A qualitative exploration of older people's lived experiences of homelessness and memory problems - stakeholder perspectives

Penny Rapaport; Garrett Kidd; Rosario Espinoza Jeraldo; Ava Mason; Martin Knapp; Jill Manthorpe; Caroline Shulman; Gill Livingston

doi:10.1186/s12877-023-04250-0

A qualitative exploration of older people's lived experiences of homelessness and memory problems - stakeholder perspectives

BMC Geriatr. 2023 Sep 12;23(1):556. doi: 10.1186/s12877-023-04250-0.

Authors

Penny Rapaport¹, Garrett Kidd², Rosario Espinoza Jeraldo², Ava Mason², Martin Knapp³, Jill Manthorpe^{4

5}, Caroline Shulman^{6

7

8}, Gill Livingston^{2

9}

Affiliations

¹ UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK. P.Rapaport@ucl.ac.uk.
² UCL Department of Mental Health of Older People, Division of Psychiatry, Wing B, Floor 6 Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK.
³ Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
⁴ NIHR Policy Research Unit in Health and Social Care Workforce, King's College London, London, UK.
⁵ NIHR Applied Research Collaboration (ARC) South London, London, UK.
⁶ Pathway, London, UK.
⁷ Healthy London Partnership, London, UK.
⁸ Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK.
⁹ Camden and Islington NHS Foundation Trust, London, UK.

Abstract

Background: The numbers of older people experiencing both homelessness and memory problems are growing, yet their complex health, housing and care needs remain undelineated and unmet. There is a critical gap in understanding what can improve the care, support and experiences of this group. In this qualitative study we explore how stakeholders understand memory problems among older people in the context of homelessness and consider what they judge gets in the way of achieving positive outcomes.

Method: We conducted reflexive thematic analysis of qualitative interviews (n = 49) using a semi-structured topic guide, with 17 older people (aged ≥ 50 years) experiencing memory problems and homelessness, 15 hostel staff and managers, and 17 health, housing and social care practitioners. We recruited participants from six homelessness hostels, one specialist care home and National Health and Local Authority Services in England.

Results: We identified four overarching themes. The population is not taken seriously; multiple causes are hard to disentangle; risk of exploitation and vulnerability; and (dis)connection and social isolation. The transience and lack of stability associated with homelessness intensified the disorienting nature of memory and cognitive impairment, and those providing direct and indirect support required flexibility and persistence, with staff moving beyond traditional roles to advocate, provide care and safeguard individuals. Memory problems were perceived by frontline staff and older people to be overlooked, misinterpreted, and misattributed as being caused by alcohol use, resulting in pervasive barriers to achieving positive and desired outcomes.

Conclusions: Efforts to meet the needs of older people living with memory problems and experiencing homelessness and future interventions must reflect the complexity of their lives, often in the context of long-term alcohol use and current service provision and we make suggestions as to what could be done to improve the situation.

Keywords: Ageing; Homelessness; Inclusion health; Memory problems; Qualitative.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Alcohol Drinking
Cognitive Dysfunction* / diagnosis
Cognitive Dysfunction* / epidemiology
Humans
Ill-Housed Persons*
Memory Disorders / diagnosis
Memory Disorders / epidemiology
Social Isolation

Abstract

Publication types

MeSH terms

Grants and funding