This research aimed to determine the prevalence of frailty in PEH in England and identify associated factors, such as health behaviours, situational factors and healthcare usage. By using a large, Nation-wide dataset of health survey data collected from PEH, to date, this is the largest scale frailty prevalence study of this often-overlooked population.
Secondary analysis was conducted using cross-sectional, interviewer-led health needs audit data collected from PEH in England between 2015 and 2022. Adults who were homeless at time of survey or in the previous 12-months were included. A frailty index (FI) was created by reviewing survey variables, reaching expert consensus using modified Delphi process, following published guidance for FI creation and comparing with existing published FIs. Input from people with lived experience of homelessness informed this process. Prevalence of frailty was calculated using the FI, with analysis of associations calculated using Chi-square test (for large samples) or Fisher’s Exact tests (smaller samples or lower proportions).
2,288/ 2,679 PEH were included in the analysis, with 93.4% aged 18-59 years, a male-to-female ratio of 3:1, and a predominantly white, heterosexual and UK-national demographic. Prevalence of frailty across whole cohort was 41.5% (39.4, 43.5) and pre-frailty was 43.8% (41.7, 45.8). When stratifying by age, prevalence amongst 18-24-year-olds was 23.0% (19.4, 26.9) frail and 51.9% (47.4, 56.3) pre-frail. Amongst 50-54-year-olds, 56.7% (49.8, 63.4) were frail and 36.9% (30.4, 43.7) were pre-frail. Frailty was associated with health behaviours such as smoking, higher alcohol consumption, and low nutrition (all p0.001). It was also positively associated with situational factors such as incarceration and domestic violence (both p0.001). Healthcare utilisation (visits to General Practitioner, ambulance services, Emergency Department and hospital admission) were greater amongst PEH who were frailer (p0.001).
Prevalence of frailty in PEH is higher than reported in the comparably aged, general population and younger PEH are affected by frailty at levels typically associated with much older adults. This finding is critical, because current frailty interventions are predominantly designed for older, housed populations.
To improve physical wellbeing and reverse frailty, younger homeless individuals may require age-appropriate, targeted interventions in physical activity, nutrition, and addiction support. Physiotherapists, as part of a multi-disciplinary team, are key in providing frailty services. Our profession must adapt to meet the unique health needs of excluded groups like PEH. Strengths of this study include large sample size and robust methods of FI creation. A limitation is the lack of a comparison group.
Homelessness
Primary Care
