Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants

Abstract

IntroductionOlder people experiencing homelessness (PEH) are a rapidly growing population at risk of accelerated aging and the early onset of geriatric conditions. One construct that shows promise in predicting age-related decline is frailty. Better understanding the rates and causes of frailty in PEH may improve understanding of its antecedents, thereby facilitating more targeted health and aged care service interventions. The aim of this study was to conduct a rapid review on the prevalence and determinants of frailty in adult PEH.MethodsWe conducted a rapid review of primary research papers studying PEH and frailty or frailty-related concepts.ResultsFourteen studies were included, which indicate that frailty presents earlier and at higher rates in PEH than community-dwelling cohorts. A notable difficulty for many aging PEH was early-onset cognitive impairment which was associated with a range of negative functional outcomes. Another recurrent theme was the negative impact that drug and alcohol use and dependence can have on the health of PEH. Further, psychosocial and structural determinants such as loneliness, living in an impoverished neighborhood and being female had statistically significant associations with frailty and functional decline in PEH.Discussion and implicationsPEH in their 40s and 50s can be frail and experience geriatric conditions, including cognitive impairment. Factors that have important relationships to frailty and functional decline in PEH include cognitive deficits, drug and alcohol dependence and loneliness, as well as upstream determinants such as gender and ethnicity. More targeted data and research on these factors, including cohort studies to better investigate their potentially causal effects, is important for researchers and practitioners assessing and treating frailty in PEH, particularly those interested in early intervention and prevention.Prospero registration IDCRD42022292549.

Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study

“…Our participants echoed the need to include language that empowered OAEH and decreased power differentials between patient and provider. While we limited our OAEH to 50 years and older, unhoused adults seem to have chronic illness even younger than “older adult” age; [ 61 ] thus, these conversations may need to occur with unhoused persons in their 40s. Overall, using a tool to guide a conversation with OAEH was well received by all participants in our study and emphasizes a needed area of focus in both practice and research.…”

Exploring the Role of Rehabilitation Medicine within an Inclusion Health Context: Examining a Population at Risk from Homelessness and Brain Injury in Edinburgh

“…As stated by multiple interviewees, the population of PEH has an extent of multimorbidity usually associated with much older populations; however, unlike the older population, they do not tend to have the same recognition of this among health care professionals. The impact of frailty secondary to multimorbidity has been explored and characterized in other studies [ 36 , 37 ]. Any attempts to improve the health of PEH need to take this into account and will need to be sufficiently holistic to address this.…”

Exploring the Role of Rehabilitation Medicine Within an Inclusion Health Context: Examining a Population at Risk From Homelessness and Brain Injury in Edinburgh

“…As stated by multiple interviewees the population of PEH has an extent of multi-morbidity usually associated with much older populations, however unlike the older population, they do not tend to have the same recognition of this among health care professionals. The impact of frailty secondary to multimorbidity has been explored in other studies [32,33].…”