title: Residential patterns in older homeless adults: Results of a cluster analysis.
abstract: Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. They may have different life trajectories and reside in different environments than do younger homeless adults. Although the environmental risks associated with homelessness are substantial, the environments in which older homeless individuals live have not been well characterized. We classified living environments and identified associated factors in a sample of older homeless adults. From July 2013 to June 2014, we recruited a community-based sample of 350 homeless men and women aged fifty and older in Oakland, California. We administered structured interviews including assessments of health, history of homelessness, social support, and life course. Participants used a recall procedure to describe where they stayed in the prior six months. We performed cluster analysis to classify residential venues and used multinomial logistic regression to identify individual factors prior to the onset of homelessness as well as the duration of unstable housing associated with living in them. We generated four residential groups describing those who were unsheltered (n = 162), cohabited unstably with friends and family (n = 57), resided in multiple institutional settings (shelters, jails, transitional housing) (n = 88), or lived primarily in rental housing (recently homeless) (n = 43). Compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Cohabiters and renters were significantly more likely to be women and have experienced a shorter duration of homelessness. Cohabiters were significantly more likely than unsheltered participants to have experienced abuse prior to losing stable housing. Pre-homeless social support appears to protect against street homelessness while low levels of social support may increase the risk for becoming homeless immediately after losing rental housing. Our findings may enable targeted interventions for those with different manifestations of homelessness.
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA. Electronic address: christopher_lee@post.harvard.edu.
authors.forename: Christopher Thomas
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Guzman
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ponath
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Lina
authors.initials: L
authors.lastname: Tieu
authors.affiliation: Division of HIV/AIDS, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Riley
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Division of General Internal Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Margot
authors.initials: M
authors.lastname: Kushel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California; D016000:Cluster Analysis; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012944:Social Support
keywords: Ageing; Cluster analysis; Environmental health; Gender; Homelessness; Housing; Social support; United States