Ongoing Homelessness and Late-Life Homelessness Associated with Increased Risk of Death among Older Adults

A new study from researchers at the University of Pennsylvania and the University of California, San Francisco, “Factors Associated with Mortality among Homeless Older Adults in California,” assessed mortality outcomes for adults aged 50 and older experiencing homelessness over a period of four to eight years. The study finds that adults who experience homelessness for the first time at age 50 or older and adults who experience ongoing homelessness after age 50 are at increased risk of death. The primary causes of death included cancer, heart disease, and drug overdose. Recent increases in homelessness among older adults and the associated increased risk of mortality points to the need for policy solutions that prevent homelessness among older adults and provide permanent housing to those experiencing ongoing homelessness.

The study enrolled 450 adults aged 50 and older who were experiencing homelessness in Oakland, CA. Adults were enrolled in two periods: July 2013 through June 2014 and August 2017 through June 2018. Researchers followed up with participants every six months through December 2021, collecting data on housing status, health outcomes, substance use, and sociodemographic factors. Researchers also determined mortality among participants using data from local coroner’s offices, California state death records, social contacts, and online sources.

The research found that among the 450 adults, 117 (26%) had died by the end of 2021. The mortality rate among the sample was 3.5 times higher than the rate in the general population. The median age of death was 64.6 years. Factors associated with increased risk of mortality included experiencing homelessness for the first time at age 50 or older and experiencing ongoing homelessness during the follow-up period. Institutionalization in jail or at a skilled nursing facility at follow-up was also associated with increased risk of death, though participants may have been more likely to stay in a nursing facility due to lack of options for end-of-life care.

Seventeen participants (14.5%) died of heart disease and 17 (14.5%) died of cancer. The third most common cause of death was drug overdose (12%), followed by chronic respiratory diseases (9.4%) and chronic liver disease (6.8%). Many participants were never diagnosed with the disease that resulted in their death. Nearly 60% of participants who died of cancer did not have a prior diagnosis, and nearly 70% of participants who died of heart disease did not have a prior diagnosis. The authors suggest that the lack of diagnoses among these participants may reflect the challenges accessing healthcare faced by people experiencing homelessness.

Previous research finds that homelessness among older adults is increasing. More than 33% of single adults experiencing homelessness are age 50 and older, up from 11% in 1990. Given the increased risk of mortality associated with experiencing homelessness at this age, the authors suggest that targeted policy interventions should be developed to prevent homelessness among older adults. The authors also point to permanent supportive housing as an evidence-based solution for ending chronic homelessness. 

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