We compared health‐related characteristics between older and younger homeless adults in the four major Dutch cities and showed that, compared to younger homeless adults, older homeless adults more often reported cardiovascular diseases, visual problems, limited social support, and medical hospital use during the past year. Conversely, they less often reported cannabis and excessive alcohol use in the past month and dental and mental healthcare use in the past year. Both older and younger homeless people experienced multiple health problems, but, especially among older homeless people, not all these problems were addressed by healthcare services. Nevertheless, in both age groups, few people expressed unmet health‐related needs.

Consistent with results of previous studies among homeless people, we found that older age was associated with worse physical health (Abdul‐Hamid, 1997; Brown & Steinman, 2013; Garibaldi et al., 2005; Gelberg et al., 1990; Kellogg & Horn, 2012; Kimbler et al., 2017; Nakonezny & Ojeda, 2005; Tompsett et al., 2009) and that about 30 percent of both the older and younger homeless people had elevated levels of psychological distress (DeMallie et al., 1997; Garibaldi et al., 2005) and were screened positive for suspected intellectual disability (Hurstak et al., 2017; Spence, Stevens, & Parks, 2004). Among both older and younger homeless people in our study, levels of substance use were lower than generally reported in studies among homeless populations (DeMallie et al., 1997; Garibaldi et al., 2005; Landefeld et al., 2017; Nielsen et al., 2011; Tompsett et al., 2009). As many as 33.0% and 27.8% of the older participants, compared to 19.6% and 14.6% of the younger participants in our study reported to only rarely or never receive social support from family and friends or acquaintances, respectively. This finding warrants attention, all the more because several studies in other Western, high‐income countries did comparable observations, showing that older homeless people had fewer informal social contacts (Gelberg et al., 1990) and smaller social networks (Tompsett et al., 2009), and stayed in shelters that were further removed from their emergency contacts (Kimbler et al., 2017) than younger homeless people. Moreover, lack of social support has found to be predictive of new episodes of homelessness (Duchesne & Rothwell, 2016).

We found several differences in healthcare service use between older and younger participants. Compared to younger participants, older participants reported more use of medical hospital care in the past year. Remarkably, despite reporting similar and even higher levels of dental and mental health problems, they reported relatively less use of dental and mental healthcare services, respectively. Also in exploratory statistical models, these age differences in healthcare service use could not be explained by the prevalence of corresponding health problems. Indirectly, a comparable association was observed between social support and use of social and mental healthcare services: while older homeless participants reported more social problems, they did not use more social or mental healthcare services than younger homeless participants. These distinct age‐related patterns of healthcare service use may thus indicate that older homeless people are less inclined than younger homeless people to use non‐acute and/ or preventive care. This interpretation is supported by an American study that showed that older homeless people, while suffering from more diseases, were less likely to seek out‐of‐hospital care than younger homeless people (Gelberg, Andersen, & Leake, 2000).

Despite multiple health problems, both older and younger homeless participants in this study expressed few unmet health‐related needs. Furthermore, rather than reporting that their needs had been met, in most health domains, the vast majority of participants reported no needs at all. These results are noteworthy, as they do not seem to match the finding that health problems of especially the older participants were not always addressed by healthcare services.

Our study thus suggests that among homeless people, there is a mismatch between health problems on the one hand, and healthcare service use and expressed health‐related needs on the other hand. This mismatch seemed to be more pronounced among older participants, who reported more health problems but less use of non‐acute, preventive healthcare services and (slightly) fewer health‐related needs than younger participants. Possibly, having become used to certain health problems or perceiving them as untreatable or normal for their age interfered with expressing needs and seeking healthcare services among especially the older participants in our study. The observed discrepancies might also be explained by competing priorities and hierarchy of needs in multiple care domains. Indeed, in the CODA‐G4 cohort, as well as in two other studies assessing needs among older and younger homeless people, participants reported considerably more needs in domains of housing and residential care, finance and/ or work than in domains of health (Abdul‐Hamid, 1997; Garibaldi et al., 2005; Van Straaten et al., 2017). Also, homeless people have been shown to make less use of non‐acute medical services as levels of competing subsistence priorities increase (Gelberg, Gallagher, Andersen, & Koegel, 1997).