Policing, Housing, and Health Outcomes in Older Homeless Adults - Adults 50 and over comprise half of US single homeless adults. Homelessness is associated with high rates of enforcement by the police and other policing agents (e.g., private security, officials conducting forced displacement). Police enforcement includes interactions with the police that could have either positive (e.g., received assistance) and negative (e.g., arrested, harassed) valence. A recent Supreme Court decision (Grants Pass v. Johnson) allows jurisdictions to cite people for sleeping outdoors, increasing the likelihood of police enforcement. Research on the association between police enforcement and health has focused on younger, not older, adults and focused on the impact of incarceration, rather than police enforcement itself. Research on policing has not focused on people experiencing homelessness, nor has it differentiated between different forms of homelessness (unsheltered vs sheltered). There is a knowledge gap about the extent, type of interactions, and association with health outcomes among older homeless adults, and how police enforcement throughout the life course is associated with health outcomes in people experiencing homelessness in late life. To close this gap, we propose to leverage an existing novel cohort of older homeless adults and use the NIA Health Disparities Research Framework to examine the experience of police enforcement over the life course and prospectively, and their association with health outcomes using longitudinal convergent mixed-methods. The Health Outcomes in People Experiencing Homelessness in Older Middle agE “HOPE HOME” cohort, (3AG041860), active since 2013, uses convergent mixed methods to understand the causes, consequences, and solutions to homelessness in older adults. We propose the following specific aims: Aim 1: Examine the association between police enforcement across the life course and current health outcomes in a cohort of 350 older adults with a history of homelessness, using structured interviews and in-depth qualitative interviews. Aim 2: Estimate the incidence, frequency, and severity of police enforcement prospectively, and factors associated with a higher likelihood of negative police enforcement. Aim 3: Examine the relationship between police enforcement, homelessness, and health using longitudinal qualitative methodologies (interviews, ethnography) and key informant interviews. Our experienced interdisciplinary team has a track record of successful collaborations using similar methods. The proposed project will add sections on police enforcement through the life course and currently to the existing HOPE HOME structured interview (Aims 1 and 2); conduct in-depth, life course interviews (Aim 1); and, develop a nested sub-cohort for annual qualitative interviews and conduct ethnographic observations and key informant interviews (Aim 3). We will use convergent mixed-methods strategies to integrate findings from quantitative and qualitative methods. The long-term goal of the proposed study is to inform policies and practices to improve interactions between police and third-party police and older homeless adults, in order to improve health outcomes.
