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.
The study was funded by the National Institute on Aging, the
National Center for Advancing Translational Sciences through the UCSF Clinical
and Translational Science Institute, and a Medical Student in Aging Research
Program award from the American Federation for Aging Research.
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