Characteristics of the old and homeless: identifying distinct service needs

Mental health service needs and mental health of old adults living alone in urban and rural areas in China: The role of coping styles

This study aimed to explore the level and relationship between the mental health service needs (MHSN), coping styles (CS), and mental health (MH) of old adults living alone in urban and rural, and to explore the moderating effects of coping styles. A cross-sectional study was conducted with 717 older adults living alone. The survey measured MHSN, CS, and MH. Data were analyzed using a structural equation and bootstrapping method. There were significant differences in the MHSN, CS, and MH between urban and rural old adults living alone (P < 0.05). The model of the impact of MHSN on MH in urban and rural old adults living alone showed a good fit. These findings highlighted the importance of high MHSN and positive CS as potential protective factors of mental health in old adults living alone. This provides a theoretical basis for psychological nursing for old adults living alone in the community.

"A right place for everybody": Supporting aging in the right place for older people experiencing homelessness

While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age-related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities-Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small-table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service-enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place.

Housing and Social Connection: Older Formerly Homeless Veterans Living in Subsidized Housing and Receiving Supportive Services

Objectives: The purpose of this study was to (Aim 1) describe United States military veterans' experiences and attitudes about project-based housing (PBH) and tenant-based housing (TBH), including perceptions of their new environment, self-sufficiency, and social integration. We identified (Aim 2) features of program design and housing facilities associated with self-sufficiency and social integration including describing differences in veterans' experiences of housing (PBH vs. TBH).Methods: Interviews were conducted with 30 Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program (25 male and 5 female; average age 63). Thirteen lived in PBH and 17 in TBH in the Greater Boston Metro Area.Results: Social isolation may be a particular challenge of older formerly homeless adults. Veterans in both types of supportive housing struggled with social isolation despite social engagement opportunities available in PBH. Healthcare and transportation issues were important for veterans living in TBH while behavioral health issues were a major factor for those living in both types of housing. Both groups of veterans relied on their case management teams as a means of support and social engagement.Conclusions: To reduce social isolation and loneliness, more attention is needed by program staff to provide varied social engagement opportunities, from one-on-one to group activities.Clinical Implications: These findings can help providers recognize issues inhibiting formerly homeless veterans from being successful in supportive housing. Clinicians should consider how veterans' behavioral health impacts their ability to engage in social activities. Substance use disorder remains a challenge for many veterans interviewed. Its effects impact their perceptions of fellow residents, perceptions of housing, and recovery.

Shelter/housing options, supports and interventions for older people experiencing homelessness

While experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.

Exploring Tiny Homes as an Affordable Housing Strategy to Ameliorate Homelessness: A Case Study of the Dwellings in Tallahassee, FL

An emerging strategy to combat homelessness is the development of “tiny homes”. However, the advent of tiny homes as a new form of housing intervention raises a number of questions about their intentions, efficacy, and policy feasibility. This paper seeks to understand the strategies used by stakeholders to plan, design, and implement a tiny home community to meet the needs of those experiencing homelessness, and to understand where these plans were effective and where challenges arose in meeting the intended project goals. Utilizing the recent development of Tallahassee’s “The Dwellings” project as a case study, we examine how the community was planned, resident experiences, and constraints to implementing a tiny home development. We use qualitative methods that include interviews with stakeholders who were integral to the planning and development process. Our findings highlight how funding constraints and NIMBYism (Not in My Backyard-ism) stymied stakeholder efforts to achieve equity and affordability at The Dwellings, resulting in the inability to achieve project aims of developing housing that serves the homeless population. We conclude by offering some observations and lessons learned for future research on tiny homes as a solution to ameliorate homelessness.

Self-reported health, healthcare service use and health-related needs: A comparison of older and younger homeless people

The number of older homeless people with a limited life expectancy is increasing. European studies on their health-related characteristics are lacking. This study compared self-reported health, healthcare service use and health-related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross-sectional data from 378 participants who completed 2.5-year follow-up, we analysed differences in self-reported health, healthcare service use, and health-related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health-related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non-acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter-based or community outreach programmes that proactively provide multidisciplinary healthcare services.

Geriatric Conditions in a Population-Based Sample of Older Homeless Adults

Purpose of the Study

Older homeless adults living in shelters have high rates of geriatric conditions, which may increase their risk for acute care use and nursing home placement. However, a minority of homeless adults stay in shelters and the prevalence of geriatric conditions among homeless adults living in other environments is unknown. We determined the prevalence of common geriatric conditions in a cohort of older homeless adults, and whether the prevalence of these conditions differs across living environments.

Design and Methods

We interviewed 350 homeless adults, aged 50 and older, recruited via population-based sampling in Oakland, CA. We evaluated participants for common geriatric conditions. We assessed living environment using a 6-month follow-back residential calendar, and used cluster analysis to identify participants' primary living environment over the prior 6 months.

Results

Participants stayed in 4 primary environments: unsheltered locations (n = 162), multiple locations including shelters and hotels (n = 88), intermittently with family/friends (n = 57), and, in a recently homeless group, rental housing (n = 43). Overall, 38.9% of participants reported difficulty performing 1 or more activities of daily living, 33.7% reported any falls in the past 6 months, 25.8% had cognitive impairment, 45.1% had vision impairment, and 48.0% screened positive for urinary incontinence. The prevalence of geriatric conditions did not differ significantly across living environments.

Implications

Geriatric conditions were common among older homeless adults living in diverse environments, and the prevalence of these conditions was higher than that seen in housed adults 20 years older. Services that address geriatric conditions are needed for older homeless adults living across varied environments.