September 15, 2022

Homelessness Hastens Mortality for Older Adults

BY LeadingAge

Research from the University of California San Francisco looks at mortality rates of older adults experiencing homelessness. Researchers found that people who first became homeless at age 50 or later were about 60% more likely to die than those who had become homeless earlier in life. Of course, homelessness was a risk for everyone. Researchers found that older adults who remained homeless were about 80% more likely to die than those who were able to return to housing. 

Mortality rates were high compared to the general Oakland population. The risk of dying was 3 times higher for men and 5 times higher for women, compared to people of the same age and sex in Oakland. The median age for participants entering the study was 58, and 80% were black; 76% were male, and 24% were female.

Expanding the supply of affordable senior housing is LeadingAge’s top affordable housing priority. There is a severe shortage of affordable housing for older adults with low incomes. One of the worst effects of this shortage is the rise in homelessness among older adults.

The study, funded by the National Institute on Aging and carried out by researchers at the University of California San Francisco, recruited people who were 50 and older and homeless, and followed them for a median of 4.5 years. By interviewing people every six months about their health and housing status, researchers were able to examine how things like regaining housing, using drugs, and having various chronic conditions, such as diabetes, affected their risk of dying.

Many study participants had serious conditions that went untreated. “We looked at how frequently people reported diagnosis of heart disease or cancer before dying of these diseases. It was really low,” said Rebecca Brown, MD, affiliated assistant professor of medicine in the Division of Geriatrics at UCSF and a researcher on the study. “We think this represents a lack of access to care and delayed diagnosis. Often, we didn’t even know people were ill because they didn’t report it in their six-month interviews. But we found it on their death certificates.”

Among the study’s 450 participants, 117 had died by December 31, 2021. Of these deaths, the median age of death was 64.6 years old, and the most common causes of death for people in the study were heart disease (14.5%), cancer (14.5%), and drug overdose (12%). Two of the deaths were from COVID. Participants entered the study in two waves, with 350 enrolled in 2013-14 and another 100 enrolled in 2017-18; 101 of the deaths were from the first wave, and 16 were from the second.

“Becoming homeless late in life is a major shock to the system,” said Margot Kushel, MD, who directs the Benioff Housing and Homelessness Initiative and is a professor of Medicine at UCSF and senior author of the study, said in a statement upon the research’s release.

The research, Factors Associated With Mortality Among Homeless Older Adults in California, was published in JAMA Internal Medicine in August 2022.