Intersections of Ageism and Homelessness Among Older Adults: Implications for Policy, Practice, and Research

Abstract

Ageism remains a key issue in gerontological literature and has long been recognized as a deeply harmful form of discrimination. Despite advances in ageism scholarship related to education, advocacy, and prevention, there are calls for ongoing intersectional examinations of ageism among minority groups and across older people facing multiple exclusions. In particular, very little ageism research has considered the experiences of age-based discrimination and prejudice among older people experiencing homelessness. We problematize this gap in knowledge and provide recommendations for policy, practice, and research to address ageist discrimination toward older people experiencing homelessness. Intersections of ageism and homelessness are summarized at four levels: intrapersonal, interpersonal, institutional/community, and societal/structural. Building upon the limited research, we recommend key strategies for supporting and protecting older people experiencing homelessness through the reduction of ageism at each level. We present these insights and recommendations as a call to action for those working in both the aging and housing/homelessness spheres.

Discrimination, Housing insecurity, Stigma

Homelessness in later life is a growing problem in North America, with recent reports estimating that the number of older people experiencing homelessness is increasing (Culhane et al., 2021; Gaetz et al., 2016). Factors including the shortage of secure and affordable housing, insufficient income supports, health challenges, and older adults abuse have been noted as contributing to the risk of homelessness among older people (Grenier et al., 2016). Older people living in precarious or unstable housing are at increased risk of becoming unhoused as a result of so-called “renovictions,” rapidly increasing rental costs, and other challenges linked to the housing crisis (Crane et al., 2005; Wyndham-West et al., 2022). The complexity of homelessness in later life is further amplified by a shortage of age-friendly services in the homelessness sector, leaving older adults inadequately supported by shelters, transitional housing, and other homelessness services (Canham, Humphries, et al., 2022; Gonyea et al., 2010).

Older people experiencing homelessness face many barriers to exiting homelessness and securing stable housing. Service access barriers (Grenier, 2022; Weldrick et al., 2023), social exclusion (Dej, 2020; Fitzpatrick et al., 2011; Gonyea et al., 2010), accelerated aging (Brown et al., 2012; Cohen, 1999), and social stigma (Canham et al., 2022; Kane et al., 2013) are but a few challenges confronted by older people experiencing homelessness. Discrimination, stigmatization, and prejudice based on housing status, now known as homeism, has been described by people with lived experience of homelessness for decades (Otiniano Verissimo et al., 2023) but has only recently been labeled (Canham et al., 2022). Homeism has been shown to negatively affect people experiencing homelessness and likely intersects with other identities and statuses, such as race (Paul et al., 2020). What is less known, however, are the ways in which older people experiencing homelessness may face additional and/or compounding discrimination based on their age—that is, ageism and age-based stereotyping.

Over the past several decades, ageism has remained a key issue in gerontology. Ageism, a term originally coined and popularized by Robert Butler (1969, 1975, 1989), has traditionally been defined as a “process of systematic stereotyping or discrimination against people because they are old, just as racism and sexism accomplish with skin colour and gender” (Butler, 1975, p. 12). Butler’s efforts to label age-based discrimination have generated critical dialogue and served as a call to action for older people at the receiving end of these attitudes. This foundational work also spurred research and education related to ageism and the ways in which it could be countered (Achenbaum, 2015). Butler notably predicted that ageism was not going to be solved overnight, stating that “age-ism might parallel racism as the great issue of the next 20 to 30 years” (Butler, 1969, p. 246). Although progress has been made in terms of research, policy, and activism, ageism remains a prevalent form of discrimination and stereotyping more than 50 years after this statement was made (Burnes et al., 2019; São José et al., 2019).

Advancements in knowledge on various levels of ageism have shed light on the experiences and perceptions of ageism across a wide range of older individuals and groups. Gendered experiences of ageism, specifically older women’s experiences of ageism, have been examined (Krekula et al., 2018; Rosenthal, 1990, 2014), as well as intersections of ageism, race, and ethnicity (Parsons et al., 2021; Taylor & Richards, 2019; Yang & Levkoff, 2005). Advancements have also been made in conceptualizing, defining, and measuring types of ageism (Achenbaum, 2015; Iversen et al., 2009) including institutional ageism (Gullette, 2010a, 2010b) and implicit and internalized ageism (Levy, 1999, 2001, 2003). Interventions and educational efforts to combat ageism have also been documented. For instance, global organizations (e.g., the United Nations), national campaigns, and community-based initiatives educate people of all ages about the harms of ageist beliefs and practices (Levy et al., 2022). These contributions build upon Butler’s formative works and have legitimized ageism as a form of discrimination worthy of scholarly, practical, and policy responses.

Despite advances in ageism scholarship, there continue to be calls for intersectional examinations of ageism among minority groups and across older people facing multiple exclusions (Krekula et al., 2018; Levy et al., 2022). Although edited collections have highlighted the wide diversity in experiences of ageism (see Ayalon & Tesch-Roemer, 2018; Levy & Macdonald, 2016), gaps remain. Notably, next to no research has explicitly considered ageism among older people experiencing homelessness. We, therefore, have outlined a brief but critical argument for the necessity of addressing ageism toward persons experiencing homelessness in later life. In this Forum piece, we problematize the existing gaps in policy, practice, and research and provide recommendations to initiate action and move scholarship forward through targeted research and investigation on the topic.

Intersections of Ageism and Homelessness

Though limited research has considered experiences of ageism among older people experiencing homelessness, we summarize evidence from the scholarly literature in alignment with Bronfenbrenner’s (1979) socioecological levels: intrapersonal, interpersonal, institutional/community, and societal/structural ageism.

Intrapersonal Ageism and Homelessness

Intrapersonal ageism refers to ageism experienced at the individual level and can include internalized ageism or age-based stereotypes directed toward the self (de São José & Amado, 2017; Levy, 2001). It has been linked to adverse mental health and cognitive decline (Levy et al., 2014, 2018). Little research has directly considered internalized ageism among older people experiencing homelessness. However, this form of ageism was identified in a qualitative study of older people experiencing homelessness in which Burns and colleagues (Burns et al., 2018) found that older shelter users displayed internalized ageism. A gendered element to this internalized ageism was noted whereby older male participants were more likely to report self-criticism by framing they are becoming homeless as a personal failure, while older female participants were more likely to fear burdening their family and those around them. For both genders in this study, internalized stigma contributed to hesitance to seek support and services (Burns et al., 2018).

Interpersonal Ageism and Homelessness

Ageism at the interpersonal level includes discriminatory or prejudiced interactions between individuals based on age, including both verbal and nonverbal interactions (Braithwaite, 2002), and can include ageist microaggressions, such as infantilizing or subtle derogatory language (Gendron et al., 2015). Interpersonal ageism directed toward older people experiencing homelessness has been described within service settings, such as emergency shelters and day centers, where older clients have reported being victimized by younger shelter users based on their older age (Canham et al., 2020; Gonyea et al., 2010). Similarly, older users of homeless drop-in and day centers have reported violence and intimidation from younger service users (Crane & Warnes, 1997). This victimization constitutes a form of interpersonal ageism as older adults are targeted because of their age. When attempting to secure housing, both older adults (Spencer, 2009) and people experiencing homelessness (Canham et al., 2018) can face discrimination, hesitance, and denial from landlords, suggesting that older people experiencing homelessness are more likely to face additional barriers to exiting homelessness.

Within health care settings, several studies have documented interpersonal stigmatization and prejudice toward older people experiencing homelessness. Canham and colleagues (2018) found that when attempting to access medical care, older people experiencing homelessness felt stigmatized by healthcare providers, including physicians, with participants noting that some general practitioners do not provide care to patients with complex health or comorbid mental and physical conditions. Another study of people aged 50 years and older who had experienced chronic homelessness found that participants experienced significant barriers to healthcare linked to long wait lists, prohibitive costs, and asking for but not receiving help (Milaney et al., 2020). Based on these findings, the authors suggest that future research should consider the role of age-based prejudice in instances of service or care denial (Milaney et al., 2020).

Institutional/Community Ageism and Homelessness

At the institutional and community levels, ageism can be embedded within policies, practices, and procedures that are discriminatory toward aging or systematically exclude older people from meaningful participation. Institutional ageism has been found in settings such as workplaces, healthcare settings, and legal procedures (World Health Organization, 2021). Ageist policies and practices that affect older people experiencing homelessness have been documented within the homelessness and housing sector, and the community more broadly. Within the homelessness sector, services have long been criticized for prioritizing the needs of and support for younger homeless populations, while neglecting the unique needs of older people. More than two decades ago, Cohen (1999) called attention to this neglect, stating that “public policy focuses implicitly on younger homeless people … or is concerned with social categories in which aging homeless people are subsumed without special notice (disabled persons and veterans, for instance)” (p. 5). The unbalanced support across different sub-populations of homeless service users has likely contributed to the development of policies that disproportionately exclude and disadvantage older people. For example, shelter policies and operational rules that require clients to vacate shelters during daytime hours can disproportionately harm older clients, who, on average, have more health challenges than younger shelter users (Canham et al., 2020; Gonyea et al., 2010). These ageist policies presuppose that shelter users will spend daytime hours seeking or engaged in employment or are physically well enough to navigate life on the street until the shelter re-opens in the evening. Such policies discredit the diverse age-specific needs of older service users and limit safe locations from which older persons experiencing homelessness can work toward health and housing goals.

Within the broader community, older people experiencing homelessness can experience multiple forms of exclusion and hostility, some of which have been linked to ageism. In a study of people aged 50 years and older experiencing homelessness in Seattle, Johnson (2022) found that participants felt “confined” to areas of the city where they were less likely to have negative experiences. These older adults felt restricted to areas where housing and social services and public transit operated and avoided areas where there was a higher chance of being arrested, robbed, or assaulted. Critically, participants felt confined to certain areas because of law enforcement, private businesses, and the overall urban landscape, and described this expulsion in relation to societal perceptions of old age (Johnson, 2022). People experiencing homelessness have long confronted sociospatial confinement linked to discrimination (Doherty et al., 2008), and these findings suggest an added element of age-based discrimination.

Communities have implemented a range of deterrents to prevent unsheltered people from occupying, sleeping, or otherwise spending time in certain places. Further, homelessness has been criminalized to varying degrees (Amster, 2008; Bence & Udvarhelyi, 2013) by policies intended to challenge unsheltered people’s ability to carry out essential daily activities, such as antiloitering policies, or by-laws that prohibit sheltering and sleeping in public places (Foscarinis et al., 1999; Robinson, 2019). Globally, hostile architecture tactics have been implemented in many urban settings (Rosenberger, 2020), including metal spikes used to deter sleeping in doorways or on benches. These designs are often installed under the guise of “crime prevention” (Cozens, 2018), yet functionally serve as obstacles to unsheltered people. Given the accelerated aging and plethora of health challenges among people experiencing homelessness (Brown et al., 2012), hostile architecture may disproportionately harm older people experiencing homelessness as they attend to their basic human needs for resting, sleeping, and eating.

Societal/ Structural Ageism and Homelessness

Last, ageism at the societal/structural level can include both current and historical ideologies that disadvantage or devalue aging and older people and, in doing so, create or sustain macrolevel inequities and power differentials across age groups (Higgs & Gilleard, 2020). Ageist ideologies and negative beliefs about older adults are firmly rooted in many cultures (Kane et al., 2013; McHugh, 2003). Societal or structural ageism can also take the form of broad political, economic, and cultural conditions (e.g., the presence or absence of policies, income support programs, and socialized services) that systematically discriminate older from younger adults (Binstock, 2005). The “pervasive lack of public focus on elder homelessness” (Gonyea et al., 2010), including the limited funding for services and resources that target the specialized needs of diverse older people experiencing homelessness (Grenier et al., 2016; Perl et al., 2018), is suggestive of broader negative societal perceptions. In other words, societal attitudes shape the types and quality of services available for older adults, including those experiencing homelessness. We argue that homeism and negative beliefs, narratives, and stereotypes related to homelessness are likely to compound with ageism to multiply and exclude older adults experiencing homelessness from political agendas and policy initiatives on a large scale. Further, actions taken at institutional or interpersonal levels may directly or indirectly stem from broader political, sociocultural, and economic conditions.

Discussion and Implications

Given the historical neglect of examining the distinct ways in which ageism manifests for older people experiencing homelessness, and the differential exclusions and discrimination when compared to younger people experiencing homelessness or housed older adults, there is an urgent need to improve understanding of these experiences. As described earlier, older people experiencing homelessness are disproportionately confronted with vulnerabilities to interpersonal victimization and violence whereas navigating service systems that have been largely designed for other age groups. These challenges are further exacerbated by the fact that older people experiencing homelessness can face a “double stigma” due to the stigma of being both older and homeless (Burns et al., 2018), and perceptions that they are “dirty, marginally capable, and mentally ill” (Kane et al., 2013, p. 843). This need to understand the intersecting and compounding experiences of discrimination related to both homelessness and age should be recognized not only within the field of gerontology and by aging service providers but also within the housing and homelessness sector. We outline implications for improving conceptual and empirical understandings of ageism faced by older persons experiencing homelessness.

Research Implications

Although significant research has examined experiences of and interventions to reduce ageism in general populations of older adults (Burnes et al., 2019; São José et al., 2019), minimal research offers insight into the intersecting phenomena of ageism and homeism (Burns et al., 2018; Johnson, 2022). Research with the primary aim of investigating the lived experiences of ageism among older persons experiencing homelessness is all but absent, suggesting a need for enhanced conceptual and empirical research on how, why, and for whom homelessness and ageism intersect. For instance, the prevalence of ageism among persons experiencing homelessness, the way it manifests itself, and its consequences require exploration. Pressing questions to improve our understanding of homelessness in later life include: Are older persons experiencing homelessness conferred with more blame/responsibility for their position than younger persons? Is the cognitive decline associated with ageism (Levy et al., 2014, 2018) compounded for older persons experiencing homelessness? What is the role of ageism in the denial of care and services to persons experiencing homelessness or the willingness of older persons to engage in services? Investigations are needed at the intersections of self-stigma and ageism to guide understandings of how power relations and inequities shape pathways out of homelessness, as well as societal, institutional, and individual responses to homelessness (Zufferey, 2016; Zufferey & Parkes, 2019). Given the evidence of age-based rationing of care in other contexts (Binstock, 1994), researchers are urged to investigate the extent to which ageism influences service barriers or care denial experienced by older homelessness persons (Milaney et al., 2020) and the ways in which structural and systemic ageism directly and indirectly govern the availability of age-supportive services. The development of a comprehensive theoretical framework that explicates the multifaceted relationship(s) between ageism and homelessness is critical to inform both research and practice. We have developed a preliminary framework that summarizes current evidence (see Figure 1) with the intention of providing an initial guide for research that can be refined and expanded as future scholarship emerges.

Figure 1.

Intersections of ageism and homelessness for older people experiencing homelessness (OPEH).

Practice Implications

As implicated by prior research with older persons experiencing homelessness (Crawford, 2022; Pope et al., 2020; Weldrick et al., 2022), enhanced trauma-informed and person-centered care training and workplace supports for health, housing, and social service providers could contribute to reductions in bias toward older adults seeking care. While workplace burnout is associated with discrimination toward persons experiencing homelessness (i.e., homeism) (Canham et al., 2022), ­education-based interventions have shown promise in reducing biases and improving attitudes among service providers in the homelessness/housing and aging service sectors (Gallup et al., 2022; Gendron et al., 2021). Moreover, there is a known need for expanded age-friendly shelter/housing options that adequately support the distinct needs of older persons experiencing homelessness (Canham, Humphries, et al., 2022; Canham, Walsh, et al., 2022). Increasing funding and community support for affordable, age-friendly housing developments are integral in creating spaces where older persons experiencing homelessness are free from ageism. Community-based efforts to shift public and self-directed perspectives on homelessness and aging are needed to address negative sociocultural attitudes and norms that contribute to ageism.

Policy Implications

Finally, there are several policy implications. First, given the significant value of including communities that are most affected by planning policies (Aboelata et al., 2011; Jacobs, 2019; Seydel & Huning, 2022), older persons experiencing homelessness should be engaged in the design and implementation of community spaces, housing, and services intended to support their needs. Simultaneously, to minimize the negative impacts of exclusionary policies and practices (e.g., hostile architecture), older persons experiencing homelessness need to be offered a voice during the policy decision-making process. There is also a need for improved policies to prohibit discrimination based on the intersection of age and homeless status. Although there are policies in place that make age discrimination illegal (Lahey, 2010; Macnicol, 2010), these policies are difficult to enforce because acts of stigmatization and discrimination can be subtle and hard to prove (Cohen, 2001; Dennis & Thomas, 2007). Decisionmakers and other stakeholders in the public sector must enhance and clarify antidiscrimination policies to better protect older people experiencing homelessness.

Conclusion

Given the significant gaps in our understanding of the experiences of ageism among older persons experiencing homelessness and how ageism is enacted within different spheres of the housing/homelessness sector, we offer this article as a call to action. First, there is a need for increased research and research funding to understand the experiences and points of intervention. Second, there is a need for age-appropriate services and supports for diverse older adults who are multiply affected by discrimination based on age and homeless status. Third, there is a need for a shift in public perceptions about both aging and homelessness to drive this call for increased research and improved policies and practices. Efforts to address these issues are urgently needed to better support and protect older people experiencing homelessness from the harmful manifestations of the intersectional experiences of ageism and homeism.

Funding

This research was made possible by the Canada Mortgage and Housing Corporation (CMHC) and the Social Sciences and Humanities Research Council (SSHRC) jointly funded Partnership Grant. The opinions and interpretations in this publication are those of the authors and do not necessarily reflect those of CMHC or SSHRC.

Conflict of Interest

None.

Data Availability

The authors do not report data and therefore the preregistration and data availability requirements are not applicable.