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. 2025 Aug;6(8):100745.
doi: 10.1016/j.lanhl.2025.100745. Epub 2025 Aug 21.

Prevalence of frailty and associated socioeconomic factors in people experiencing homelessness in England: cross-sectional secondary analysis of health needs survey data

Jo Dawes  1 , Emmanouil Bagkeris  2 , Kate Walters  3 , Alexandra Burton  4 , Debra Hertzberg  5 , Rachael Frost  6 , Natasha Palipane  3 , Andrew Hayward  7
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Free article

Prevalence of frailty and associated socioeconomic factors in people experiencing homelessness in England: cross-sectional secondary analysis of health needs survey data

Jo Dawes et al. Lancet Healthy Longev. 2025 Aug.
Free article

Abstract

Background: Frailty is a complex health state affecting multiple body systems, resulting in increased vulnerability to health stressors. People experiencing homelessness (PEH) have poorer health, including higher prevalence of frailty, than the general population. This study aimed to calculate prevalence of frailty in PEH in England and explore associated sociodemographic characteristics.

Methods: This cross-sectional, secondary analysis study of health needs data collected from PEH in England created a frailty index by seeking expert input using a modified Delphi method and following published guidance for frailty index construction. Data were collected by Homeless Link in primarily urban areas through in-person, interviewer-administered surveys between 2012 and 2021 in three waves. Participants with data for at least 80% of frailty index variables were included. Descriptive statistics summarised the population. Among participants with sufficient frailty index data, the prevalence of frailty (frailty index scores of 0·25 or more) and pre-frailty (scores between 0·08 and 0·25) was calculated. Associations between frailty and sociodemographic characteristics were explored using multinomial logistic regression (adjusted for age; gender; accommodation at time of survey; engagement in employment, volunteering, and education; and immigration status).

Findings: The study sample included 2288 PEH (2156 [94·2%] aged 18-59 years). Frailty was prevalent in 949 (41·5%) of the study population and pre-frailty in 1001 (43·8%). Frailty was identified in 210 of 789 (26·6%) PEH aged 18-29 years. PEH aged 50-59 years had over eight times higher risk of frailty compared with PEH aged 18-29 years (adjusted risk ratio 8·30, 95% CI 4·86-14·16). Women experiencing homelessness (2·30, 1·57-3·37), and PEH who were not engaged in employment, volunteering, and education (3·05, 1·97-4·71) also had higher risk of frailty than men experiencing homelessness and PEH who were engaged in these activities, respectively. PEH who were not UK nationals had lower risk of frailty than those who were UK nationals (0·20, 0·12-0·33). Sleeping outside conferred a lower likelihood of frailty compared with people who were previously homeless but now housed (0·36, 0·17-0·76). Similar patterns were observed with pre-frailty.

Interpretation: To our knowledge, this is the largest study of frailty in PEH, offering valuable insights into the high levels of non-geriatric frailty in this vulnerable group, and can act as a starting point to guide service development and policy for this population.

Funding: National Institute for Health and Care Research.

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Conflict of interest statement

Declaration of interests KW declares funding from the UK National Institute of Health and Care Research (NIHR) and is an advisory board member for the NIHR Three Schools Prevention Research Programme and School for Public Health Research. JD declares lectureship fees from King's College London and lectureship fees from St George’s, University of London. AH is the UK Health Security Agency National Lead for Inclusion Health. RF declares funding from NIHR, lectureship and marking fees from University College London, and is an Executive Committee member of the British Society of Gerontology. All other authors declare no competing interests.