Late-Life Homelessness: A Definition to Spark Action and Change

Overview

Journal Gerontologist

Publisher Oxford University Press

Specialty Geriatrics

Date 2024 Sep 2

PMID 39219172

Authors

Amanda Grenier

Tamara Sussman

Affiliations

Soon will be listed here.

Abstract

Background And Objectives: Comprehensive definitions of social issues and populations can set the stage for the development of responsive policies and practices. Yet despite the rise of late-life homelessness, the phenomenon remains narrowly understood and ill-defined.

Research Design And Methods: This article and the definition that ensued are based on the reconceptualization of interview data derived from a critical ethnography conducted in Montreal, Canada, with older homeless persons (N = 40) and service providers (N = 20).

Results: Our analysis suggests that definitions of late-life homelessness must include 4 intersecting components: (1) age, eligibility, and access to services; (2) disadvantage over the life course and across time; (3) social and spatial processes of exclusion that necessitate aging in "undesirable" places; and (4) unmet needs that result from policy inaction and nonresponse.

Discussion And Implications: The new definition derived from these structural and relational components captures how the service gaps and complex needs identified in earlier works are shaped by delivery systems and practices whose effect is compounded over time. It provides an empirically grounded and conceptually solid foundation for the development of better responses to address homelessness in late life.

References

Brown R, Goodman L, Guzman D, Tieu L, Ponath C, Kushel M . Pathways to Homelessness among Older Homeless Adults: Results from the HOPE HOME Study. PLoS One. 2016; 11(5):e0155065. PMC: 4862628. DOI: 10.1371/journal.pone.0155065. View

Brown R, Hemati K, Riley E, Lee C, Ponath C, Tieu L . Geriatric Conditions in a Population-Based Sample of Older Homeless Adults. Gerontologist. 2016; 57(4):757-766. PMC: 5881727. DOI: 10.1093/geront/gnw011. View

Padgett D, Henwood B, Tsemberis S . Response to Review of Housing First: Ending Homelessness, Transforming Systems, and Changing Lives. Psychiatr Serv. 2016; 67(12):1385. DOI: 10.1176/appi.ps.671101. View

McDonald L, Dergal J, Cleghorn L . Living on the margins: older homeless adults in Toronto. J Gerontol Soc Work. 2007; 49(1-2):19-46. DOI: 10.1300/J083v49n01_02. View

Hibbs J, Benner L, KLUGMAN L, Spencer R, Macchia I, Mellinger A . Mortality in a cohort of homeless adults in Philadelphia. N Engl J Med. 1994; 331(5):304-9. DOI: 10.1056/NEJM199408043310506. View

Hahn J, Kushel M, Bangsberg D, Riley E, Moss A . BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco. J Gen Intern Med. 2006; 21(7):775-8. PMC: 1924700. DOI: 10.1111/j.1525-1497.2006.00493.x. View

de Veer A, Stringer B, van Meijel B, Verkaik R, Francke A . Access to palliative care for homeless people: complex lives, complex care. BMC Palliat Care. 2018; 17(1):119. PMC: 6201635. DOI: 10.1186/s12904-018-0368-3. View

Gonyea J, Mills-Dick K, Bachman S . The complexities of elder homelessness, a shifting political landscape and emerging community responses. J Gerontol Soc Work. 2010; 53(7):575-90. DOI: 10.1080/01634372.2010.510169. View

Hwang S, Wilkins R, Tjepkema M, OCampo P, Dunn J . Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ. 2009; 339:b4036. PMC: 2767481. DOI: 10.1136/bmj.b4036. View

10.

Berkowitz E . The frontier thesis. [Review of: Achenbaum WA. Crossing frontiers: gerontology emerges as a science. Cambridge University Press, 1995]. Rev Am Hist. 1996; 24(4):701-5. View

11.

Crane M, Byrne K, Fu R, Lipmann B, Mirabelli F, Rota-Bartelink A . The causes of homelessness in later life: findings from a 3-nation study. J Gerontol B Psychol Sci Soc Sci. 2005; 60(3):S152-9. DOI: 10.1093/geronb/60.3.s152. View

12.

Sussman T, Barken R, Grenier A . Supporting Older Homeless Persons' Positive Relocations to Long-Term Care: Service Provider Views. Gerontologist. 2020; 60(6):1149-1158. DOI: 10.1093/geront/gnz171. View

13.

Riley M . Social gerontology and the age stratification of society. Gerontologist. 1971; 11(1):79-87. DOI: 10.1093/geront/11.1_part_1.79. View

14.

Hwang S . Mortality among men using homeless shelters in Toronto, Ontario. JAMA. 2000; 283(16):2152-7. DOI: 10.1001/jama.283.16.2152. View

15.

Grenier A, Barken R, McGrath C . Homelessness and aging: The contradictory ordering of 'house' and 'home'. J Aging Stud. 2016; 39:73-80. DOI: 10.1016/j.jaging.2016.11.002. View

16.

Brown R, Evans J, Valle K, Guzman D, Chen Y, Kushel M . Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study. JAMA Intern Med. 2022; 182(10):1052-1060. PMC: 9425284. DOI: 10.1001/jamainternmed.2022.3697. View

17.

Grenier A, Barken R, Sussman T, Rothwell D, Bourgeois-Guerin V, Lavoie J . A Literature Review of Homelessness and Aging: Suggestions for a Policy and Practice-Relevant Research Agenda. Can J Aging. 2016; 35(1):28-41. DOI: 10.1017/S0714980815000616. View

18.

Weldrick R, Canham S . Intersections of Ageism and Homelessness Among Older Adults: Implications for Policy, Practice, and Research. Gerontologist. 2023; 64(5). DOI: 10.1093/geront/gnad088. View

19.

Dannefer D . Cumulative advantage/disadvantage and the life course: cross-fertilizing age and social science theory. J Gerontol B Psychol Sci Soc Sci. 2003; 58(6):S327-37. DOI: 10.1093/geronb/58.6.s327. View

20.

Stergiopoulos V, Herrmann N . Old and homeless: a review and survey of older adults who use shelters in an urban setting. Can J Psychiatry. 2003; 48(6):374-80. DOI: 10.1177/070674370304800603. View