Understanding the research and real-world evidence around how frailty is managed in people experiencing homelessness by primary care practitioners

PI Title: Natasha Palipane

Co-PI: Cini Bhanu

Lead member: UCL

People experiencing homelessness (PEH) experience higher rates of ill- health and die at a younger age than the general population. Many of these health issues come from long term conditions such as COPD, epilepsy, heart problems and frailty.
Frailty is a specific condition that makes people weaker and less able to handle physical and mental stress. This can lead to frequent falls, difficulty with everyday tasks, more hospital visits and early deaths. Although frailty is usually experienced by older people, our previous research in a homeless hostel, where the average age was 56, found that over half of residents (55%) were frail. This is much higher than among people of the same age who are not homeless.
Despite their serious health needs, very few of these residents were receiving support from adult social care services. This places increased pressure on hostel staff who are not medically trained and often struggle to advocate for support for their clients. Although primary health care professionals are experienced in managing frailty, there are multiple barriers when trying to help PEH. As a result, PEH are not receiving the care they need until they reach crisis point.
Our previous research explored some of the difficulties that primary healthcare professionals face in supporting frail PEH. We found that there are currently no services dedicated to managing this population. Furthermore, the frailty services that do exist are often not appropriate for this population or have referral criteria that will exclude PEH. Designing targeted interventions will be important to improve the health and wellbeing of PEH and reduce health inequalities.

The aim of this study is to understand what community-based interventions could support PEH who are frail or at risk of being frail. To do this, the project will consist of two parts:
1) Review the current research around managing frailty in homeless populations. We will summarise the evidence base to understand what the current literature tells us about how to support PEH with frailty or frailty-associated needs in the primary care setting.
2) We will talk with primary care practitioners to learn how they currently manage frailty in homeless patients and what support they need to improve their care. We’ll use case examples of frail homeless people to explore these challenges.
With this understanding, we will be able to make recommendations for current care and be able to start designing a targeted intervention for frail PEH and testing it.
As well as sharing our project findings with scientific communities, we will also write blog posts and articles to reach frontline homelessness staff and people experiencing homelessness.