Very poor physical functioning of people who are homeless

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Trinity study finds homeless people in their 20s, 30s and 40s are physically comparable to those housed in their 70s and 80s

A Trinity College study released today (Monday, May 10, 2021) shows an extremely high burden of physical and mobility issues faced by people who are homeless and admitted for inpatient care at an acute hospital in Dublin. The study found that only a third of the participants could climb the stairs of a hospital and that there was a very common presentation of geriatric conditions such as frailty, falls and the need for a mobility aid on a long-term basis, despite a low median age of participants of 45 years.

The study is published in the journal Scientific reports here: http: // www.nature.com /articles/s41598-021-88590-0

Overall, the study provided visible evidence of accelerated physical aging within this cohort compared to the general population with participants (all homeless and primarily using hostel accommodation or sleeping in la rue) in their 20s, 30s and 40s with poor physical condition and geriatric syndromes comparable to those in their 70s or 80s.

It is widely accepted that homeless adults are in poor health and often require hospital care. The objective of this study, however, was to assess a wide range of variables in physical functioning in order to allow better future planning of the health and accommodation services targeted for this group.

This study collectively assessed this group using a wide range of robust measures of physical functioning, including lower limb physical function, risk of falls, functional capacity, ability to climb stairs, frailty, physical fitness. and grip strength. Notably, many participants could not even complete the simple physical tests due to pain or not feeling well enough.

The study involving 65 people (32.3% female, 66.7% male) was carried out at St James’s Hospital and initiated by the Department of Physiotherapy, Trinity College and the Health Team of inclusion of St James’s Hospital. It was led by Sinead Kiernan, Department of Physiotherapy at St. James Hospital and Researcher Discipline of Physiotherapy, Trinity and first author and led by Dr Cliona Ní Cheallaigh, Senior Inclusion Health Service, St. James’s Hospital and School of Medicine Trinity College.

Most of the participants (64.0%) used a hostel or slept on the street (17%). It has previously been noted that homeless people tend to show up more often for unplanned care – such as going to the emergency room much more often than those who are housed in stable accommodation. Some will need to be admitted to hospital for additional care – and this cohort can constitute a substantial proportion of inpatients in many acute care hospitals at any one time. Some of these patients were referred for physiotherapy and appeared to have very low levels of mobility, but the physical characteristics of this vulnerable group were not well known.

MAIN CONCLUSIONS

    – The majority (83%) of the participants had mobility problems.

    – More than half (54%) of this cohort experienced at least 1 fall in the previous 6 months.

    – Only 31% could attempt to climb a flight of stairs.

    – Only 38% could walk 6 minutes.

    – The majority of participants (70.5%) were frail or pre-frail.

    – A quarter (25%) showed an extremely poor balance

Dr. Julie Broderick, Principal Investigator and Assistant Professor, Discipline of Physiotherapy, Trinity College said:

“In our study, we found that the overall physical and mobility levels of participants who were homeless in their 20s, 30s and 40s were comparable to levels we would expect to see in people housed stably in their 70s or 80s. The enormous physical burden suffered by this group who mainly used hostels or slept rough is cause for concern. Besides other complex needs, mobility, strength and fitness levels should be targeted in this group to avoid further deterioration. prevention strategies are also needed. Accommodation services for homeless people must be adapted and accessible to people with low mobility. “

RECOMMENDATIONS

It is established that many homeless people experience problems associated with addiction and complex mental health, but physical and mobility limitations also deserve greater consideration. The Trinity research team suggests that medical and rehabilitation services are needed to target these limitations, as some may be reversible with appropriate physiotherapy services. Physiotherapy and other physical rehabilitation services are a priority for this group.

Appropriate community and outreach services are also needed, as continued support is likely to be needed after discharge from hospital. Specific community-based referral services are also needed.

Finally, the research team recommends that the housing policy meet the physical health needs of homeless people with housing and accommodation services designed with accessibility in mind.

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