摘要：Objectives. We compared the characteristics of chronically homeless and acutely homeless elderly veterans to better understand precipitants of homelessness. Methods. We conducted interviews with 33 chronically and 26 acutely homeless veterans aged 65 years and older receiving transitional housing services in Los Angeles, California, between 2003 and 2005. We asked questions regarding their sociodemographic characteristics and other social status measures. Other precipitants of homelessness were acquired via observation and open-ended and structured questions. Results. Both veterans groups were more similar than different, with substantial levels of physical, psychiatric, and social impairment. They differed significantly in homelessness history, with chronically homeless veterans having more homelessness episodes and more total time homeless. They were also less educated and had smaller social networks. In response to open-ended questioning, elderly homeless veterans revealed how health and substance use issues interacted with loss of social support and eviction to exacerbate homelessness. Conclusions. Assessment of a range of factors is needed to address risk factors and events leading to homelessness. Further research with larger samples is needed to confirm the characteristics and needs of the elderly homeless veteran population. In 2007, the US Departments of Housing and Urban Development and Veterans Affairs conducted the first comprehensive census of homeless people and found that a disproportionate number of the homeless population were veterans. 1 The population of veterans overall has been aging: veterans older than 65 years accounted for 38% of the total veteran population in 1999, and the most current estimate projected this rate rose to 42% in 2011. 2 Elderly veterans are approximately twice as likely to be homeless as elderly civilians: 39% of homeless veterans were aged 51 to 61 years and 9% of homeless veterans were aged 62 years or older (compared with 19% and 4%, respectively, for same-aged groups of homeless nonveterans). 1 Researchers have proposed a cumulative risk model composed of risk and protective factors to explain homelessness among elderly people. 3–6 Risk can include life events (death of spouse, marital breakdown, exiting employment, evictions), problem conditions (mental illness or medical conditions), and internal and external factors (minority status and higher levels of disruptive events during childhood, including parental incarceration or history of substance abuse). 4,7,8 Multiple risk factors, including substance abuse and increased mental health problems, increase the likelihood of negative outcomes. 9 To date, little research has been done on the relationship between such risk factors and their impact on the trajectory of homelessness for either elderly homeless nonveterans or elderly homeless veterans. 10 Relatedly, in recent years, risk for chronic homelessness has been a major concern in the literature on homelessness. Chronically homeless individuals have been found to be more likely to have more severe mental health, physical, and substance abuse issues. 11–13 Little research has been done on chronic homelessness among elderly individuals, 14 with no attention paid to homeless elderly veterans. The research that does exist has found that—in comparison with nonelderly homeless people—homeless elderly people experience a wider, more intense array of medical, psychological, and social problems 15 ; cognitive impairments and dementia 15 ; greater sensitivity to the effects of alcohol and drug use 16 ; dramatically lower rates of being married 17 ; and weaker social ties. 18 These issues can affect elderly people’s ability to make housing decisions and can increase the likelihood of eviction or abandonment by family or other support persons. 19 Other research has suggested that the length of time elderly people are homeless has been found to vary in relation to the timing of events during different life stages, for example, disruptive events (e.g., foster care, parental separation, incarceration) during childhood; the impact of limited education, health, and substance abuse problems during middle age on occupational functioning; and significant loss in older age. 7 For veterans across all age groups, a large body of research comparing the characteristics of homeless veterans with those of homeless nonveterans has indicated that their profiles contrast: homeless veterans are slightly more likely to be White, be better educated, be more likely to have a history of marriage (as well as divorce), and be more likely to have serious alcohol problems than drug problems. 1,7,13,20 The cumulative risk model has also been applied to homeless veterans and has shown that additional risk factors such as combat exposure, wartime trauma, and posttraumatic stress disorder (PTSD) increase vulnerability to homelessness. 21 Cohen 3 has concluded that older homeless people are invisible to researchers, policymakers, and the public at large. To provide visibility to elderly homeless veterans as a significant homeless elderly population and contribute to the understanding of homeless chronicity in this group, we conducted interviews with a sample of elderly homeless veterans receiving transitional housing services between 2003 and 2005. Given the specific vulnerabilities of veterans, we had 2 goals in examining issues relevant to homelessness for this sample. The first was to examine their characteristics, comparing those who were chronically homeless with those who were acutely homeless. The second was to better understand what precipitated homelessness through the veterans’ own narratives and structured questioning across a broad range of potentially precipitating factors.
