The elderly homeless constitute a subpopulation that is growing. At any given time, approximately 2% of the nation's homeless are aged 65 and older. Increased homelessness among this group is largely the result of demographic changes (the "aging of America"), increased poverty, and declining availability of affordable housing. Elderly individuals become elderly homeless people through two distinct processes: some who have been chronically homeless age into the category of elderly, and some elderly persons lose their housing and become homeless.
Aged persons who are isolated, live alone, and lack economic stability and family or social supports are at great risk for becoming homeless. Precipitating factors may include death of a spouse or a caregiver who provided support, job loss, familial estrangement, domestic violence, and mental illness. Once housing is lost, lack of general resources, lack of social supports, and declining health make it extremely difficult for low-income elderly men and women to relocate into other adequate housing. These elderly homeless persons are in double jeopardy. Not only do they face all of the problems that homeless people face regardless of age but they also encounter the problems that elderly people face regardless of housing status.
Few studies have been devoted specifically to the elderly homeless, and consequently, information is largely anecdotal. Public policy focuses implicitly on younger homeless people. The stereotypes attributed to the homeless include persons with mental illness, alcoholism, or drug abuse. Studies from the 1980s demonstrated that up to one fourth of homeless single adults had lifetime histories of serious mental illness, about one third had histories of alcohol abuse, and about one third had histories of drug abuse. Some observers report, however, that for the aged subpopulation of the homeless, these are relatively uncommon predisposing factors. The amount of chronic disease born by this group is largely unknown.
Each year, the Health Care for the Homeless Program cares for about 800 homeless elders. Table 1 reports the results of a medical chart review of homeless persons under our care at the single room occupancy (SRO)/Homeless Program of the Department of Community Medicine, St. Vincent's Hospital in New York City.
Through chart review of a random sample of patients aged 65 and older, as well as a comparison sample of patients aged 20-49, we have gathered diagnostic information to determine the relative prevalence of chronic disease, alcohol and drug abuse, and mental illness in the comparison age groups.
Chart review of samples of the younger patients (aged 20-49; average of 37 years) and aged patients (aged 65 and older; average of 69 years) revealed the following:
* Chronic Medical Conditions
Ninety percent of elderly homeless had at least one chronic medical condition, although this was true for only 48% of the younger group. The most prevalent can be found in Table 2.
These findings are similar to those reported by the Centers for Disease Control and Prevention (CDC)'s National Center for Health Statistics from a national health interview survey.
* Chronic Behavioral Problems
Eighty-one percent of younger homeless had histories of either substance/alcohol dependence or mental illness, whereas in the elderly group, these problems were common but less prevalent at a rate of 50%.
Through chart review survey, a demographic portrait of our homeless elderly has emerged. Most of the patients are in the young/old age range. Few are married, and most are estranged from family. Most are of minority racial/ethnic groups. Most had relatively low levels of education and worked in unskilled jobs when younger. Survey findings confirm that the aged homeless experience a higher prevalence of chronic medical conditions than younger homeless persons. Specifically, we found a high prevalence of hypertension, cardiac disease, lung disease, diabetes, and arthritis. …