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
Needs of Homeless Adults 553,742 individuals were homeless on a single day in the U.S. in 2017 1 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
Frailty Framework for Vulnerable Adults (FFVP) 10 5 5 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
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
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
Characteristics of Sample N=388 - Age Range = 18-72 years Mean = 41 + 13 **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
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
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<.0001 15 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
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
References 1 United States Department of Housing and Urban Development, Pointin-Time Count, January 2017. 2 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, 1326-1332. 4 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, 2053-2068. 19 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., 91:161-177 Fulop, T., Larbi, A., Witkowski, J., McElhaney, J., Loeb, M., Mitnitski, A., & Pawelec, G. (2010). Aging, frailty and age-related diseases. Biogerontology, 11, 547-563. 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), 70. 20 10
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