Premature frailty, geriatric conditions and multimorbidity among people experiencing homelessness: a cross-sectional observational study in a London hostel

Raphael Rogans-Watson*, Caroline Shulman, Dan Lewer, Megan Armstrong, Briony Hudson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


Purpose: The purpose of this paper is to assess frailty, geriatric conditions and multimorbidity in people experiencing homelessness (PEH) using holistic evaluations based on comprehensive geriatric assessment (CGA) and draw comparisons with general population survey data. Design/methodology/approach: Cross-sectional observational study conducted in a London-based hostel for single PEH over 30 years old in March–April 2019. The participants and key workers completed health-related questionnaires, and geriatric conditions were identified using standardised assessments. Frailty was defined according to five criteria in Fried’s phenotype model and multimorbidity as the presence of two or more long-term conditions (LTCs). Comparisons with the general population were made using data from the English Longitudinal Study of Ageing and the Health Survey for England. Findings: A total of 33 people participated with a mean age of 55.7 years (range 38–74). Frailty was identified in 55% and pre-frailty in 39%. Participants met an average of 2.6/5 frailty criteria, comparable to 89-year-olds in the general population. The most common geriatric conditions were: falls (in 61%), visual impairment (61%), low grip strength (61%), mobility impairment (52%) and cognitive impairment (45%). All participants had multimorbidity. The average of 7.2 LTCs (range 2–14) per study participant far exceeds the average for even the oldest people in the general population. Originality/value: To the best of authors’ knowledge, this is the first UK-based study measuring frailty and geriatric conditions in PEH and the first anywhere to do so within a CGA-type evaluation. It also demonstrates the feasibility of conducting holistic evaluations in this setting, which may be used clinically to improve the health outcomes for PEH.

Original languageEnglish
Pages (from-to)77-91
Number of pages15
JournalHousing, Care and Support
Issue number3-4
Publication statusPublished - 4 Dec 2020
Externally publishedYes

Bibliographical note

Funding Information:
Funding: While the study received no direct funding, Briony F. Hudson used £330 to purchase supermarket vouchers for the study, using funds from a UCL Excellence in Health Research Award she had previously been awarded and an additional £2000 from this award to contribute to publication costs. The lead author Raphael Rogans-Watson received no funding. Caroline Shulman, Megan Armstrong and Briony F. Hudson are funded by a grant from The Oak Foundation (OCAY-14–574), and Dan Lewer is funded by National Institute for Health Research (NIHR), (DRF-2018–11-ST2-016). Both grants were awarded prior to the conception of this study and neither organisation had any role in the design, execution, analysis and interpretation of data or writing of the study, and the views expressed are those of the authors alone and do not necessarily reflect the views of either organisation. All five authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Publisher Copyright:
© 2020, Raphael Rogans-Watson, Caroline Shulman, Dan Lewer, Megan Armstrong and Briony Hudson.


  • Ageing
  • Frailty
  • Geriatric conditions
  • Homelessness
  • Inclusion health
  • Multimorbidity


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