Frailty Assessment of Urban Homeless Adults

Transcription

1 Frailty Assessment of Urban Homeless Adults Creighton University College of Nursing Lori Rusch PhD RN, Cindy Hadenfeldt EdD RN, Kathy Flecky OTR/OTD, Alex Hall MA, Jenna Woster PhD RN, Pat Nilsson MSN RN Objectives Upon completion of this presentation, participants will be able to: 1) Describe unmet health needs of homeless adults. 2) Discuss frailty assessment in a homeless population. 3) Identify relationships between frailty & health indicators. 2 1

2 Needs of Homeless Adults 553,742 individuals were homeless on a single day in the U.S. in By 2050, homeless population will double 2 Approx. 89 million >65 years will be homeless 2 Focus is on daily survival Many unmet health needs 3,4,5 Lack of health care services, lack of social support, environmental instability, & food insecurity 3 3 Frailty in Homeless Adults Frailty has been defined as a: - Decline in multiple physiological systems _ & accumulation of deficits 6,7 Non-specific, multi-dimensional dynamic state of vulnerability & losses 8 - Syndrome of shrinking, weakness, exhaustion, slowness, & decrease in physical activity 9 4 2

3 Frailty Framework for Vulnerable Adults (FFVP) Purpose and Specific Aims The purpose of this study was to describe the physical, psychological, and social components of frailty identified in adults experiencing homelessness. Specific Aims: 1) To determine if the participants in a one-day health and services event for homeless adults scored as frail on a multidimensional frailty assessment tool 2) To determine if health indicators differed between frail & non-frail participants (i.e. physical exhaustion, falls, and hospitalizations) 6 6 3

4 7 Tilburg Frailty Indicator (TFI) Multidimensional measurement of frailty - Established test retest reliability of.79 - Predictive validity for disability, health care utilization - Score of >5 out of 15 classifies as frail - Has been previously used to assess homeless population 8 8 4

5 TFI Determinants of Frailty Have you experienced one or more of the following in the past year? - Death of a loved one - Serious illness of self or loved one - Ending of an intimate relationship - Traffic accident - Crime 9 TFI Components of Frailty Have you experienced problems in your daily life due to: - Physical Difficulty walking, maintaining balance, wt. loss Poor hearing, poor vision, weak hand strength - Psychological Depression, anxiety, difficulty coping, memory loss -Social Living alone, lack of support from others 10 5

6 Characteristics of Sample N=388 - Age Range = years Mean = **Under 50 years = 37% Older than 50 = 63% - Gender Male = 64% Female = 34% - Race White = 56% Black = 26% Hispanic = 11% - Education Middle School = 14% High School Diploma/GED = 76% College education = 10% 11 Characteristics of Sample N=324 (missing data = 64) -1 st time homeless = 134 (41%) -2 nd or 3 rd time homeless = 86 (27%) -4 th time in past 3 years = 28 (9%) - Homeless for 1 year = 76 (23%) - Number residing at a homeless shelter the night prior to PHCO = 325 (84%) 12 6

7 Determinants of Frailty N=388 - Death of a loved one = 142 (37%) - Divorce/ending of relationship = 87 (22%) - Serious illness of self/loved one= 88 (23%) - Experienced a crime = 75 (19%) - Traffic accident = 30 (8%) - 2 or more diseases/chronic health problems = 124 (32%) 13 Components of Frailty - Difficulty walking/balance = 114 (29%) - Poor vision = 222 (57%) - Lack of strength in hands = 92 (24%) - Problems with memory = 102 (26%) - Depression/anxiety = 267 (69%) - Lost a lot of weight unintentionally =72 (19%) - Lack support from other people = 141 (36%) - Scored as frail on TFI = 195 (50%) 14 7

8 Frail vs. Non-frail Statistically Significant Differences - Gender (female) - Age over 50-2 or more chronic diseases - Homeless 1 year - Recent serious illness of self/loved one - Recent divorce or ending of relationship - Reported physical exhaustion* - Hospitalized in past 12 months* - Falls in past 3 months* p<.05 *p< Recommendations Screen homeless people for frailty during health screenings Evaluate & manage chronic diseases with an interprofessional approach Design & implement interventions to prevent or reduce frailty to improve health markers and avoid unnecessary healthcare costs. 16 8

9 Limitations Entire tool was self-report Frailty data was limited to 388 participants not all 542 due to incomplete self-assessment forms Missing Data Frequency of ED visits Co-morbidities 17 Questions & Comments? Thank you for attending! 9

10 References 1 United States Department of Housing and Urban Development, Pointin-Time Count, January Sermons, M.W. & Henry, M. (2010). Demographics of homelessness series: The rising elderly population. 3 Baggett, T.P., O Connell, J. J., Singer, D.E., & Rigotti, N. (2010) The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100, 7, Lebrun-Harris, L.A., Baggett, T.P., Jenkins, D.M., Sri[pipatana, A., Sharma, A.S., Hayashi, A., Daly, C.A., & Ngo-Metzger (2013).Health status and health care experiences among homeless patients in Federally Supported Health Centers, Health Services Research. 5 Zur J. & Jones, E. (2014). Unmet need among homeless and nonhomeless patients served at health care for the homeless programs. Journal of Health Care for the Poor and Underserved, 25, 4, References 6 Gielen, E., Verschueren, S., O Neill, T.W., Pye, S.R., O Connell, M.D.L., Lee, D.M., Ravindrarajah, R. et al. (2012) Musculoskeletal frailty: A geriatric syndrome at the core of fracture occurrence in older age, Calcif Tissue Int., 91: Fulop, T., Larbi, A., Witkowski, J., McElhaney, J., Loeb, M., Mitnitski, A., & Pawelec, G. (2010). Aging, frailty and age-related diseases. Biogerontology, 11, Fried, L.P., Tangen, C. M, Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J. T, Seeman, T., Tracy, R., Kop, W., J., Burke, G., and McBurnie, M.A. (2001). Frailty in older adults: Evidence for a Phenotype, Journal of Geronotology: MEDICAL SCIENCES, 56A, No. 3, M146-M156. Salem, B., Nyamathi, A., Phillips, L., Mentes, J., Sarkisian, C., & Brecht, L. (2014). Identifying frailty among vulnerable populations. Advances in Nursing Sciences, 37(1),

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