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General Principles in Older Adults

Homelessness and housing instability are common in the United States, and affect the health and welfare of many older adults. 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 70–1).

Table 70–1.Definition of homelessness, U.S. 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 more than 50% of household income on housing; moving frequently; living in overcrowded conditions; and “doubling up” (eg, living temporarily with family or friends).

In the last 2 decades, the proportion of the homeless population in the United States age 50 years or older has increased dramatically. In 1990, only 11% of adults experiencing homelessness in the United States were age 50 years or older; however, by 2003 one-third of these adults were older than age 50 years. This trend has continued over the past decade. In 2003, the median age of adults experiencing homelessness was 46 years, but is now estimated to be 49–50 years. 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, the number ...

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