Objectives: Since 2010, the number of homeless people in the UK has increased, and homelessness in its different types has become a major public health problem. Housed older people with past experience of homelessness are an understudied population that can provide valuable insight into this problem. For this reason, we examined the lifetime prevalence of homelessness and its associations with childhood adversity and mortality in a national sample of older people.
Study design: This is a longitudinal cohort study.
Methods: We studied 6649 housed individuals aged 55-79 years in 2007 from the English Longitudinal Study of Ageing (ELSA). We used logistic regression to model the association between adverse childhood experiences (ACE) and lifetime experience of homelessness (ever been homeless for ≥1 months) and Cox proportional hazards regression to model the prospective association between lifetime experience of homelessness and mortality.
Results: We identified 107 participants with lifetime experience of homelessness. We found a strong graded association between the number of ACE and lifetime experience of homelessness; participants with two ACE had 5.35 (95% confidence interval [CI]: 3.17-9.05) times greater odds of having experienced homelessness than those reporting none. Most ACE were individually associated with lifetime homelessness, but fewer remained so in the mutually adjusted model. Participants with lifetime experience of homelessness had 1.55 (95% CI: 1.01-2.37) times greater risk of mortality over a 10-year follow-up and after adjustment for covariates.
Conclusions: Exposure to childhood adversity is associated with increased risk of experiencing homelessness. Older housed people with past experience of homelessness are at increased risk of mortality.
Keywords: Adverse childhood experiences; Ageing; Cohort; Homelessness; Longitudinal; Mortality.
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