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High levels of frailty among homeless people

More than two-thirds of homeless people accessing healthcare at one of the country's busiest hospitals were classified as frail or pre-frail and fewer than a third were able to climb one flight of stairs.
The research into a sample of homeless people presenting at St James's Hospital in Dublin also found that even though the mean age was 47, one-third of the group was using a walking aid, and more than half of those assessed had had at least one fall in the previous six months.

The research, titled 'A Profiling Study of Physical Function and Performance in Inpatient Adults Experiencing Homelessness at St. James’s Hospital', was written by Sinéad Kiernan, a chartered physiotherapist currently working at St James's. Sinead is studying for a Masters in Research in the Discipline of Physiotherapy, School of Medicine, Trinity College Dublin and the research is part of her Master’s project.

A total of 65 people took part in some or all of a battery of tests, including a six-minute walk test, tests on stair-climbing ability, pain levels, frailty, muscle strength, falls risk and more.
Just over two-thirds of participants were men and the group ranged in age from 23 to 80 years. Most participants (64%) used hostel accommodation and 17% were rough sleepers, while almost 37% used a mobility aid.

"For some participants, their current level of engagement in exercise greatly contrasted with their former exercise habits," the study said. "Interestingly, some participants who no longer exercised previously exercised at a high or even elite level." It quoted one participant, a 41-year-old man who said: "I used to play football for Ireland underage”. Another, a 29-year-old man, said: "In the last 6 months no (exercise), but before that – gym, kickboxing, football”.

According to the study: "Of note, participants had globally poor physical status, irrespective of age or gender. Low physical fitness and function was noted in the younger participants aged between 20 and 30 and was broadly consistent throughout the various age groups. The normal age-related decrements in mobility and physical status did not occur but rather widespread substandard levels of physical fitness and function were observed.

"Low physical activity levels were consistently reported. Prolonged mobility aid use was noted, which underlines an unmet rehabilitation need among this population.

Of those in this study, the majority were smokers, more than half reported consuming excess alcohol and more than one-third admitted to actively using heroin or intravenous drugs.

Many participants had multiple comorbidities, including Hep C and mental health problems.

Almost 70% of participants did not carry out the stair climb test, most claiming they were unable to do so or felt it would be unsafe. Of those that did do the stair climb, a 29-year-old man took the longest at just under 50 seconds.

Pain reporting was high among participants with over 63% reporting at least one area of pain, while 84% of participants reported some level of anxiety and/or depression.
According to the study: "There certainly is an unmet rehabilitation need among homeless individuals."