Older women's perceptions of the impact of homelessness on their health needs and their ability to access healthcare

Abstract

Objective: This study explored the healthcare needs and barriers to health services in older homeless women in the Perth metropolitan area, Western Australia. Methods: Twenty‐two older women experiencing homelessness completed a questionnaire and semi‐structured interview. Data were analysed using descriptive statistics and thematic analysis. Results: The study highlighted that these women had complex and inter‐related issues that affected their health. The nine major themes that emerged from the interview data consisted of: safe accommodation; financial insecurity; experience of trauma and abuse; stigma, embarrassment and fear of being judged; the health impact of not fulfilling their role as family nurturer; mental health; complex interaction of physical and mental health issues; healthcare costs; and the need for ongoing psychosocial and healthcare support once housed. Conclusion: Provision of safe and secure accommodation is pivotal to women's health, as is the need for greater understanding of the impact of poverty, women's traditional roles, social disconnection and domestic violence, and ongoing access to healthcare and support services. Implications for public health: A structural and systemic approach based on a social determinants of health framework is required to address the health needs of the increasing numbers of older women becoming homeless in this country.

“Just a knife wound this week, nothing too painful”:an ethnographic exploration of how homeless clients attending an urban primary care and addiction service view their own health and healthcare

“…In some instances, this was related to the internalised belief of being beyond help. Other times, in line with previous findings, service users desired targeted help to work through loss and grief [34,35]. One recommended response would be to create space and opportunity for memorial services within housing services or public settings to reduce social exclusion and disenfranchised grief, and provide a form of advocacy [44].…”

“…Mental health concerns are internationally recognised as being of high priority to homeless service users [34][35][36][37][38][39][40][41]. Depression [34][35][36][37][38][39], anxiety [34][35][36], post-traumatic stress [35], and general emotional distress [40] are widespread in homelessness [36].…”

“…Another layer of complexity was added for women we spoke with who -in addition to navigating mental health concerns, fear, and family responsibilities -were dealing with loss of cognitive function due to traumatic injury. Unhoused women internationally have identified the impact of injuries and trauma stemming from domestic violence as their priority health concern [34].…”

“…as have self-identified concerns about sleep [34,41], chronic pain [34,39,60], and loss of both physical and cognitive function due to injuries resulting in/from homelessness [34,39,41]. Encouragingly, service users did not mention cost as a barrier to care as has been noted in other countries [34,47], nor did the issue of food insecurity come up [37,40]. Homelessness is associated with high rates of tobacco smoking [35] and we witnessed a strong reliance on tobacco as a small comfort in the face of stress and sadness.…”

Capital, change and Elsie's Place: Understanding the history of safe accommodation in Australia

“…According to the World Health Organization (2022) 30% of women experience this form of abuse, and the consequences on the wellbeing of women are considerable. Specifically in Australia, DV is the main reason for homelessness among women and children (Australian Institute of Health & Welfare, 2018; Sutherland et al., 2022).…”