Community-based interventions for managing frailty among people experiencing homelessness: a systematic review

People experiencing homelessness (PEH) have extremely poor health outcomes including a lower life expectancy [1], high level of chronic illness [2], and a significant rate of frailty [3]. Frailty is “a state of vulnerability to adverse outcomes” marked by progressive decline in physical health and increased risk of adverse health outcomes [4]. Due to the high incidence of poor health generally and frailty specifically in this population, this review aimed to assess existing evidence for the management of frailty in PEH. We conducted a systematic review using a range of terms for ‘homelessness’, ‘frailty’ and ‘community care’ across 7 databases. Search results were deduplicated and first the abstracts then the full texts were screened. Once a study was included, risk of bias was assessed, and data was extracted and analysed using a narrative synthesis approach. An advisory group of people with lived experience of homelessness were consulted at various points in the project. After the screening process, 3 papers were found to meet all the criteria to be included in the review. One was a randomised control trial which tested a frailty health promotion programme and found that participants in the control group (who participated in a general health promotion programme) had better outcomes at 3 months follow up, although these results were not statistically significant [1]. Another was a mixed-method study which reviewed a group exercise and nutrition programme and found minimal, non-statistically significant differences in physical tests among pre/frail participants at follow-up [2]. The final study was a prospective single arm cohort study which found an improvement in a number of measures at 6 months follow up from a residential respite service with a geriatric care model [3]. Our review demonstrates the need for further research into the care of frail PEH, specifically studies with larger sample sizes, longer follow up periods, and interventions that address the unique needs of that population. More qualitative research in particular would help us better understand the challenges of managing frailty in PEH and to develop interventions for this underserved population.