21 Assessing frailty in people experiencing homelessness: developing and piloting a tool for hostel staff

Abstract

<h3>Introduction</h3> People experiencing homelessness (PEH) often have complex health and support needs, and are often supported by non-clinical hostel staff. Extreme levels of multimorbidity, premature onset of frailty and geriatric conditions at a young age have been observed in this population. Frailty is characterised by issues like reduced muscle strength and fatigue. It is a multidimensional state of vulnerability arising from a complex interplay of biological, cognitive, and social factors. There is growing recognition of the impact of frailty in this population, but it is not consistently recognised or responded to. <h3>Aims</h3> This study aimed to develop and pilot a questionnaire in collaboration with homelessness staff and other experts, to screen for frailty and other health and social care needs among PEH residing in hostels. <h3>Method</h3> Through a consultation process with hostel staff and inclusion health experts, we developed a Frailty and Holistic Needs Questionnaire based on the Edmonton Frail Scale (validated for use by non-clinical staff). We piloted the questionnaire in two hostels, with staff completing the questionnaires with PEH. Staff focus groups explored the acceptability and potential usage of the questionnaire to screen for frailty and advocate for support where needs are identified. <h3>Results</h3> 70 PEH completed the tool with their keyworkers. Over half of responding PEH (54%) were identified as frail and 21% identified as pre frail. Multiple other health issues were also reported. The questionnaire and its completion were viewed positively by staff and PEH, indicating that it may be an acceptable intervention. <h3>Conclusion</h3> The screening questionnaire was a feasible intervention to screen for frailty and other health and social care needs among residents of homeless hotels. <h3>Impact</h3> This intervention has great potential for gathering evidence about health and social care needs to advocate for better access to care for a population that historically struggle to access it.