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

Association between eGDR and accelerated aging: the mediating role of ePWV

OBJECTIVE

This study examines the association between estimated glucose disposal rate (eGDR) and accelerated aging in middle-aged and older adults, with a focus on the mediating role of estimated pulse wave velocity (ePWV).

METHODS

Data from the 2011 wave of the China Health and Retirement Longitudinal Study (CHARLS) were analyzed, including middle-aged and older participants. Biological age was estimated using the Klemera-Doubal method, and accelerated aging was defined as the difference between biological and chronological age. The eGDR was calculated based on waist circumference, hypertension status, and HbA1c levels, while ePWV was estimated using mean blood pressure and age. Logistic regression models assessed the relationship between baseline eGDR, ePWV, and accelerated aging, adjusting for confounders.

RESULTS

A total of 8,529 participants (mean age 59.31 years) were included. A significant inverse association was found between eGDR and accelerated aging. Participants with the lowest eGDR quartile had an 81% higher risk of accelerated aging compared to those in the highest quartile (OR = 0.19, 95% CI 0.17-0.22, P < 0.001). Mediation analysis showed that ePWV mediated 12.90% of the relationship between eGDR and accelerated aging (95% CI 9.20%-16.60%).

CONCLUSION

Reduced insulin sensitivity, indicated by low eGDR, is a significant risk factor for accelerated aging. Vascular aging, measured by ePWV, mediates part of this relationship. These findings highlight the importance of monitoring insulin sensitivity and vascular health to mitigate aging and age-related health risks.

A Community-Engaged Ethnographic Investigation into Public Transit Among Older Adults Experiencing Homelessness

Nearly 50% of single homeless adults are over the age of 50, and adults aged 50 years and older are the fastest growing subpopulation of the homeless in the U.S. This subpopulation has unique mobility needs and barriers to transportation. We used rapid ethnographic assessments to explore the practices, needs, perceptions, and values of unhoused older adults in relation to their efforts to access and navigate health and social services via public transit. We conducted 23 observations of 12 participants as they navigated public transit to meet their travel needs. Our data consist of 65 h of observations with field notes, walking interviews, and travel diaries. Two themes-waiting and friction-encompassed participants' experiences of mobility and their ongoing negotiations that involved time, space, individual ability, and interpersonal interactions within their environmental context. For this population, attainment of housing and improved health and well-being is contingent on access to reliable transportation-a condition that is not met in many communities. For the participants in our study, the physical demands of accessing public transit combined with the cognitive load of interpreting multi-step directions in specific time schedules were often insurmountable. The public transit system was often hostile, such that participants were stigmatized and segregated. Professionals who work with older homeless individuals must consider the capacity of their clients to successfully navigate public transit, and policymakers should consider the transit needs of their entire population when designing transit systems.

An Intersectional Perspective on Digital Health: Longitudinal Narratives and Observations With Older and Middle-Aged Women Experiencing Homelessness

BACKGROUND AND OBJECTIVES

People experiencing homelessness and older people encounter barriers as health and social care services are increasingly delivered online, however, there is limited knowledge about how this relates to older and middle-aged women experiencing homelessness, especially those from minoritized and/or migrant communities. We aimed to explore how technology, including digital health, can help or hinder older and middle-aged women to navigate paths through and out of homelessness.

RESEARCH DESIGN AND METHODS

This 16-month qualitative longitudinal study utilized narrative interviews and participant observations with seven older and two middle-aged women experiencing homelessness, in London, England. Additionally, we observed interactions between the women experiencing homelessness and 2 information and communications technology class facilitators. We collected and analyzed data using a narrative, interpretative approach. An advisory board of women with lived experiences of homelessness supported the interpretation of findings and development of practice and policy recommendations.

RESULTS

We present our findings as 3 composite narrative vignettes co-constructed with the participants: (1) "No, I'm not taking this telephone appointment"; (2) "Technology doesn't judge you"; and (3) "You have to be a digital person now." The findings illuminate determinants of digital health equity related to aging, gender, and migration status among older and middle-aged women experiencing homelessness.

DISCUSSION AND IMPLICATIONS

Using an intersectional lens, we provide recommendations about how to better align digital health to the needs of older and middle-aged women experiencing homelessness. The findings will inform intervention development.

How Are Dehumanizing Perceptions of Homelessness Associated With Age?

BACKGROUND AND OBJECTIVES

Increasing numbers of unhoused older individuals in the United States underscores the urgency for tailored services and support. Previous studies demonstrate prevalent negative attitudes and dehumanizing perceptions toward unhoused people. Additionally, past research highlights the influence of ageism and dehumanization on the care older adults receive. However, limited work addresses the layered dehumanization faced by unhoused aging individuals. This study investigated how dehumanizing perceptions of homelessness were associated with age.

RESEARCH DESIGN AND METHODS

In this experimental study, participants (N = 399; Mage = 23) were randomly assigned to scenarios depicting unhoused individuals who were discernibly either older or younger. Participants were prompted with different empathy tasks and assessed on dehumanization levels.

RESULTS

Results revealed older unhoused individuals faced significantly higher levels of dehumanization compared to their younger counterparts. Findings also indicated that older participants and male participants demonstrated stronger dehumanization toward unhoused adults.

DISCUSSION AND IMPLICATIONS

Dehumanization may be intensified for unhoused aging individuals due to their intersecting identities. In turn, this may affect willingness to provide care and the quality of services offered, impacting care settings, medical facilities, and policies focused on homelessness. This research sheds light on the complexities of dehumanization, emphasizing the urgency to address these linked biases to create more inclusive and supportive environments for unhoused aging individuals.

Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review

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.

Early Recognition of Loneliness and Frailty in Relation to Chronic Disease Self-Management: A Quantitative Cross-Sectional Study

BACKGROUND

Chronic disease significantly influences mental health, identity, and self-esteem. It is deeply interconnected with loneliness, frailty, stress, mental health, and the ageing process, forming a complex and interrelated dynamic. The aim was to find an association between loneliness, frailty, mental health, and the patient's self-management.

METHODS

A cross-sectional study was conducted between October 2023 and May 2024. A total of 605 patients with chronic disease took part in the research, of whom 67% were female and 33% were male. In total, 71% of participating patients lived in a home environment, and 19% lived in retirement homes.

RESULTS

605 respondents with chronic disease participated in the study and were recruited using a purposive sampling method. Participants were drawn from healthcare settings, including primary care centres, outpatient clinics, and nursing homes, to increase representativeness. The study achieved a response rate of 55% after distributing 1100 questionnaires. Data were analysed with SPSS Statistics 25.0 using descriptive and inferential statistical methods, including non-parametric tests (Kruskal-Wallis test, Mann-Whitney U test) and Spearman's correlation. The main results showed that patients who self-rated their chronic disease as well- or very well-managed (81%) were less frail (p < 0.001), less lonely (p < 0.001), and had better mental health (p = 0.015). Significant associations were found between frailty, loneliness (rs = 0.428, p < 0.001), and lower mental health (rs = 0.185, p < 0.001). In addition, frequent social contact was associated with lower frailty and loneliness (p < 0.001).

CONCLUSIONS

Without adequate assessment and support from the healthcare system, patients may face challenges in meeting their needs, which can contribute to loneliness, frailty, and mental health decline. It is crucial to acknowledge that every individual with a chronic disease, regardless of age, education level, or condition, must actively participate in managing their chronic disease. Recognising the importance of self-management and its impact on mental health is essential to mitigating the negative effects of chronic disease on a patient's quality of life.

Housing insecurity pathways to physiological and epigenetic manifestations of health among aging adults: a conceptual model

Introduction

Housing insecurity is a social determinant of health, as evidenced by its associations with mental, physical, and biological outcomes. The scientific understanding of the mechanisms by which housing insecurity is associated with health is still limited. This review adapts existing stress process models to propose a conceptual model illustrating potential pathways linking the specific stressor of housing insecurity to physiological and epigenetic manifestations of stress among aging adults.

Methods

This narrative review examines literature across multiple fields, including public health, psychology, and sociology. The literature selected for this review was identified through scientific databases including Web of Science, PubMed, JSTOR, and Google Scholar; primarily peer-reviewed empirical studies, literature reviews, and research reports published in English between 1981 and 2024; and principally based in the United States context. A synthesis of this literature is presented in a proposed conceptual model.

Results

The literature supports the existence of two main predictors of housing insecurity: sociodemographic characteristics and the historical/current context. The main mediating pathways between housing insecurity and manifestations of stress include health behaviors, psychosocial resources, and structural resources. Moderating factors affecting the associations between housing insecurity and manifestations of stress include government assistance, chronic discrimination/unfair treatment, and individual differences. These interdependent mediating and moderating mechanisms affect stressor reactivity, a proximal manifestation of stress, which contributes to the physiological and epigenetic distal manifestations of stress in aging adults.

Discussion and implications

The prevalence of housing insecurity among aging adults is growing in the United States, with significant implications for public health and health disparities, given the growing percentage of aging adults in the population. Further empirical testing of the mediating and moderating mechanisms proposed in the conceptual model will elucidate how housing insecurity is connected to health and provide insight into preventive strategies to ameliorate the adverse effects of housing insecurity on biological health among aging adults.

Health Deficits Among People Experiencing Homelessness in an Australian Capital City: An Observational Study

People experiencing, or at risk of, homelessness face challenges that result in poorer health outcomes compared to those in stable housing. This study provides the results of over 40 health measures that capture the health status of a group of people in temporary accommodation due to experiencing homelessness, aged 22 to 84 years, in an inner-city location, invited to participate in a comprehensive assessment of physical and psychological health. Evidence of accelerated ageing was found, with 44.2% of people being clinically frail, 63% having poor functional movement, and 36% having pain associated with oral health. Additionally, 90.6% of participants showed health risks due to nutritional deficiencies, over half reported poor sleep quality, 55.3% reported having psychological distress, and almost half reported fair or poor overall dental health. This study suggests a pathway to providing a relatively easily implemented series of health assessments to help respond to a group of underlying causes for accelerated ageing among a group of inner-city people experiencing homelessness. This work can be used to inform the prioritisation and development of community-based health services to address functional deficits that may contribute to accelerated ageing.

Examining the risk of delirium in patients hospitalized with COVID-19: Insights from the homeless population

For patients hospitalized with COVID-19, delirium is a serious and under-recognized complication, and people experiencing homelessness (PEH) may be at greater risk. This retrospective cohort study compared delirium-associated risk factors and clinical outcomes between PEH and non-PEH. This study used patient records from 154 hospitals discharged from 2020-2021 from the Texas Inpatient Public Use Data file. Study subjects (n = 878) were patients, aged 18-69 years, who were hospitalized with COVID-19 and were identified as homeless. The baseline group included (n = 176,518) patients with COVID-19 aged 18-69 years who were not homeless. Logistic regression models were used to identify risk factors for delirium. Relevant risk factors included chronic comorbidities, substance use disorders, and traumatic brain injury (TBI). Seven of the delirium-associated risk factors were more prevalent among PEH compared to baseline. PEH had higher rates of TBI, alcohol, cannabis, and opioid use disorders. PEH had significantly higher rates of delirium (10.6% vs. 8.1%; P<0.01). However, PEH had fewer respiratory complications, including pneumonia (48.5% vs. 81.9%; P<0.001) and respiratory failure (28.7% vs. 61.9%; P<0.001), and lower in-hospital mortality (3.3% vs. 9.5%; P<0.001). The anti-viral Remdesivir had a protective effect against delirium (AOR = 0.63; CI: 0.60, 0.66). Mean hospital length of stay (LOS) was more than twice as long for delirious patients compared with non-delirious patients (18.4 days vs. 7.7 days; P<0.001). Delirium greatly increased the risk of in-hospital mortality (AOR = 3.8; CI: 3.6, 4.0). For PEH (n = 29) who died from COVID-19, delirium was present in more than half (52%) of cases. Hospitals should screen PEH for delirium and adopt nursing protocols to prevent delirium and reduce its severity.

Health Status of People Who Are and Are Not Experiencing Homelessness: Opportunities for Improvement

This study assessed the physical and psychological health parameters of adults experiencing homelessness to inform the development and delivery of health services by comparing with a housed population in the same South Australian city. Adults experiencing homelessness, known to existing support services, were invited to participate in a comprehensive assessment of their physical and mental health using questionnaires and objective assessments. Descriptive analyses using the percentage of participants failing to attain recommended published thresholds and accumulated health deficits for 16 health assessments were compared for the young group of people experiencing homelessness (18-40 years), the middle aged and older people experiencing homelessness (40-75 years), and a housed population of the middle aged and older people (40-75 years). Those experiencing homelessness had multiple and potentially inter-related health deficits compared with a population of people not experiencing homelessness in the same city. They were significantly less likely to meet healthy population norms for clinical frailty (p < 0.001), psychological distress (p < 0.001), grip strength (p < 0.001), lung function (p < 0.001), sleep quality (p < 0.001), and pelvic floor bother (p = 0.002). Significantly more accumulated health deficits were found for people experiencing homelessness when compared with the same ages for those who were not (mean 6.5 (SD 2.4) compared with 5.0 (SD 2.1)). This considerably increased for people experiencing homelessness aged less than 40 years (mean 8.7 (1.7)). Priorities for health service provision for people of different ages experiencing homelessness, when compared with housed community dwellers, have been described. The provision of targeted health assessments and service provision that specifically address healthcare needs among people experiencing homelessness are likely to have the biggest impacts across multiple health domains.

Unhoused and Injured: Injury Characteristics and Outcomes in Unhoused Trauma Patients

INTRODUCTION

The unhoused population is known to be at high risk for traumatic injury. However, there are scarce data regarding injury patterns and outcomes for this patient group. This study aims to investigate any differences in injury characteristics and hospital outcomes between unhoused and housed patients presenting with traumatic injuries.

METHODS

We conducted a 3-y retrospective cohort study at a level 1 trauma center in a metropolitan area with a large unhoused population. All adult trauma patients who were identified as unhoused or housed underinsured (HUI) were included in the study. Injury characteristics, comorbidities, and hospital outcomes were compared between the two groups.

RESULTS

A total of 8450 patients were identified, of which 7.5% were unhoused. Compared to HUI patients, unhoused patients were more likely to sustain minor injuries (65.2% versus 59.1%, P = 0.003) and more likely to be injured by assault (17.9% versus 12.4%, P < 0.001), stab wound (17.7% versus 10.8%, P < 0.001), and automobile versus pedestrian or bike (21.0% versus 15.8% P < 0.001). We found that unhoused patients had higher odds of mortality (adjusted odds ratio [AOR]: 1.93, 95% confidence interval [CI]: 1.10-3.36, P = 0.021), brain death (AOR: 5.40, 95% CI: 2.11-13.83, P < 0.001), bacteremia/sepsis (AOR: 4.36, 95% CI: 1.20-15.81, P = 0.025), and increased hospital length of stay (regression coefficient: 0.08, 95% CI: 0.03-0.12, P = 0.003).

CONCLUSIONS

This study observed significant disparities in injury characteristics and hospital outcomes between the unhoused and HUI groups. Our results suggest that these disparities are impacted by social determinants of health unique to the unhoused population.

Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study

BACKGROUND

Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH.

METHODS

We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: "SICG interpretation" and "SICG feedback". For providers, we used domains from the Toolkit of Adaptation Approaches: "collaborative working", "team", "endorsement", "materials", "messages", and "delivery". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement.

RESULTS

The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses' and social workers' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations.

CONCLUSIONS

The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.

Exploring the Role of Rehabilitation Medicine within an Inclusion Health Context: Examining a Population at Risk from Homelessness and Brain Injury in Edinburgh

People experiencing homelessness are at risk from a number of comorbidities, including traumatic brain injury, mental health disorders, and various infections. Little is known about the rehabilitation needs of this population. This study took advantage of unique access to a specialist access GP practice for people experiencing homelessness and a local inclusion health initiative to explore the five-year period prevalence of these conditions in a population of people experiencing homelessness through electronic case record searches and to identify barriers and facilitators to healthcare provision for this population in the context of an interdisciplinary and multispecialist inclusion health team through semi-structured interviews with staff working in primary and secondary care who interact with this population. The five-year period prevalence of TBI, infections, and mental health disorders was 9.5%, 4%, and 22.8%, respectively. Of those who had suffered a brain injury, only three had accessed rehabilitation services. Themes from thematic analysis of interviews included the impact of psychological trauma, under-recognition of the needs of people experiencing homelessness, resource scarcity, and the need for collaborative and adaptive approaches. The combination of quantitative and qualitative data suggests a potential role for rehabilitation medicine in inclusion health initiatives.

The Use of Mobile Medical Units for Populations Experiencing Homelessness in the United States: A Scoping Review

With annual point-in-time counts indicating a rise in unsheltered homelessness in the United States, much attention has been paid to how to best provide care to this population. Mobile medical units (MMUs) have been utilized by many programs. However, little is known regarding the evidence behind their effectiveness. A scoping review is conducted of research on MMU provision of medical services for populations experiencing homelessness in the USA to examine the extent and nature of research activity, summarize available evidence, and identify research gaps in the existing literature. Following guidelines for scoping reviews, PubMed and Google Scholar were used to identify an initial 294 papers published from January 1, 1980, to May 1, 2023, using selected keywords, which were distilled to a final set of 50 studies that met eligibility criteria. Eligible articles were defined as those that pertain to the provision of healthcare (inclusive of dental, vision, and specialty services) to populations experiencing homelessness through a MMU in the United States and have been published after peer review. Of the 50 studies in the review, the majority utilized descriptive (40%) or observational methods (36%), with 4 review and 8 controlled studies and no completed randomized controlled trials. Outcome measures utilized by studies include MMU services provided (58%), patient demographics (34%), health outcomes (16%), patient-centered measures (14%), healthcare utilization (10%) and cost analysis (6%). The studies that exist suggest MMUs can facilitate effective treatment of substance use disorders, provision of primary care, and services for severe mental illness among people experiencing homelessness. MMUs have potential to provide community-based healthcare services in settings where homeless populations reside, but the paucity of randomized controlled trials indicates further research is needed to understand if MMUs are more effective than other care delivery models tailored to populations experiencing homelessness.

Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis

BACKGROUND

Cognitive decline in people experiencing homelessness is an increasingly recognised issue. We compared the prevalence of dementia among people experiencing homelessness to housed individuals in the general population and those living in low-income neighbourhoods.

METHODS

We conducted a population-based, cross-sectional, comparative analysis using linked health-care administrative data from Ontario, Canada. We included individuals aged 45 years or older on Jan 1, 2019, who visited hospital-based ambulatory care (eg, emergency department), were hospitalised, or visited a community health centre in 2019; and identified people experiencing homelessness if they had one or more health-care records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained as of Dec 31, 2019, using a validated case definition for Alzheimer's disease and related dementia that was modified to include diagnoses made at a community health centre. Poisson models were used to generate estimates of prevalence. Estimates were compared with Ontarians that accessed any of the same health-care services over the same time, overall (general population group), and among those who were in the lowest quintile of area-based neighbourhood income (low-income group).

FINDINGS

12 863 people experiencing homelessness, 475 544 people in the low-income comparator group, and 2 273 068 people in the general population comparator group were included in the study. Dementia prevalence was 68·7 per 1000 population among people experiencing homelessness, 62·6 per 1000 population in the low-income group, and 51·0 per 1000 population in the general population group. Descriptively, prevalence ratios between people experiencing homelessness and the comparator groups were highest within the ages of 55-64 years and 65-74 years in both sexes, ranging from 2·98 to 5·00. After adjusting for age, sex, geographical location of residence (urban vs rural), and health conditions associated with dementia, the prevalence ratio of dementia among people experiencing homelessness was 1·71 (95% CI 1·60-1·82) compared with the low-income group and 1·90 (1·79-2·03) compared with the general population group.

INTERPRETATION

People experiencing homelessness experience a high burden of dementia compared with housed populations in Ontario. Findings suggest that people experiencing homelessness might experience dementia at younger ages and could benefit from the development of proactive screening and housing interventions.

FUNDING

The Public Health Agency of Canada.

Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults

OBJECTIVE

To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed.

METHOD

Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N  = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities.

RESULTS

Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B  = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F  = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013).

CONCLUSIONS

Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.

Involving people with lived experience of homelessness in palliative and end of life care research: key considerations from experts in the field

BACKGROUND

Co-production of research aims to include people with lived experience of a phenomena throughout the research process. People experiencing homelessness often experience advance ill-health at a young age, yet access palliative care services at a disparately low rate to the level of palliative care need. The voices of people experiencing homelessness are infrequently heard throughout palliative care research, despite the complexities and intricacies of the area.

AIM

To explore the experiences of experts in the field to identify key context considerations for involving people with lived experience of homelessness in palliative and end of life care research.

METHODS

Qualitative study comprising two data collection streams: interviews with professionals with experience of involving people experiencing homelessness in their work, and focus groups with people with lived experience (PWLE) of homelessness. Data were analysed using iterative, reflexive thematic analysis. Patient and Public Involvement contributors gave feedback on themes.

RESULTS

A total of 27 participants took part in semi-structured interviews (N = 16; professionals) or focus groups (N = 11; PWLE homelessness). Key considerations of involving people experiencing homelessness in palliative and end of life care research were developed into four key themes: complexity of lived experience of homelessness; representation of homelessness within experts by experience; professionalising lived experience; and methods for involvement.

CONCLUSIONS

Involvement of people with lived experience of homelessness is important in developing palliative care research. This paper begins to outline some contextual considerations for promoting involvement in a complex and intricate field of research.