Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review

Abstract

Background: older people experiencing homelessness can have mental and physical indicators of aging several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Digital interventions could positively impact the health and well-being of homeless people. However, increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation warranting further research. Few studies have synthesized available literature on digital interventions for older people experiencing homelessness.

Objective: This scoping review examined the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them.

Methods: The scoping review followed Arksey and O'Malley's proposed methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and recent Joanna Briggs Institute guidelines. We searched 14 databases. Gray literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis.

Results: A total of 19,915 records were identified through database and gray literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined a participant age group of >50 years or a mean participant age of >50 years. A total of 9 of 10 studies were published in the United States. The study design included descriptive studies, uncontrolled pilot studies, and pilot randomized controlled trials. No studies aimed to deliver an intervention exclusively to older people experiencing homelessness or organizations that supported them. Four types of intervention were identified: telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion, and cognitive behavioral therapy. Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness, and all 10 studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion, such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organizational and peer support.

Conclusions: Our findings highlight a paucity of evaluated digital interventions targeted at older people experiencing homelessness. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for older people experiencing homelessness. Further research on digital interventions that provide services and support older people experiencing homelessness is required. Future interventions must address the barriers older people experiencing homelessness face when accessing digital technology with the input of those with lived experience of homelessness.

Trial registration: OSF Registries OSF.IO/7QGTY; https://doi.org/10.17605/OSF.IO/7QGTY.

Keywords: aging; databases; digital exclusion; digital intervention; ehealth; elderly; homeless; homelessness; indicators; mhealth; older people; premature mortality; rough sleeping; scoping review; systematic scoping review; technology; telehealth; thematic analysis.

Figure 1

PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flow diagram for the identification of studies via databases [25]. OECD: Organization for Economic Co-operation and Development; PEH: people experiencing homelessness.

Figure 2

Summary of the 10 digital interventions included in this review. Interventions were categorized into implementing telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminder interventions, and 4 interventions delivered digitally. CBT: cognitive behavioral therapy.