Risk factors and circumstances associated with homelessness in older adults: a scoping review of quantitative and qualitative studies.

BACKGROUND AND

OBJECTIVES

Circumstances more common with aging may challenge the ability for older adults to maintain appropriate housing. The objective of this scoping review was to identify the risk factors and conditions associated with homelessness in older adults.

RESEARCH DESIGN AND

METHODS

We searched OVID, CINAHL, Embase, PsycINFO, CENTRAL, and Social Work Abstracts from inception to February 2023. We included studies of older adults (defined as 50 years of age or older) or completed subgroup analyses accounting for older adults. We mapped the risk factors and conditions using an ecological framework (individual, relational, and structural/societal components).

RESULTS

Sixty-five studies were included. Individual factors included identifying membership in a racialized group and experiencing psychiatric illnesses or substance use disorders. Relational factors included being unmarried, relationship breakdown, and adverse childhood events. Structural factors included the lack of affordable housing or income supports and systemic discrimination. Those experiencing first-onset late-life homelessness were more likely to be female, had relative lifelong socioeconomic stability, but experienced sudden relational or economic changes. Those experiencing chronic homelessness were more likely to be male, often facing persistent structural vulnerabilities with comorbid substance use or psychiatric disorders. Important research gaps include measures of social support and age- and sex-disaggregated analyses.

DISCUSSION AND IMPLICATIONS: Key individual, relational, and structural factors are associated with homelessness in older adults. Adverse experiences and structural factors, such as social losses and isolation, have important implications toward the risk of homelessness at different stages in life. Further research evaluating age-appropriate interventions is paramount.