Abstract
Interventions are needed to address frailty and other behaviors (e.g., drug and alcohol use) among prefrail and frail homeless women (P/FHW). The purpose of this pilot randomized controlled trial (RCT) was to compare the efficacy of a Frailty Intervention (FI) versus a Health Promotion (HP) program among P/FHW (N = 32). Structured instruments assessed sociodemographics, individual, situational, health-related, and behavioral factors. While program differences were not statistically significant with the main outcome variables, medium-to-large effect sizes were found in favor of the HP program as it relates to physical and overall frailty, as well as, any drug use, alcohol use, and drug dependency. Based on these findings, it is critical to strengthen the HP program to optimize all domains of frailty (e.g., physical, psychological, and social) and substance use for P/FHW.
Similar content being viewed by others
References
Brown, R. T., Kiely, D. K., Bharel, M., Grande, L. J., & Mitchell, S. L. (2013). Use of acute care services among older homeless adults. JAMA Internal Medicine, 173(19), 1831–1834. doi:10.1001/jamainternmed.2013.6627.
Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L. (2012). Geriatric syndromes in older homeless adults. Journal of General Internal Medicine: Official Journal of the Society for Research and Education in Primary Care Internal Medicine, 27(1), 16–22. doi:10.1007/s11606-011-1848-9.
Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L. (2013). Factors associated with geriatric syndromes in older homeless adults. Journal of Health Care for the Poor and Underserved, 24(2), 456–468. doi:10.1353/hpu.2013.0077.
Downtown Women’s Action Coalition. (2016). Downtown women’s needs assessment. In A. S. Morrissette (Ed.), Downtown women’s needs assessment (pp. 1–40). Los Angeles: Shelter Partnership, Inc.
Feingold, A. (2009). Effect sizes for growth-modeling analysis for controlled clinical trials in the same metric as for classical analysis. Psychological Methods, 14(1), 43–53. doi:10.1037/a0014699.
Feingold, A. (2013). A regression framework for effect size assessments in longitudinal modeling of group differences. Review of General Psychology, 17(1), 111–121. doi:10.1037/a0030048.
Gobbens, R. J., van Assen, M. A., Luijkx, K. G., & Schols, J. M. (2012). Testing an integral conceptual model of frailty. Journal of Advanced Nursing, 68(9), 2047–2060. doi:10.1111/j.1365-2648.2011.05896.x.
Harris, M., & Fallot, R. D. (2001). Designing trauma-informed addiction services. In M. Harris & R. D. Fallot (Eds.), Using trauma theory to design service systems (pp. 57–73). San Francisco: New Directions for Mental Health Services.
Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142(11), 1259–1264.
Knight, K., Simpson, D., & Morey, J. (2002). Evaluation of the TCU drug screen. Washington, DC: National Institute of Justice, Office of Justice Programs, US Department of Justice (196682).
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi:10.1177/014662167700100306.
Rochon, J. (1998). Application of gee procedures for sample size calculations in repeated measures experiments. Statistics in Medicine, 17(14), 1643–1658.
Rockwood, K., & Mitnitski, A. (2007). Frailty in relation to the accumulation of deficits. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 62(7), 722–727.
Romero-Ortuno, R., Walsh, C. D., Lawlor, B. A., & Kenny, R. A. (2010). A frailty instrument for primary care: Findings from the survey of health, ageing and retirement in europe (share). BMC Geriatrics, 10, 57. doi:10.1186/1471-2318-10-57.
Salem, B. E., & Ma-Pham, J. (2015). Understanding health needs and perspectives of middle-aged and older women experiencing homelessness. Public Health Nursing, 32(6), 634–644. doi:10.1111/phn.12195.
Salem, B. E., Kwon, J., & Ames, M. (2017). On the frontlines: Perspectives of providers working with homeless women. Western Journal of Nursing Research. doi:10.1177/0193945916689081.
Salem, B. E., Nyamathi, A., Phillips, L. R., Mentes, J. C., Sarkisian, C., & Brecht, M. L. (2014). Development of a frailty framework among vulnerable populations. Advances in Nursing Science, 37(1), 70–81. doi:10.1097/ANS.0000000000000013.
Salem, B. E., Nyamathi, A. M., Brecht, M. L., Phillips, L. R., Mentes, J. C., Sarkisian, C., & Leake, B. (2013). Correlates of frailty among homeless adults. Western Journal of Nursing Research, 35(9), 1128–1152. doi:10.1177/0193945913487608.
Sangha, O., Stucki, G., Liang, M. H., Fossel, A. H., & Katz, J. N. (2003). The self-administered comorbidity questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis and Rheumatism, 49(2), 156–163. doi:10.1002/art.10993.
Sherbourne, C., & Stewart, A. (1991). The mos social support survey. Social Science & Medicine (1982), 32(6), 705–714.
Wolitzky-Taylor, K., Sewart, A., Vrshek-Schallhorn, S., Zinbarg, R., Mineka, S., Hammen, C., …, Craske, M. G. (2017). The effects of childhood and adolescent adversity on substance use disorders and poor health in early adulthood. Journal of Youth and Adolescence, 46(1), 15–27.
Acknowledgements
I wish to acknowledge the support of Dr. Adey Nyamathi, Dr. Priscilla Kehoe, Sarah Callender and Zaneta Smith along with all the participants in the community. This work was supported by the National Institute of Health (NIH)/Nursing Research (NINR) T32 NR007077.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salem, B.E., Ma-Pham, J., Chen, S. et al. Impact of a Community-Based Frailty Intervention Among Middle-Aged and Older Prefrail and Frail Homeless Women: A Pilot Randomized Controlled Trial. Community Ment Health J 53, 688–694 (2017). https://doi.org/10.1007/s10597-017-0147-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-017-0147-2