Impact of a Community-Based Frailty Intervention Among Middle-Aged and Older Prefrail and Frail Homeless Women: A Pilot Randomized Controlled Trial

Abstract

Interventions are needed to address frailty and other behaviors (e.g., drug and alcohol use) among prefrail and frail homeless women (P/FHW). The purpose of this pilot randomized controlled trial (RCT) was to compare the efficacy of a Frailty Intervention (FI) versus a Health Promotion (HP) program among P/FHW (N=32). Structured instruments assessed sociodemographics, individual, situational, health-related, and behavioral factors. While program differences were not statistically significant with the main outcome variables, medium-to-large effect sizes were found in favor of the HP program as it relates to physical and overall frailty, as well as, any drug use, alcohol use, and drug dependency. Based on these findings, it is critical to strengthen the HP program to optimize all domains of frailty (e.g., physical, psychological, and social) and substance use for P/FHW.

Systematic review and meta‐analyses of randomized control trials of the effectiveness of psychosocial interventions for homeless adults

“…The therapy aimed at improving cognitive skills, such as attention, memory, speed of processing and reasoning, and problem solving. The frailty intervention used by Salem et al () aimed to address the physical, psychological and social frailty of homeless women and consisted of six group sessions for health promotion education and nurse case management. Shern et al () used the psychiatric rehabilitation model for homeless persons with severe psychiatric disabilities.…”

“…Five studies reported an adequate method of blinding of participants and personnel and six studies clearly stated blinding of outcome assessors. Attrition bias was low in 13 studies for the following reasons: six studies reported results of intention‐to‐treat analyses (Chang et al, ; Garland et al, ; Guo et al, ; Krabbenborg et al, ; Reback et al, ; Shern et al, ); four studies reported that missing outcome data were unlikely to be related to true outcomes (Himle et al, ; Malte et al, ; Medalia et al, ; Salem et al, ); two studies imputed missing data using appropriate statistical methods (Lester et al, ; Toro et al, ) and missing outcome data were balanced in numbers across groups in one study (Upshur et al, ). Low risk of bias in selective reporting was observed in 11 studies, which reported all expected outcomes.…”

“…Three studies (Guo et al, 2016;Malte et al, 2017;Toro et al, 1997) involved case management programs. The ecologically based treatment used by Guo et al (2016) Regarding outcome variables in the included studies, seven studies assessed substance use behaviours such as substance craving, addiction severity, drug dependency, and drinking status (Chang et al, 2010;Garland et al, 2016;Malte et al, 2017;Reback et al, 2010;Salem et al, 2017;Toro et al, 1997;Upshur et al, 2015). Depression was assessed in five studies (Garland et al, 2016;Guo et al, 2016;Himle et al, 2014;Krabbenborg et al, 2017;Medalia et al, 2017), anxiety in five studies (Chang et al, 2010;Garland et al, 2016;Himle et al, 2014;Krabbenborg et al, 2017;Medalia et al, 2017), mental health status in four studies (Chang et al, 2010;Guo et al, 2016;Malte et al, 2017;Upshur et al, 2015), PTSD symptoms in three studies (Garland et al, 2016;Held & Owens, 2015;Lester et al, 2007), psychological distress in two studies (Medalia et al, 2017;Toro et al, 1997), self-efficacy in two studies (Guo et al, 2016;Toro et al, 1997), and quality of life in two studies (Krabbenborg et al, 2017;Shern et al, 2000).…”

“…distress; stress; Self-efficacy; drinking status Baseline and at 6, 12, 18 months after baselineUpshur et al (2015); USA; Cluster RCT Homeless women with alcohol dependence problem Chronic care intervention: NA Reduction in alcohol; alcohol use consequences; mental and physical health status; housing status Baseline, 3 months after baseline, and immediately at post-intervention Abbreviations: CBT, cognitive-behavioural therapy; PTSD, post-traumatic stress disorder; RCT, randomized controlled trial; NA, not available.TA B L E 1 (Continued)adequate method of blinding of participants and personnel and six studies clearly stated blinding of outcome assessors. Attrition bias was low in 13 studies for the following reasons: six studies reported results of intention-to-treat analyses(Chang et al, 2010;Garland et al, 2016;Guo et al, 2016;Krabbenborg et al, 2017;Reback et al, 2010;Shern et al, 2000); four studies reported that missing outcome data were unlikely to be related to true outcomes(Himle et al, 2014;Malte et al, 2017;Medalia et al, 2017;Salem et al, 2017);…”

Chronic Disease Self-Management Challenges among Rural Women Living with HIV/AIDS in Prakasam, Andhra Pradesh, India: A Qualitative Study

“…45 Based on our most recent qualitative findings in Prakasam and in consideration of our previous research findings, it is critical to incorporate both nurses and community health workers (CHWs) or ASHA to deliver the intervention taking into account the family unit, along with providing food supplementation, the provision of emotional support, and assistance with transportation and health care access. Previous research has utilized a combination of nurses and CHWs in the provision of health services 56,57 ; this cost-effective model can be applied and tailored in a culturally sensitive manner to rural WLHA. The purpose of using this model is to provide self-management support utilizing a health care provider and CHW equivalent, namely ASHA.…”