color being at the greatest risk. To assess vulnerabilities risk factors for homelessness among older adult populations, measures of current health status, mental health status, substance misuse, and cognitive status were examined. This poster reports community-based participatory research results of an interdisciplinary intervention to provide mental health outreach to residents of four elderly housing communities, as a component of Hartford Partnership Program for Aging Education (HPPAE), supported by John A. Hartford Foundation. A team of health providers (MSW, APRN, MD) made weekly visits offering diagnostic, triage, and psychosocial services to residents. Evaluation data were collected at baseline, 3-month and 6-month follow-ups.
• Methods: This community-based participatory research study, interviewed 200 older adults, aged 50 and older, recruited via community-based sampling method and evaluated mental health status, cognitive impairment or inability to complete the assessment, food and housing security, number of chronic health conditions, at 3 and 6-month follow-up and stability, and 3 domains of risk factors.
• Statistical Analyses: Participant characteristics and life course experiences were examined using descriptive statistics. Life course experiences associated with experiencing (1) not ever having experienced an episode of homeless, (2) a first episode of homelessness before age 50 versus (3) at age 50 or older. Four models were evaluated, representing alternative hypothetical associations between each life course experience and first episode of adult homelessness before age 50. After selecting the bivariate model for each exposure, we entered those life course variables into a multivariable model along with covariates with bivariate P values of 0.20 or less; reduced multivariable model using backward elimination until variables with P values of 0.05 or less remained. Odds ratio and 95% confidence interval (CI) were used with conditional logistic regression. *P < .05; **P < .01.
  Results: The sample was diverse (45 % African American, 45% Latino, and 9% Caucasian). The most significant findings were: 38.9% of participants reported having experienced at least 1 or more homeless episodes, 33.7% reported having used informal (family support network) in the past 6 months, 25.8% reported substance use/misuse since age 50, 45.1% screened positive for 2 or more chronic illnesses (most common, hyperlipidemia, hypertension and diabetes mellitus), and 48.0% screened positive for financial insecurity (not having money or food to last 30 days).
  Conclusions and Implications: Nearly half of the older adults reporting their first episode at or after age 50 described it as temporary, as opposed to chronic. Those with first homelessness before age 50 had more adverse life experiences, more chronic episodes and fewer social supports.