University Healthcare Report: Aging Adults Living on the Street

This report delves into the critical healthcare issues faced by aging adults living on the streets, a subpopulation experiencing significant challenges. It examines the increasing global population of older adults and highlights the rising rates of homelessness within this demographic, supported by statistical data. The report explores the multifaceted factors contributing to homelessness among the elderly, including financial constraints, health deterioration, and lack of social support, referencing various studies and reports. It also addresses the specific health problems prevalent in this population, such as mental health disorders, chronic illnesses, and the impact of violence and victimization. Furthermore, the report emphasizes the crucial role of nurses in providing care, including the development of therapeutic relationships and appropriate interventions. Finally, it discusses the implications for healthcare systems, including housing, palliative care, and the need for increased awareness and support to address the complex needs of this vulnerable group.

Running head: HEALTHCARE
Aging adults living on the street
Name of the Student
Name of the University
Author Note

1HEALTHCARE
Introduction
Reports from the World Population Prospects: the 2017 Revision provide evidence for
the fact that the proportion of older adults, who are aged more than 60 years is anticipated to
double by the year 2050 and also expected to increase by three fold by the year 2100, thereby
increasing from a global proportion of 962 million in 2017 to an anticipated 2.1 billion in
2050, and eventually 3.1 billion in 2100 (United Nations, 2018). It has also been found that
there were approximately 962 million in 2017, aged more than 60 years, and comprised of
13% of the global population. According to data, population of older adults is increasing at an
alarming rate of 3% each year, with the highest percentage being found in the European
Union (Theconversation.com, 2016). In addition, older adults are increasingly been
considered as major contributors to development, and several nations are expected to face
political and fiscal pressures, in relation to healthcare systems. This assignment will elaborate
on a subpopulation that comprises of aging adults living on the street.
Subpopulation description
Ageing and homelessness is a neglected topic and there is a widespread notion that
the proportion of aged and homeless people is considerably low. However, statistical reports
suggest that an increase has been observed in the proportion of aging population living in the
streets in the United Nations (United Nations, 2017). While 11% of the total population was
aged and homeless in the early 90s, the number increased by 37% in the year 2003, and
eventually 50% of the nation’s aged population is homeless presently (Homelesshub.ca,
2018). The event of homelessness has also increased in Canada in recent years, and according
to reports from the National Shelter study conducted during 2005-2009, older adults are
subjected to homelessness owing a plethora of factors such as lack of adequate income to pay
for housing facilities, inadequate pension facilities lack of government assistance, low wages
and lack of sufficient savings (Piat et al., 2015).

2HEALTHCARE
In addition, deterioration in mental and physical health of the older adults, exposure to
abuse or violence, and shortage of affordable housing also contribute to the increase in the
number of aged individuals who live on the streets. The risk of living on the streets for aged
adults also gets augmented under circumstances that are marked by the death of a beloved
person, discrimination, social isolation, or absence of adequate understanding and awareness
on the available services and benefits. Reports from the Preventing Evictions of Senior
Tenants in the GTA also provide evidence for the fact that 27% seniors often find it
problematic to pay their rent, with 62% older adults reporting trouble in monthly expense
coverage (CERA, 2017). In addition, the proportion of seniors who live in poverty in GTA
demonstrated an increase to 12.1% from 10.5% from 2011-14. Furthermore, the number of
older adults residing in Toronto who became homeless and started living on the streets also
doubled in the past decade. It has also been reported by government officials of Canada that
an estimated 30,000 older adults were found on the wait list in Toronto, in order to seek
social housing services in 2014.
Evidences from literature
According to Sorrell (2016) older adults have been found to be at an increased risk for
losing their homes and living on the streets in recent decades. An estimated one half of
individuals who are homeless in the United States are found to be older than 50 years, which
in turn has resulted in the onset of several challenges for the governments, cities, and
healthcare providers for the aging and homeless population. In addition, it has also been
argued by the researchers that several systems had been established by the government,
however, they failed to accurately address the issues of aging. Hence, the researchers
recognised the need of increasing financial support for the elderly population, besides making
healthcare facilities accessible and affordable, increasing their access to low expenditure legal
services, and increasing provisions for affordable housing. It is hence imperative for all

3HEALTHCARE
health professionals to gain a sound understanding of the exclusive preferences and concerns
of homeless older adults.
The same has been affirmed by Ailshire, Lincoln and Brown (2018) who highlighted
the fact that homelessness is a malicious social concern that affects all people, regardless of
their age or background. However, the authors argued that the elderly population is the
rapidly growing section of the homeless people, who are predominantly susceptible to the
severe circumstances of living on the streets. With the use of survey-based data that was
conducted among 4,802 persons from the homeless count of the 2017 Los Angeles County,
the researchers estimated that adults aged more than 50 years comprised of an estimated 47%
of the total population. In addition, among all such aged adults, 46% comprised of African
American, notwithstanding the fact that they represented only 9% of the
population. According to Ko, Kwak and Nelson-Becker (2015) it is imperative for public
health officials to create provision for good death of older adults, the end of life (EOL). The
researchers also elaborated on the fact that palliative and hospice care have been identified as
crucial aspects of EOL interventions, with the aim of facilitating and promoting an enhanced
dying experience for the vulnerable population. On using a grounded theory based approach,
the researchers were able to recognise the perception of older adults towards good death and
identified several themes namely, (i) dying peacefully, (ii) experiencing spiritual association,
(ii) lack of suffering, and (iv) making compensations with significant others. In addition,
some noticeable themes that emerged, in relation to bad death were namely, (i) dying alone,
(ii) increased lifespan with life support, (iii) death due to violence or accident, and (iv)
increasing dependence at the time of entering a dying course.
This is in accordance to the Brown et al. (2016) who illustrated that older homeless
people often lived in shelters and reported increased rates of geriatric conditions, which
directly increased their likelihood for nursing home placement and acute care use. On

4HEALTHCARE
conducting an interview for 350 homeless older adults, the researchers found that 162 stayed
in unsheltered locations, 57 tried living intermittent with friends and family, with 43 seeking
shelter in rental housing. This calls for the need of services that are able to address geriatric
conditions of adults living on the streets. Tong, Kaplan, Guzman, Ponath and Kushel (2019)
also elaborated on the fact that older adults living on the streets are at an increased risk of
being victims of violence. The researchers suggested that as much as 10.6% of the target
population had experienced sexual or physical victimisation and re-entering their houses
often lowers their risk. Hence, it is imperative for policymakers to identify the exposure to
victimisation as a direct negative impact of homelessness that can be averted by adequate
housing.
Issues faced by older homeless adults
In the words of Joshi and Beizai (2018) homelessness among older adults increases
the mortality risk of the population manifold and also leads to the onset of serious health
complications, such as, substance dependence, unemployment, and early death. In addition,
while living on the streets, the older adults also demonstrate a reduced life expectancy, in
addition to an augmented burden for age-related illnesses. Some common concerns that the
aging individuals face while living in streets include problems in completing their activities
of daily living such as, dressing and bathing. Furthermore, researchers have also associated
homelessness among geriatric population with increased hazard for assault, lack of insurance,
and poor health related quality of life. Research evidences also elaborate on the fact that
geriatric population that is homeless faces several mental health issues that commonly
encompass affective disorders such as, bipolar disorder, depression, schizophrenia, and
anxiety disorders (Gannon & Hsu, 2018).
Most researchers elaborate on the fact that the link between mental illness and
homelessness of older adults is multifaceted. Time and again it has been established that

5HEALTHCARE
mental illness is often responsible for the manifestation of behavioural and cognitive
problems that create difficulties for homeless adults to earn a steady income or conduct
activities of daily activities (Chung et al., 2018). Presence of mental illness, concomitant with
homelessness also makes the older adults victims of alcohol consumption, violent
victimisation and drug abuse. It has also been found that childhood experiences, which are
generally described in the form of feelings of being unloved during childhood, general
unhappiness, or adverse childhood experiences act as controlling risk factors for geriatric
homelessness. It has often been argued by researchers that the social conceptualizations of
poverty and homelessness can be compared and contrasted, thereby resulting in diverse
manifestations of discrimination and stigma (Salem, Brecht, Ekstrand, Faucette & Nyamathi,
2019). Under certain circumstances, the community also uses law and legislation for
discriminating against homeless older adults by limiting the public spaces where sleeping or
sitting is allowed, or enforcing ordinances that limit aggressive panhandling (Katz, 2017).
Homeless old people who violate these rules characteristically experience criminal
consequences, which eventually bring about incarceration, fines or both. Such aged people
who live on the streets are at an increased risk for suffering from chronic and acute illnesses
also. The most common health issue faced by such people is chronic schizophrenia, that
occurs with a worsening of disabilities, and act as an impediment in the pathway of coping
with life stressors.
Another present-day case of illness that is commonly found in old homeless people is
AIDS. With a progress in the disease, it leads to opportunistic infections, thereby making the
individual incapable of working and paying rent (Gass, Mahan & Balfour, 2018). This makes
it difficult for them to secure affordable housing and also forces them to live on the streets.
Homelessness among geriatric population also increases the likelihood of developing a range
of health ailments such as, skin infections and disease that involve the extremities. In

6HEALTHCARE
addition, such people also suffer from parasitic infestation, malnutrition, periodontal and
dental disease, veneral disease, degenerative joint diseases, infectious hepatitis, and hepatic
cirrhosis. Research evidences also suggest that pustular skin lesions that are secondary to
insect bites are quite common among old homeless people (Aminbakhsh, Strong, Chau,
Vafadaran & Faroughi, 2018).
It has often been found that old homeless people suffer from varicose veins due to
prolonged period of sleeping or sitting with their legs that directly predispose the population
to edema and also increase their susceptibility to skin ulcerations and cellulitis (Canham,
Custodio, Mauboules, Good & Bosma, 2019). Furthermore, older people who live on the
streets reports cases of recurrent dermatitis, which is probably associated to insufficient
occasions to shower or bathe, thereby making the people more prone to suffer from
infestations with scabies and lice. According to Rajagopalan (2016) they also report presence
of acute nonspecific respiratory illnesses such as, tuberculosis, which in turn is related to poor
diet and alcoholism. Diabetes, hypertension and chronic obstructive pulmonary disease are
also common in the target population, which increase the complexity of pharmacological and
dietary management.
Nursing interventions
Nurses working in any private, public or veterans' hospital have the accountability of
delivering realistic care plans for homeless adults, besides referring them to appropriate
community agencies. It is imperative for the nurses to gain a sound understanding of the
personal beliefs and values of the older adults, prior to addressing their health needs. The
ordinary lives of homeless elderly people and healthcare providers are such dissimilar that
they might often act as cultural strangers, and avoid contact due to presence of mutual fears
(Caldwell, Meraz & Sweeney, 2018). Nursing professionals must build rapport with the

7HEALTHCARE
patients, while meeting them in their turf-shelters or on the street. They must also display
understanding and awareness of the factors that deter treatment.
Development of a non-judgmental nurse-patient therapeutic relationship would help
in demonstrating dignity, respect, and value. The nurses can also intervene under
circumstances where other healthcare professionals stereotype the target population, and can
treat each homeless individual as a discrete (Nyamathi et al., 2016). Displaying an awareness
of the body language and gestures of the patient would also ensure effective treatment. At the
time of assessment, nurses must allow time to the patient for answering health-related
questions and should also provide a summary of the information collected, in order to seek
clarification. Eliciting information about perception of the patient and tailoring the
assessment according to the housing and behavioural conditions of the older adult would also
enable an effective care strategy (Roche et al., 2018).
It has been stated earlier that, homeless older adults have inadequate access to bathing
facilities, dental care, and food, hence, special attention must be given to the teeth, feet and
skin during physical examination, besides checking them for signs of malnutrition. Nursing
professionals also have the duty of demonstrating alertness towards signs of drug abuse like
nasal abnormalities or needle marks. Domains of self-empowerment, self-esteem and
assertiveness must also be identified, in addition to placing a focus on building their strengths
and talent, in place of weaknesses (Astroth, Jenkins, Kerber & Woith, 2018). For homeless
older adults who are acutely ill, nursing professionals must coordinate necessary
interventions with mental health units, medical facilities, and detoxification care.
Conclusion
Thus, it can be concluded that almost every nation of the world is undergoing a
massive growth in the proportion and number of older people and population ageing has been

8HEALTHCARE
identified as a major social transformation in this 21st century. It has major implication in
different sections of the community, such as, financial market and labour, demand of services
and goods, like transportation, housing and social protection, intergenerational ties, and
family structures. Older adults who are homeless generally experience poor quality of life and
suffer from a range of health issues that affects their wellbeing. They also experience the
problems of increased frailty and absence of access to secure health and social care. Hence,
there is a need to increase resources in the community where the homeless elderly population
resides. Nursing professionals can therefore play an important role in addressing their
healthcare needs and helping them lead a meaningful and disease-free life.

9HEALTHCARE
References
Ailshire, J., Lincoln, K. D., & Brown, L. L. (2018). Aging on the streets: the emerging crisis
of older homeless adults in Los Angeles County. Innovation in Aging, 2(Suppl 1),
376. doi: 10.1093/geroni/igy023.1395
Aminbakhsh, R., Strong, R. A., Chau, D., Vafadaran, A., & Faroughi, E. (2018). Infectious
Diseases in Homeless Geriatrics Population: Part I: Viral. Homeless Older
Populations: A Practical Guide for the Interdisciplinary Care Team, 121. Retrieved
from https://books.google.co.in/books?
hl=en&lr=&id=ZvY_DwAAQBAJ&oi=fnd&pg=PA121&dq=homeless+geriatric+AI
DS&ots=EdBscIKRmo&sig=cP3WlsV7QwXN-
W2OqxLYC9w4nVc#v=onepage&q=homeless%20geriatric%20AIDS&f=false
Astroth, K. S., Jenkins, S. H., Kerber, C., & Woith, W. M. (2018, October). A qualitative
exploration of nursing students’ perceptions of the homeless and their care
experiences. In Nursing forum (Vol. 53, No. 4, pp. 489-495).
https://doi.org/10.1111/nuf.12276
Brown, R. T., Hemati, K., Riley, E. D., Lee, C. T., Ponath, C., Tieu, L., ... & Kushel, M. B.
(2016). Geriatric conditions in a population-based sample of older homeless
adults. The Gerontologist, 57(4), 757-766. https://doi.org/10.1093/geront/gnw011
Caldwell, R., Meraz, R., & Sweeney, R. R. (2018). Homeless No More: A Christ-Centered,
Comprehensive Homeless Recovery Program. Journal of Christian Nursing, 35(4),
228-233. doi: 10.1097/CNJ.0000000000000446

10HEALTHCARE
Canham, S. L., Custodio, K., Mauboules, C., Good, C., & Bosma, H. (2019). Health and
Psychosocial Needs of Older Adults Who Are Experiencing Homelessness Following
Hospital Discharge. The Gerontologist. https://doi.org/10.1093/geront/gnz078
Centre for Equality Rights in Accomodation. (2017). Preventing evictions of senior tenants
in the gta- A Call to Action to Curtail an Emerging Crisis. Retrieved from
http://www.equalityrights.org/wp-content/uploads/2017/04/Final-Report-CERA-
Seniors-Eviction-Prevention-Initiative.pdf
Chung, T. E., Gozdzik, A., Palma Lazgare, L. I., To, M. J., Aubry, T., Frankish, J., ... &
Stergiopoulos, V. (2018). Housing First for older homeless adults with mental illness:
a subgroup analysis of the At Home/Chez Soi randomized controlled
trial. International journal of geriatric psychiatry, 33(1), 85-95.
https://doi.org/10.1002/gps.4682
Gannon, J., & Hsu, A. (2018). Chronic Mental Health Issues (Psychosis) in the Geriatric
Homeless. Homeless Older Populations: A Practical Guide for the Interdisciplinary
Care Team, 23. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=ZvY_DwAAQBAJ&oi=fnd&pg=PA23&dq=homeless+geriatric+issu
es&ots=EdBscIDUmh&sig=CSDd9YCR1PGyxYWPTkAhFR9mqjg#v=onepage&q=
homeless%20geriatric%20issues&f=false
Gass, A. P., Mahan, Z., & Balfour, M. (2018). Definition, Background, and Case Studies of
Geriatric Homelessness. Homeless Older Populations: A Practical Guide for the
Interdisciplinary Care Team, 1. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=ZvY_DwAAQBAJ&oi=fnd&pg=PA1&dq=homeless+geriatric+AIDS
&ots=EdBscIKRmo&sig=VCyEOSFJvPdEFo9zj0XMdBB96fg#v=onepage&q=home
less%20geriatric%20AIDS&f=false

11HEALTHCARE
Homelesshub.ca. (2018). Supporting communities to prevent and end homelessness.
Retrieved from https://www.homelesshub.ca/about-homelessness/population-
specific/seniors
Joshi, Y., & Beizai, K. (2018). Ethical and Legal Issues in the Geriatric Homeless. Homeless
Older Populations: A Practical Guide for the Interdisciplinary Care Team, 75.
Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=ZvY_DwAAQBAJ&oi=fnd&pg=PA75&dq=homeless+geriatric+issu
es&ots=EdBscIDUmh&sig=r9oZwSUAowXmKWpUYcNPfzT_2WQ#v=onepage&q
=homeless%20geriatric%20issues&f=false
Katz, M. H. (2017). Homelessness—Challenges and Progress. Jama, 318(23), 2293-2294.
doi:10.1001/jama.2017.15875
Ko, E., Kwak, J., & Nelson-Becker, H. (2015). What constitutes a good and bad death?:
perspectives of homeless older adults. Death studies, 39(7), 422-432.
https://doi.org/10.1080/07481187.2014.958629
Nyamathi, A. M., Zhang, S., Salem, B. E., Farabee, D., Hall, B., Marlow, E., ... & Yadav, K.
(2016). A randomized clinical trial of tailored interventions for health promotion and
recidivism reduction among homeless parolees: outcomes and cost analysis. Journal
of experimental criminology, 12(1), 49-74. https://doi.org/10.1007/s11292-015-9236-
9
Piat, M., Polvere, L., Kirst, M., Voronka, J., Zabkiewicz, D., Plante, M. C., ... & Goering, P.
(2015). Pathways into homelessness: Understanding how both individual and
structural factors contribute to and sustain homelessness in Canada. Urban
Studies, 52(13), 2366-2382. https://doi.org/10.1177%2F0042098014548138

12HEALTHCARE
Rajagopalan, S. (2016). Tuberculosis in older adults. Clinics in geriatric medicine, 32(3),
479-491. https://doi.org/10.1016/j.cger.2016.02.006
Roche, M. A., Duffield, C., Smith, J., Kelly, D., Cook, R., Bichel‐Findlay, J., ... & Carter, D.
J. (2018). Nurse‐led primary health care for homeless men: a multimethods
descriptive study. International nursing review, 65(3), 392-399.
https://doi.org/10.1111/inr.12419
Salem, B. E., Brecht, M. L., Ekstrand, M. L., Faucette, M., & Nyamathi, A. M. (2019).
Correlates of physical, psychological, and social frailty among formerly incarcerated,
homeless women. Health care for women international, 1-25.
https://doi.org/10.1080/07399332.2019.1566333
Sorrell, J. M. (2016). Aging on the street: Homeless older adults in America. Journal of
psychosocial nursing and mental health services, 54(9), 25-29.
https://doi.org/10.3928/02793695-20160817-04
Theconversation.com. (2016). How the homeless population is changing: it’s older
and sicker. Retrieved from https://theconversation.com/how-the-homeless-
population-is-changing-its-older-and-sicker-50632
Tong, M. S., Kaplan, L. M., Guzman, D., Ponath, C., & Kushel, M. B. (2019). Persistent
homelessness and violent victimization among older adults in the HOPE HOME
Study. Journal of interpersonal violence, 0886260519850532.
https://doi.org/10.1177%2F0886260519850532
United Nations. (2017). World Population Prospects- The 2017 Revision Key Findings and
Advance Tables. Retrieved from
https://esa.un.org/unpd/wpp/Publications/Files/WPP2017_KeyFindings.pdf

13HEALTHCARE
United Nations. (2018). Global issues- Ageing. Retrieved from
https://www.un.org/en/sections/issues-depth/ageing/