Review

Old, cold and more

UNDERSTANDING OLDER HOMELESS PEOPLE
Maureen Crane
Open University Press, 1999

Maureen Crane is the British authority on older homeless people and this book is the result of over ten years’ commitment to work with a group whose problems ‘are complex and deep seated, are intricately related to psychological and sociological factors, and extend far beyond a lack of housing’. The most important finding in the first part of the book is that any cross-sectional census greatly underestimates the number of older homeless people. Since local authorities have a statutory duty to re-house homeless pensioners, most do not remain homeless for more than a few months. Those who do are likely to have special problems, such as inability to settle, alcoholism, mental health or learning difficulties. Men greatly outnumber women, and migrants from Ireland and Scotland are heavily over-represented (30 per cent of the 225 in the main research study) but other migrants are almost entirely absent.

Two-thirds appeared to have or admitted having mental health problems, with a significantly higher proportion of women. Even this high rate is likely to be an underestimate, because as Crane notes, when older people tell researchers or support workers to ‘fuck off’ they may be expressing paranoia or simply avoiding contact with people they don’t like. Alcoholism is strongly associated with homelessness and a much higher percentage of older men drank heavily than in the general elderly population. On the other hand, a disproportionate number avoided alcohol altogether and this was even more true for homeless older women. Fewer than 10 per cent were being treated for depression or schizophrenia. Some attended detoxification centres but relapsed into heavy drinking when they were discharged. Mental health and alcohol problems were more strongly associated with rough sleepers than with those who attended hostels or were otherwise temporarily housed.

Even higher rates of physical illness appeared common and three-quarters of those admitted to the hostel study needed treatment and one third needed to be hospitalised urgently. Tuberculosis was highest among middle aged and older homeless men (at around 5 per cent) but many more had chronic bronchitis, arthritis or liver disease. Lack of sleep and poor diet exacerbated all these problems. Street life is dangerous and violent assaults produced further health problems. Older homeless people often fear the young and dislike or avoid the rowdiness of mixed age hostels. GPs are often unwilling to register older homeless people who have multiple problems, are high cost and do not keep appointments. Hospital A&E departments may see homeless older people as wasting their time and they may be refused treatment or discharged without adequate support. Since 1990 specialist outreach teams and similar schemes which offer multidisciplinary support have been developed under the Homeless Mentally Ill Initiative, but much more is needed. Resettlement is possible but only if the real problems of loneliness, boredom, mental illness and alcoholism can be overcome.

The great advantage of this book is that a reader in a hurry could digest the tables, informative diagrams and pictures and read the case studies, while missing few of the important messages presented.