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Kennedy F, Ní Cheallaigh C, Romero-Ortuno R, Doyle SL, Broderick J. Outcomes of the LEAP feasibility trial-A low-threshold, exercise programme with protein supplementation to target frailty and poor physical functioning in people experiencing homelessness and addiction issues. PLoS One 2024; 19:e0301926. [PMID: 38820432 PMCID: PMC11142616 DOI: 10.1371/journal.pone.0301926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/25/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND People experiencing homelessness are more likely to experience poor health with physical functioning deficits and frailty commonly reported. It is not well known how strategies to target physical functioning deficits and frailty work in practice in this group. The primary aim of this study was to explore the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, programme feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in effectiveness outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition. METHOD This prospective single-arm study evaluated the feasibility of a 16-week rolling, low-threshold, 'drop-in' once weekly exercise programme with protein supplementation. The main recruitment site was a day-service centre for people who are homeless. Feasibility was assessed by the recruitment and retention rates, adherence to the exercise sessions and protein supplement as well as adverse effects, programme feedback and evaluation of characteristics of non-returners, sporadic (≤50% of available sessions) and frequent attenders (≥50% of available sessions). Effectiveness outcomes included pain (Visual Analogue Scale), physical functioning and performance (hand-grip dynamometry, limb circumference, the Short Physical Performance Battery), frailty (SHARE-FI and Clinical Frailty Scale) and nutritional status (Mini Nutritional Assessment). RESULTS Thirty-one participants were recruited mean (SD) age 45(16) years. There was a recruitment rate of a median (IQR) of 2(1-3) new participants per week. The retention rate was 45% (n = 14) to the main recruitment site. Adherence to the exercise sessions and nutritional intervention was 90% and 100% respectively. Three adverse events were recorded during 74 interventions over the 16-week programme. The acceptability of the programme was highlighted in participant feedback. Characteristics of frequent returners (≥50%) were older age, female, more stably housed and more stable in addiction. The programme did not induce any changes in effectiveness outcomes. CONCLUSION The feasibility of this programme was demonstrated. Overall, the programme was well received with higher retention rates in older participants, females, those more stably housed and those stable in addiction. A higher powered, more intense programme is needed to demonstrate programme effectiveness.
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Affiliation(s)
- Fiona Kennedy
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Clíona Ní Cheallaigh
- St James’s Hospital, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological, Health and Sports Sciences, Technological University Dublin, Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Boozary A, Varner C, Laupacis A. Homelessness is a health crisis: why hospitals are resorting to building housing. CMAJ 2024; 196:E666-E667. [PMID: 38772600 PMCID: PMC11104578 DOI: 10.1503/cmaj.240649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Affiliation(s)
- Andrew Boozary
- Dalla Lana School of Public Health (Boozary), University of Toronto, Toronto, Ont.; executive director, Gattuso Centre for Social Medicine (Boozary), University Health Network, Toronto, Ont.; Health and Social Policy (Boozary), University Health Network, Toronto, Ont.; Harvard T.H. Chan School of Public Health (Boozary), Boston, Mass.; deputy editor, CMAJ (Varner); Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine, Sinai Health, Department of Family & Community Medicine (Varner), University of Toronto, Toronto, Ont.; consulting editor, CMAJ (Laupacis)
| | - Catherine Varner
- Dalla Lana School of Public Health (Boozary), University of Toronto, Toronto, Ont.; executive director, Gattuso Centre for Social Medicine (Boozary), University Health Network, Toronto, Ont.; Health and Social Policy (Boozary), University Health Network, Toronto, Ont.; Harvard T.H. Chan School of Public Health (Boozary), Boston, Mass.; deputy editor, CMAJ (Varner); Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine, Sinai Health, Department of Family & Community Medicine (Varner), University of Toronto, Toronto, Ont.; consulting editor, CMAJ (Laupacis)
| | - Andreas Laupacis
- Dalla Lana School of Public Health (Boozary), University of Toronto, Toronto, Ont.; executive director, Gattuso Centre for Social Medicine (Boozary), University Health Network, Toronto, Ont.; Health and Social Policy (Boozary), University Health Network, Toronto, Ont.; Harvard T.H. Chan School of Public Health (Boozary), Boston, Mass.; deputy editor, CMAJ (Varner); Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine, Sinai Health, Department of Family & Community Medicine (Varner), University of Toronto, Toronto, Ont.; consulting editor, CMAJ (Laupacis)
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Arbour M, Fico P, Atwood S, Yu N, Hur L, Srinivasan M, Gitomer R. Primary Care-Based Housing Program Reduced Outpatient Visits; Patients Reported Mental And Physical Health Benefits. Health Aff (Millwood) 2024; 43:200-208. [PMID: 38315923 DOI: 10.1377/hlthaff.2023.01046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Screening for housing instability has increased as health systems move toward value-based care, but evidence on how health care-based housing interventions affect patient outcomes comes mostly from interventions that address homelessness. In this mixed-methods evaluation of a primary care-based housing program in Boston, Massachusetts, for 1,139 patients with housing-related needs that extend beyond homelessness, we found associations between program participation and health care use. Patients enrolled in the program between October 2018 and March 2021 had 2.5 fewer primary care visits and 3.6 fewer outpatient visits per year compared with those who were not enrolled, including fewer social work, behavioral health, psychiatry, and urgent care visits. Patients in the program who obtained new housing reported mental and physical health benefits, and some expressed having stronger connections to their health care providers. Many patients attributed improvements in mental health to compassionate support provided by the program's housing advocates. Health care-based housing interventions should address the needs of patients facing imminent housing crises. Such interventions hold promise for redressing health inequities and restoring dignity to the connections between historically marginalized patient populations and health care institutions.
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Affiliation(s)
| | | | | | - Na Yu
- Na Yu, Brigham and Women's Hospital
| | - Lynn Hur
- Lynn Hur, Harvard University, Boston, Massachusetts
| | - Maahika Srinivasan
- Maahika Srinivasan, University of Pennsylvania, Philadelphia, Pennsylvania
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Mistry N, Knoeckel J, McBeth L, Johnson A, Bredenberg E, Raffel K, Cunningham J, Sarcone E, Misky G, Stella SA. Prevalence of homelessness among hospitalized patients: A point-in-time survey. J Hosp Med 2024; 19:45-50. [PMID: 38058085 DOI: 10.1002/jhm.13241] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/24/2023] [Accepted: 11/04/2023] [Indexed: 12/08/2023]
Abstract
Although homelessness is associated with increased acute healthcare utilization and poorer health outcomes, the prevalence of homelessness and housing insecurity in hospitalized patients is poorly characterized. We conducted an in-person survey to determine the prevalence of housing insecurity and homelessness among hospitalized patients at two hospitals in metropolitan Denver in conjunction with the Housing and Urban Development point-in-time count on January 24, 2022. Of the 271 surveyed patients, 79 (29.2%) reported experiencing either housing insecurity (17.3%) or homelessness (11.8%). Of those experiencing housing insecurity or homelessness, 69.6% reported chronic health conditions, 55.7% reported multiple hospitalizations in the preceding year, 38% reported mental health concerns and 39.2% reported substance use. The prevalence of homelessness among a hospitalized patient population was over 20-fold higher than community prevalence estimates. Housing insecurity also impacted a substantial proportion of hospitalized patients and was associated with high rates of co-morbid conditions.
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Affiliation(s)
- Neelam Mistry
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Julie Knoeckel
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amanda Johnson
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Erin Bredenberg
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Katie Raffel
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John Cunningham
- Division of Hospital Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ellen Sarcone
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Gregory Misky
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
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Wu J, Fu Y, Chen D, Zhang H, Xue E, Shao J, Tang L, Zhao B, Lai C, Ye Z. Sedentary behavior patterns and the risk of non-communicable diseases and all-cause mortality: A systematic review and meta-analysis. Int J Nurs Stud 2023; 146:104563. [PMID: 37523952 DOI: 10.1016/j.ijnurstu.2023.104563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The association between sedentary behavior and health-related outcomes has been well established, whereas it is inconclusive whether a sedentary behavior pattern is an additional risk factor for health-related outcomes independent of total sedentary time and physical activity. OBJECTIVES To determine sedentary behavior patterns and their association with risks of noncommunicable diseases and all-cause mortality and to assess whether this association is independent of total sedentary time and physical activity. DESIGN This was a systematic review and meta-analysis. METHODS Studies were obtained by searching the Web of Science Core Collection, PubMed/Medline, the Cochrane Library, Embase, CINAHL, and SPORTDiscus up to April 2023. All observational studies published in English or Chinese were included if they explored sedentary behavior patterns and their association with risks of abdominal obesity, metabolic syndrome, diabetes, cardiovascular disease, cancer, and all-cause mortality among individuals who had never experienced the outcome event before the baseline assessment. Data extraction using a standardized form and quality appraisal using two authoritative tools were then performed. All these steps were completed by two independent reviewers from December 2022 to May 2023. If data were sufficiently homogenous, meta-analyses were performed; otherwise, narrative syntheses were employed. Harvest plots were also used to visually represent the distribution of evidence. RESULTS Eighteen studies comprising 11 prospective cohort studies and seven cross-sectional studies were included. The findings suggested that prolonged sedentary time and usual sedentary bout duration were two metrics that reflected the nonlinear dose-response effect of prolonged sedentary behavior patterns. Only extremely high levels of prolonged sedentary behavior patterns significantly increased the risk of adverse health outcomes, independent of physical activity. Whether prolonged sitting was an additional risk factor for adverse health outcomes, independent of total sedentary time, was inconclusive due to an insufficient number of primary studies that included total sedentary time as one of the potential covariates. There was some evidence that supported a sedentary bout that significantly increased the risk of adverse health outcomes was 30-60 min. The threshold of prolonged sedentary time differed with outcomes, and future studies are needed to make this threshold more precise. CONCLUSION A prolonged sedentary behavior pattern was associated with increased risks of several major noncommunicable diseases and all-cause mortality. People, especially those who do not reach the recommended level of moderate-to-vigorous physical activity, are encouraged to interrupt sedentary bouts every 30 to 60 min and limit prolonged sedentary time per day as much as possible. TWEETABLE ABSTRACT Breaking up consecutive sedentary bouts >30 to 60 min and substituting them with brief bouts of physical activity.
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Affiliation(s)
- Jingjie Wu
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Yujia Fu
- The Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Dandan Chen
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang City, Guizhou Province, China
| | - Erxu Xue
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Jing Shao
- The Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Leiwen Tang
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Binyu Zhao
- The Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Chuyang Lai
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China
| | - Zhihong Ye
- Nursing Department, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou City, Zhejiang Province, China.
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Schiffler T, Carmichael C, Smith L, Doñate-Martínez A, Alhambra-Borrás T, Varadé MR, Barrio Cortes J, Kouvari M, Karnaki P, Moudatsou M, Tabaki I, Gil-Salmeron A, Grabovac I. Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study. EClinicalMedicine 2023; 62:102095. [PMID: 37533422 PMCID: PMC10393536 DOI: 10.1016/j.eclinm.2023.102095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Background People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality-outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population. Methods In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach. Findings Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified. Interpretation Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context. Funding This study received funding from the European Union's Horizon 2020 Research and Innovation Programme under GA 965351.
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Affiliation(s)
- Tobias Schiffler
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
| | - Christina Carmichael
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | | | | | - Miguel Rico Varadé
- General Directorate of Social Services, Council of Family, Youth and Social Policy, Community of Madrid, Madrid, Spain
| | - Jaime Barrio Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain
| | - Matina Kouvari
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Pania Karnaki
- Institute of Preventive Medicine, Environmental and Occupational Health Prolepsis, Athens, Greece
| | - Maria Moudatsou
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | - Ioanna Tabaki
- PRAKSIS – Programs of Development, Social Support and Medical Cooperation, Athens, Greece
| | | | - Igor Grabovac
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria
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Liu M, Pridham KF, Jenkinson J, Nisenbaum R, Richard L, Pedersen C, Brown R, Virani S, Ellerington F, Ranieri A, Dada O, To M, Fabreau G, McBrien K, Stergiopoulos V, Palepu A, Hwang S. Navigator programme for hospitalised adults experiencing homelessness: protocol for a pragmatic randomised controlled trial. BMJ Open 2022; 12:e065688. [PMID: 36517099 PMCID: PMC9756200 DOI: 10.1136/bmjopen-2022-065688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION People experiencing homelessness suffer from poor outcomes after hospitalisation due to systemic barriers to care, suboptimal transitions of care, and intersecting health and social burdens. Case management programmes have been shown to improve housing stability, but their effects on broad posthospital outcomes in this population have not been rigorously evaluated. The Navigator Programme is a Critical Time Intervention case management programme that was developed to help homeless patients with their postdischarge needs and to link them with community-based health and social services. This randomised controlled trial examines the impact of the Navigator Programme on posthospital outcomes among adults experiencing homelessness. METHODS AND ANALYSIS This is a pragmatic randomised controlled trial testing the effectiveness of the Navigator Programme at an urban academic teaching hospital and an urban community teaching hospital in Toronto, Canada. Six hundred and forty adults experiencing homelessness who are admitted to the hospital will be randomised to receive support from a Homeless Outreach Counsellor for 90 days after hospital discharge or to usual care. The primary outcome is follow-up with a primary care provider (physician or nurse practitioner) within 14 days of hospital discharge. Secondary outcomes include postdischarge mortality or readmission, number of days in hospital, number of emergency department visits, self-reported care transition quality, and difficulties meeting subsistence needs. Quantitative outcomes are being collected over a 180-day period through linked patient-reported and administrative health data. A parallel mixed-methods process evaluation will be conducted to explore intervention context, implementation and mechanisms of impact. ETHICS AND DISSEMINATION Ethics approval was obtained from the Unity Health Toronto Research Ethics Board. Participants will be required to provide written informed consent. Results of the main trial and process evaluation will be reported in peer-reviewed journals and shared with hospital leadership, community partners and policy makers. TRIAL REGISTRATION NUMBER NCT04961762.
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Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts, USA
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Jesse Jenkinson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Biostatistics, University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rebecca Brown
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sareeha Virani
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Fred Ellerington
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Alyssa Ranieri
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Oluwagbenga Dada
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Matthew To
- Division of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Fabreau
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Family Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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