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Homelessness and housing instability are common in the United States and increasingly affect the health and welfare of many older adults. In the past three decades, the proportion of the homeless population in the United States aged 50 years or older has increased dramatically. Approximately half of single homeless adults are now aged 50 years or older, compared to only 11% in 1990. The aging of the homeless population is thought to be the result of a cohort effect: individuals born in the second half of the “baby boom” generation (1954–1964) have an increased risk of homelessness compared to other age groups. As this cohort ages, the median age of the homeless population is expected to continue to increase. In the wake of the foreclosure crisis and with rising housing costs in many areas of the United States, the number of adults experiencing housing instability is also increasing. To provide appropriate clinical care to the growing population of older adults experiencing homelessness and housing instability, clinicians need to understand how housing problems interact with health.


Although definitions of homelessness vary, the most commonly used definition in the United States comes from Congress’s 1987 McKinney-Vento Homeless Assistance Act. The McKinney Act defines homeless individuals or families as lacking “a fixed, regular, and adequate nighttime residence,” including persons in emergency shelters and places not meant for human habitation. In 2009, Congress expanded the definition of homelessness to include people facing imminent loss of housing (eg, within 14 days after their application for homeless assistance) (Table 75–1).

Table 75–1.Definition of homelessness, US Department of Housing and Urban Development.

Most individuals who become homeless have a preceding period of housing instability. Housing instability is defined by varying criteria, including difficulty paying a mortgage, rent, or utilities; spending >50% of household income on housing; moving frequently; living in overcrowded conditions; and “doubling up” (ie, living ...

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