A Profiling Study of Physical Function and Performance in Inpatient Adults Experiencing Homelessness at St. James's Hospital

Abstract

Background: Homelessness is a particularly intransient form of social exclusion, which is associated with markedly poor health outcomes. Research has shown that adults who are homeless suffer higher levels of premature mortality and age-related medical conditions compared to the general population. Despite the effect of homelessness on physical health, information on physical function and performance in adults who are homeless is largely unexplored. Methods: This cross-sectional study assessed inpatients of St. James's Hospital who were registered as homeless from November 2018 to May 2019. The following physical performance variables were assessed; functional exercise capacity (six minute walk test), stair-climbing ability (stair climb test), quality of life (EQ5D5L), pain (visual analogue scale), frailty (clinical frailty scale), muscle strength (handgrip dynamometry), loss of skeletal muscle function/sarcopenia (calf circumference), physical performance (short physical performance battery), falls risk (timed up and go), perceptions of physical activity and physiotherapy (open-ended questionnaire). A number of open-ended questions were also asked to ascertain participants' perspective on their physical ability. Results: A total of 65 participants completed some or all of the test battery. Participants were predominately male (n=44, 67.7%) and most used hostel accommodation or were rough sleepers (n=52, 80%). The mean (+/- SD) age was 47 (13.2) years with a range of 23 to 80 years. 24 participants (36.9%) required the use of a mobility aid. Pain reporting was high among participants with over 63% (n=41) reporting at least one area of pain. Falls were common with 53.8% (n=35) reporting at least one fall in the last 6 months. Only 31% (n=20) of participants were able to climb one flight of stairs and 38% (n=25) were able to walk for 6 minutes. The majority (68.3%, n=X) of participants were classified as frail or pre-frail. Participants provided valuable insights highlighting their low physical capacity and their desire to walk. Conclusion: It was found that this sample of individuals who are homeless had complex health needs and extremely low levels of physical fitness and performance. This study proved that carrying out research with this population is feasible as the study participants were both receptive and engaging. Follow on studies should explore suitable rehabilitation interventions for this vulnerable group