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Review
. 2023 Mar 16:11:1086215.
doi: 10.3389/fpubh.2023.1086215. eCollection 2023.

Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants

Rhys Mantell  1 , Ye In Jane Hwang  1   2 , Kylie Radford  2   3   4 , Silvija Perkovic  1 , Patricia Cullen  1   5   6 , Adrienne Withall  1   2
Affiliations
Review

Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants

Rhys Mantell et al. Front Public Health. .

Abstract

Introduction: Older people experiencing homelessness (PEH) are a rapidly growing population at risk of accelerated aging and the early onset of geriatric conditions. One construct that shows promise in predicting age-related decline is frailty. Better understanding the rates and causes of frailty in PEH may improve understanding of its antecedents, thereby facilitating more targeted health and aged care service interventions. The aim of this study was to conduct a rapid review on the prevalence and determinants of frailty in adult PEH.

Methods: We conducted a rapid review of primary research papers studying PEH and frailty or frailty-related concepts.

Results: Fourteen studies were included, which indicate that frailty presents earlier and at higher rates in PEH than community-dwelling cohorts. A notable difficulty for many aging PEH was early-onset cognitive impairment which was associated with a range of negative functional outcomes. Another recurrent theme was the negative impact that drug and alcohol use and dependence can have on the health of PEH. Further, psychosocial and structural determinants such as loneliness, living in an impoverished neighborhood and being female had statistically significant associations with frailty and functional decline in PEH.

Discussion and implications: PEH in their 40s and 50s can be frail and experience geriatric conditions, including cognitive impairment. Factors that have important relationships to frailty and functional decline in PEH include cognitive deficits, drug and alcohol dependence and loneliness, as well as upstream determinants such as gender and ethnicity. More targeted data and research on these factors, including cohort studies to better investigate their potentially causal effects, is important for researchers and practitioners assessing and treating frailty in PEH, particularly those interested in early intervention and prevention.

Prospero registration id: CRD42022292549.

Keywords: accelerated aging; cognitive impairment; frailty; homelessness; marginalized and vulnerable groups; social determinants of health.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Fried's phenotype model of frailty (13).
Figure 2
Figure 2
The cumulative model of frailty (–16). ADLs, activities of daily living; TBI, traumatic brain injury.
Figure 3
Figure 3
Clinical Frailty Scale (14).
Figure 4
Figure 4
Tilburg Frailty Indicator (TFI) (–20).
Figure 5
Figure 5
PRISMA diagram.
See this image and copyright information in PMC

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