POSITIVE HEALTH AMONGST OLDER TRAVELLERS AND OLDER HOMELESS PEOPLE: LIFE-COURSE AND STRUCTURAL DETERMINANTS

Abstract Focusing on older Irish Travellers and older homeless people (OTOH) as two marginalised sub-sections of the older population, this paper investigates life-course and structural forms of material disadvantage, and its implications for positive health and accessing community care in older age. With growing interest in strengthening home care structures for older people, it is critical to interrogate the relevance of these structures for those who experience environmental uncertainty in later life, and possess significant trajectories of disadvantage. The analysis draws on 50 life-course interviews with OTOH aged between 50-72 years. The findings illustrate significant life-course experiences of material and multi-faceted forms of disadvantage, including stigma and discrimination, with implications across health and social lives. Housing deprivation was a multi-factorial player, causing certain physical illnesses, hindering some health treatments, and contributing to precarious conditions and sense of self worth. Findings are discussed in relation to flexible models of home care delivery.

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Positive Subjective Health of Older Homeless and Older Irish Travelers: a Participant-Led Approach

Innovation in Aging ◽

10.1093/geroni/igaa057.353 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 107-107

Author(s):

Bridin Carroll ◽

Kieran Walsh

Keyword(s):

Older People ◽

Life Course ◽

Community Care ◽

Well Being ◽

Subjective Health ◽

Social Connections ◽

Structural Determinants ◽

Care Models ◽

Nuanced Understanding ◽

Positive Ageing

Abstract Older people experiencing homelessness and older Irish Travellers (OTOH) are both over-represented in the cohort who use acute health services. Impending health care reform in Ireland will be based on primary care models, meaning home and community care will be, for the first time, underpinned by a regulatory framework. For these reasons, this study aims to gain a nuanced understanding of how OTOH, as marginalised older people, might be best served by new home care and community care models. Using a qualitative, voice-led approach, a life course and structural determinants lens is employed to probe the health conditions, experiences and expectations of OTOH, as well as their perceptions and values around the concept of ‘home’. The research processes and outcomes of one of five phases of research are presented in this paper: participant-led research. In this phase, five OTOH were trained and assisted to complete a short research project which fed into the goals of the wider study. Emergent findings suggest that social connections underpin health and well-being for OTOH, throughout the life course, and presently. This was also seen as a fundamental element for healthy and positive ageing. In addition, ‘home’ was defined with reference to the presence (or absence) of familial or other social connections. This study represents an important contribution to scholarship on old age social exclusion. It is entirely novel in its approach to focusing on OTOH health and wellbeing. The outputs of this study also have important implications for upcoming health reform policies in Ireland.

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Poverty

Encyclopedia of Social Work ◽

10.1093/acrefore/9780199975839.013.297 ◽

2013 ◽

Author(s):

Mark R. Rank

Keyword(s):

Social Work ◽

Life Course ◽

Structural Level ◽

Structural Vulnerability ◽

Structural Determinants ◽

Cross Sectional ◽

Longitudinal Dynamics ◽

Research Areas ◽

Measurement Of Poverty

Poverty has been a subject of concern since the beginnings of social work. This entry reviews three key research areas. First, the extent and dynamics of poverty are examined, including the measurement of poverty, patterns of cross-sectional and comparative poverty rates, the longitudinal dynamics of poverty, and poverty as a life-course risk. Second, reasons for poverty are discussed. These are divided into individual versus structural level explanations. The concept of structural vulnerability is offered as a way of bridging key individual and structural determinants in order to better understand the existence of poverty. Third, strategies and solutions to poverty are briefly reviewed.

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Health Patterns Reveal Interdependent Needs of Dutch Homeless Service Users

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.614526 ◽

2021 ◽

Vol 12 ◽

Author(s):

Coline van Everdingen ◽

Peter Bob Peerenboom ◽

Koos van der Velden ◽

Philippe Delespaul

Keyword(s):

Mental Health ◽

Mental Health Problems ◽

Homeless People ◽

Health Problems ◽

Primary Data ◽

Public Health Approach ◽

Snowball Sampling ◽

Positive Health ◽

Cross Sectional ◽

Mental Health Questionnaire

Background: Homelessness is an increasing problem in Western European countries. Dutch local authorities initiated cross-sectional reviews to obtain accurate health and needs information on Homeless Service (HS) users.Methods: The Homeless People Treatment and Recovery (HOP-TR) study uses a comprehensive assessment strategy to obtain health data. Using a naturalistic meta-snowball sampling in 2015–2017, 436 Dutch HS users were assessed. The lived experience of HS users was the primary data source and was enriched with professional assessments. The InterRAI Community Mental Health questionnaire and “Homelessness Supplement” provided information in different areas of life. The approach for mental health assessments was transdiagnostic. Raw interview data were recoded to assess health and needs. The positive health framework structured symptomatic, social, and personal health domains relevant to recovery.Results: Most subjects were males, low educated, with a migration background. The majority were long-term or intermittently homeless. Concurrent health problems were present in two domains or more in most (95.0%) subjects. Almost all participants showed mental health problems (98.6%); for a significant share severe (72.5%). Frequent comorbid conditions were addiction (78%), chronic physical conditions (59.2%), and intellectual impairments (39.9%).Conclusion: The HOP-TR study reveals significant concurrent health problems among Dutch HS users. The interdependent character of different needs requires an integrated 3-D public health approach to comprehensively serve symptomatic, social, and personal dimensions, required to facilitate recovery.

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A Comprehensive Assessment to Enable Recovery of the Homeless: The HOP-TR Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.661517 ◽

2021 ◽

Vol 9 ◽

Author(s):

Coline Van Everdingen ◽

Peter Bob Peerenboom ◽

Koos Van Der Velden ◽

Philippe A. E. G. Delespaul

Keyword(s):

Mental Health ◽

Homeless People ◽

Primary Data ◽

Snowball Sampling ◽

Physical And Mental Health ◽

Structured Interviews ◽

Positive Health ◽

Cross Sectional ◽

Mental Health Questionnaire

Background: Homelessness is an increasing problem in Western European countries. In the Netherlands, policy reforms and austerity measures induced an urgent need for management information on local homeless citizens. Municipal authorities initiated cross-sectional reviews of Homeless Service (HS) users. The resulting Homeless People Treatment and Recovery (HOP-TR) study developed a health and needs assessment strategy over different domains to comprehensively assess individuals and care networks with the perspective on recovery.Methods: Dutch HS users were selected using a naturalistic meta-snowball sampling. Semi-structured interviews provided the primary data source. The interview content was partly derived from the InterRAI Community Mental Health questionnaire and the “Homelessness Supplement.” Using the raw interview data, algorithmic summary scores were computed and integrating clinical parameters assessed. The data describe health and needs in a rights-based, recovery-oriented frame of reference. The mental health approach is transdiagnostic. The positive health framework is used for structuring health and needs aspects in relation to the symptomatic (physical and mental health), social (daily living, social participation), and personal (quality of life, meaning) dimensions of recovery.Results: Recruitment (between 2015 and 2017) resulted in a saturated sample of 436 HS users in 16 facilities and seven cities. Most participants were long-term or intermittently homeless. The sample characteristics reveal the multi domain character of needs and the relevance of a broad, comprehensive approach. Local authorities used the reports to reflect and discuss needs, care provision, access, and network cooperation. These dialogs incited to improve the quality of care at various ecosystem levels.Discussion: This paper describes new recruitment strategies and data collections of comprehensive data domains, to improve our knowledge in the field of homelessness. Traditional epidemiological literature on homelessness is often domain specific and relies on administrative sources. The HOP-TR study uses an analytical epidemiological approach. It shifts the assessment focus from problem-centered marginalization processes toward a comprehensive, three-dimensional recovery-oriented vision of health. Different perspectives are integrated to explore the interaction of homeless people with care networks.

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Incorporating a Life-Course Perspective in the Development of Research and Public Policy Impacting Older Refugees

Health Tomorrow: Interdisciplinarity and Internationality ◽

10.25071/2564-4033.40237 ◽

2018 ◽

Vol 5 ◽

Author(s):

Thrmiga Sathiyamoorthy

Keyword(s):

Life Course ◽

Theoretical Perspective ◽

Life Course Perspective ◽

Structural Determinants ◽

Personal Issue ◽

The Social ◽

At Risk Populations ◽

Facilitating Conditions ◽

Most At Risk Populations ◽

The Life Course

Older refugees are widely recognized as one of the most at-risk populations living with multiple intersecting barriers of political insecurity, financial insolvency, and poor health. Drawing upon secondary literature, this review essay builds upon a critique of multiculturalism to argue that the successful integration of older refugees is a two-way process. This process includes: 1) refugees making active attempts to embed themselves into Canadian society, and; 2) government facilitating conditions to help refugees integrate. The social integration of refugee elders is not a personal issue. It is a public problem that requires active government intervention via generous universal benefits. I use the life-course theoretical perspective to undertake an analysis of public policies and existing research to identify structural determinants of older refugees’ integration.

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Towards an integrated approach to homeless hospital discharge

Journal of Integrated Care ◽

10.1108/jica-11-2015-0043 ◽

2016 ◽

Vol 24 (1) ◽

pp. 4-14 ◽

Cited By ~ 4

Author(s):

Francesca Albanese ◽

Rachel Hurcombe ◽

Helen Mathie

Keyword(s):

Hospital Discharge ◽

Online Survey ◽

Homeless People ◽

Integrated Approach ◽

Small Scale ◽

Structured Interviews ◽

Positive Health ◽

Project Staff ◽

Content Type ◽

Telephone Interviews

Purpose – The purpose of this paper is to present the findings of a small-scale evaluation of the Department of Health “Homeless Hospital Discharge Fund” (HHDF) in England. Design/methodology/approach – The paper is based on a mixed-method approach comprising 52 telephone interviews with project staff, 48 responses from an online survey with staff, outcomes data collected by projects, 30 semi-structured interviews with patients and nine in-depth telephone interviews with staff and commissioners. Findings – Overall the 52 pilots funded under the “HHDF” provided positive health and accommodation outcomes for homeless people admitted and discharged from hospital. In contrast to previous studies patients described not feeling judged during their stay, however the admission process was a more mixed experience due to communication breakdown by hospital staff. Integrating housing and clinical staff in the hospital discharge projects produced better outcomes for patients and the availability of accommodation as part of the model allowed improved and more stable housing outcomes. We recommend integrated commissioning takes place for future funding of any hospital discharge projects. Research limitations/implications – The study was small in scale and carried out before some of the projects had become fully established. The data were self-reported and the quality and completeness varied between projects. Originality/value – This is one of the few examples of hospital discharge outcomes for homeless people across a number of different localities and project models which examine the role of both health and housing professionals in the process.

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