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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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Dawes J, Rogans-Watson R, Broderick J. 'You can change your life through sports'-physical activity interventions to improve the health and well-being of adults experiencing homelessness: a mixed-methods systematic review. Br J Sports Med 2024; 58:444-458. [PMID: 38413132 PMCID: PMC11041619 DOI: 10.1136/bjsports-2023-107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Systematically synthesise evidence of physical activity interventions for people experiencing homelessness (PEH). DESIGN Mixed-methods systematic review. DATA SOURCES EMBASE, Web of Science, CINAHL, PubMed (MEDLINE), PsycINFO, SPORTDiscus and Cochrane Library, searched from inception to October 2022. ELIGIBILITY CRITERIA PICO framework: population (quantitative/qualitative studies of PEH from high-income countries); intervention (physical activity); comparison (with/without comparator) and outcome (any health/well-being-related outcome). The risk of bias was assessed using Joanna Briggs Institute critical appraisal tools. RESULTS 3615 records were screened, generating 18 reports (17 studies, 11 qualitative and 6 quantitative (1 randomised controlled trial, 4 quasi-experimental, 1 analytical cross-sectional)) from the UK, USA, Denmark and Australia, including 554 participants (516 PEH, 38 staff). Interventions included soccer (n=7), group exercise (indoor (n=3), outdoor (n=5)) and individual activities (n=2). The risk of bias assessment found study quality to vary; with 6 being high, 6 moderate, 4 low and 1 very low. A mixed-methods synthesis identified physical and mental health benefits. Qualitative evidence highlighted benefits carried into wider life, the challenges of participating and the positive impact of physical activity on addiction. Qualitative and quantitative evidence was aligned demonstrating the mental health benefits of outdoor exercise and increased physical activity from indoor group exercise. Quantitative evidence also suggests improved musculoskeletal health, cardiovascular fitness, postural balance and blood lipid markers (p<0.05). CONCLUSION Qualitative evidence suggests that physical activity interventions for PEH can benefit health and well-being with positive translation to wider life. There was limited positive quantitative evidence, although most was inconclusive. Although the evidence suggests a potential recommendation for physical activity interventions for PEH, results may not be transferable outside high-income countries. Further research is required to determine the effectiveness and optimal programme design.
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Affiliation(s)
- Jo Dawes
- Department of Epidemiology & Public Health, UCL, London, UK
| | | | - Julie Broderick
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Mantell R, Hwang YIJ, Radford K, Perkovic S, Cullen P, Withall A. Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants. Front Public Health 2023; 11:1086215. [PMID: 37006541 PMCID: PMC10061143 DOI: 10.3389/fpubh.2023.1086215] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionOlder 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.MethodsWe conducted a rapid review of primary research papers studying PEH and frailty or frailty-related concepts.ResultsFourteen 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 implicationsPEH 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 IDCRD42022292549.
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Affiliation(s)
- Rhys Mantell
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- *Correspondence: Rhys Mantell
| | - Ye In Jane Hwang
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kylie Radford
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales (UNSW), Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Silvija Perkovic
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Patricia Cullen
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Ngarruwan Ngadju: First Peoples Health and Wellbeing Research Centre, University of Wollongong, Wollongong, NSW, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
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Stubbs JL, Jones AA, Wolfman D, Chan RCY, Vila-Rodriguez F, Vertinsky AT, Heran MK, Su W, Lang DJ, Field TS, Gicas KM, Woodward ML, Thornton AE, Barr AM, Leonova O, MacEwan W, Rauscher A, Honer WG, Panenka WJ. Differential age-associated brain atrophy and white matter changes among homeless and precariously housed individuals compared with the general population. BMJ Neurol Open 2023; 5:e000349. [PMID: 36660541 PMCID: PMC9843194 DOI: 10.1136/bmjno-2022-000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Background Homeless or precariously housed individuals live with poor health and experience premature mortality compared with the general population, yet little is known about age-related brain changes among these individuals. We evaluated whether MRI measures of brain structure are differentially associated with age and selected risk factors among individuals who are homeless or precariously housed compared with a general population sample. Methods We compared T1-weighted and diffusion tensor imaging measures of brain macrostructure and white matter microstructure in a well-characterised sample of 312 precariously housed participants with a publicly available dataset of 382 participants recruited from the general population. We used piecewise and multiple linear regression to examine differential associations between MRI measures and between the samples, and to explore associations with risk factors in the precariously housed sample. Results Compared with the general population sample, older age in the precariously housed sample was associated with more whole-brain atrophy (β=-0.20, p=0.0029), lower whole-brain fractional anisotropy (β=-0.32, p<0.0001) and higher whole-brain mean diffusivity (β=0.69, p<0.0001). Several MRI measures had non-linear associations with age, with further adverse changes after age 35-40 in the precariously housed sample. History of traumatic brain injury, stimulant dependence and heroin dependence was associated with more atrophy or alterations in white matter diffusivity in the precariously housed sample. Conclusions Older age is associated with adverse MRI measures of brain structure among homeless and precariously housed individuals compared with the general population. Education, improvements in care provision and policy may help to reduce the health disparities experienced by these individuals.
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Affiliation(s)
- Jacob L Stubbs
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Andrea A Jones
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Wolfman
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Ryan C Y Chan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,Non-Invasive Neurostimulation Therapies Laboratory, University of British Columbia, Vancouver, BC, Canada
| | | | - Manraj K Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Donna J Lang
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Thalia S Field
- Division of Neurology, University of British Columbia, Vancouver, BC, Canada
| | | | - Melissa L Woodward
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - Allen E Thornton
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Olga Leonova
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - William MacEwan
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Rauscher
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - William G Honer
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
| | - William J Panenka
- Department of Psychaitry, University of British Columbia, Vancouver, BC, Canada,British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada,British Columbia Neuropsychiatry Program, University of British Columbia, Vancouver, BC, Canada
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