Age-related loss of autonomy, residential instability and alcohol use: suggestions to improve intervention and services
Background: Both community resources offering housing programs and public health and social services increasingly encounter people experiencing an age-related loss of autonomy. Through its interactions with other social and health problems, and especially use of alcohol and other substances, this loss of autonomy affects the housing trajectory and all services received. While the delay or absence of adequate care is a major challenge to address, stakeholders and resources remain ill-equipped to adequately support this growing clientele. The research depicted in this presentation aims to identify avenues to improve intervention and service organization.
Methods: As part of a larger collaborative research project, we conducted semi-structured interviews with 28 users of housing programs from community resources (i.e., emergency shelters, transitional housing, residences with support, subsidized private apartments) and 29 stakeholders and service managers in contact with this population in Montréal, Québec, Canada. We carried out a thematic analysis of the content of the transcribed verbatims, in line with the intersectionality approach. In parallel, we led a scoping review of the scientific and grey international literature. Of the 1,623 documents identified, we selected 44 for analysis, focusing on intervention philosophies, service provision and organization.
Results: Participants emphasized the need to facilitate their access to specialized addiction services, especially after hospital discharge or in a post-therapy follow-up. They also mentioned the need to take better account of age-related limitations in the organization of services, including the operating rules of programs and resources, and to provide a larger choice of recreational, employment and volunteer opportunities. The creation of facilities or units dedicated to this aging population was an element shared by both interviews’ participants and the literature, as was the need to create better partnerships between health and social services and community resources. Other essential elements included better staff training related to these users’ complex profiles, and smaller caseloads.
Conclusions: This research highlight several promising avenues to better support this population of aging service users presenting complex needs. Some suggestions are still subjects of debate. For instance, would it be more relevant to create dedicated resources or to provide more resources to ‘regular’ services and programs? Other avenues are more widely accepted. These include the need for better staff training, or for specific corridors between services and expertise. Overall, this study underlines the larger need to mobilize a diversity of players (e.g., health and social services public network, community resources, private partners, concerned persons and service users, researchers, policymakers) to act collectively on the improvement of these services, in the global context of an aging population.
