Homeless people suffer geriatric conditions decades early, study shows

Although the people in the study had a median age of just 58, they had more trouble bathing, dressing and eating than 80 year olds who had housing. They had a harder time using transportation, taking their medications, managing money, applying for benefits, arranging a job interview and finding a lawyer. They had higher rates of cognitive and visual impairment and urinary incontinence. And they were more likely to fall and to be depressed.

"Usually, we think of geriatric conditions as affecting much older adults in their 70's, 80's and 90's," said Rebecca Brown, MD, MPH, assistant professor of Medicine in the Division of Geriatrics and first author of the paper. "We found these conditions were very common in homeless adults with an average age of just 58. We studied a very vulnerable population. Our systems need to be responsive to the challenges that these older adults have."

About 40 percent of homeless adults reported difficulty with one or more activities of daily living, while a third reported having fallen in the past six months. About a quarter had cognitive impairment, 45 percent had vision impairment and 48 percent had urinary incontinence.

Researchers said their findings, published Feb. 26, 2016 in The Gerontologist, point to the need to develop new ways of helping homeless people, who are increasingly older. Half of single homeless adults are now 50 or older, compared to 11 percent in 1990.

"The traditional way of providing services for homeless people may need to be adapted for the aging population, who may need assistance with activities like using the toilet and are at high risk of falling," said Margot Kushel, MD, professor of Medicine at UCSF and senior author of the paper.

She said a better alternative for chronically homeless older adults would be to adapt permanent supportive housing to meet the needs of the aging homeless population. This would include accommodations, such as having personal care attendants, as well as grab bars in the bathroom. Even short-term solutions, like homeless shelters, will need to adapt for the needs of the aging population.

"We need to figure this out, otherwise many homeless people will be placed in nursing homes, for lack of an alternative, even though they would be better off living in less restrictive -- and less expensive -- environments."

The study is among the first to look at a broad cross section of the homeless population. Rather than just recruiting subjects from shelters, the researchers also canvassed recycling centers, food lines and homeless encampments to better represent the population.

Three quarters of the people in the study were male and 80 percent were African American. Nearly half experienced their first episode of adult homelessness at age 50 or older. The majority of participants, 56 percent, reported poor or fair health status, and chronic medical conditions like high blood pressure were common. Nearly three quarters had a history of mental health problems, two thirds smoked tobacco and more than half had lifelong problems with alcohol or drug use.

Researchers did not find any difference in geriatric conditions between homeless people who camped on the streets, cycled between shelters and hotels, stayed part time with family and friends or had recently lost their rental housing.