Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel

Abstract

Purpose The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data. Design/methodology/approach Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried’s phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England. Findings A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population. Originality/value To the best of authors’ knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH.

The benefits and challenges of embedding specialist palliative care teams within homeless hostels to enhance support and learning: Perspectives from palliative care teams and hostel staff

“…2 Recent research demonstrated that within this population there are extremely high rates of multi-morbidity, frailty and age-related conditions at a young age. 3 These factors contribute to the young average age of death for people experiencing homelessness. 4 – 6 Palliative care involvement from specialists or other health care professionals for this population is rare for a number of reasons, including complexities in identifying who may benefit from palliative care, a lack of appropriate places of care for people with high care and support needs, mental health difficulties and/or addiction issues and the recovery focused nature of many homelessness services.…”

Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data

“…High rates of multimorbidity, defined as the presence of two or more long-term conditions (LTCs) [ 11 ], have been observed in homeless primary care studies previously, with multiple studies finding that over 90% of people experiencing homelessness had more than two LTCs [ 12 , 13 , 14 ]. By comparison, general Australian population figures show that only about a quarter (25.7%) of the population has 2+ LTCs [ 15 ].…”

Frailty as biographical disruption

“…Frailty is not an inevitable consequence of the arrival of old age. Frailty has a multifactorial aetiology that can overlap with the ageing process (Rogans‐Watson et al, 2020). Those experiencing frailty will likely also experience a variety of chronic illnesses such as arthritis, diabetes and Parkinson's disease (Rahman, 2018).…”

“…Those experiencing frailty will likely also experience a variety of chronic illnesses such as arthritis, diabetes and Parkinson's disease (Rahman, 2018). Besides older people, frailty has been described in homeless people (Rogans‐Watson et al, 2020), middle‐aged adults (Petermann‐Rocha et al, 2021) and younger people with HIV (Montaño‐Castellón et al, 2021). While not unique to the ‘very old’ or even the old, its incidence and prevalence increase with age, as people accumulate more deficits that can render them susceptible to frailty (Rockwood & Mitnitski, 2007).…”