Suh Kevin, Beck Jordan, Katzman Wendy, Allen Diane D
Graduate Program in Physical Therapy, UCSF/SFSU, San Francisco, CA, USA.
Physiother Theory Pract. 2022 Jul;38(7):858-867. doi: 10.1080/09593985.2020.1809045. Epub 2020 Aug 24.
Homeless adults may experience accelerated aging, presenting earlier with geriatric syndromes such as falls and functional limitations. Though homelessness is surging in United States, data are scarce regarding rates of physical dysfunctions characteristic of geriatric syndromes experienced in this underserved population.
Examine associations between homelessness, premature geriatric syndromes, and functional limitations.
Two reviewers independently searched PubMed, CINAHL, and PEDro databases for prognostic studies reporting rates of geriatric syndromes in homeless adults aged 40 years and older. Two reviewers independently performed study selection. Data were extracted for homeless adults and community-dwelling controls regarding age, demographic information, limitations of activities of daily living (ADL) and instrumental ADL (IADL), frailty, and falls the past year. Risk ratio (RR) and 95% confidence interval (CI) were calculated across studies to compare groups.
Five studies met predetermined criteria. Meta-analysis revealed greater rates in homeless adults (average age 56) compared to housed adults (average age 78) for ADL limitation (RR = 1.50, 95% CI = 1.37-1.64) and IADL limitation (RR = 1.36, 95% CI = 1.28-1.45). Falls were three times more prevalent in homeless individuals (RR = 3.42, 95% CI = 3.16-3.70). Heterogeneous frailty data did not reach significance (RR = 2.59, 95% CI = 0.90-7.46).
Homeless adults have increased risk of premature geriatric syndromes. Limitations in ADL and IADL rates were 30-50% higher than adults with stable housing averaging 20 years older, and fall rates were three times higher than controls averaging 4.5 years older. These results underscore the need for healthcare providers such as physical therapists to address physical dysfunction in homeless adults.
无家可归的成年人可能经历加速衰老，更早出现老年综合征，如跌倒和功能受限。尽管美国无家可归者人数激增，但关于这一服务不足人群中出现的老年综合征所特有的身体功能障碍发生率的数据却很匮乏。
研究无家可归、过早出现的老年综合征和功能受限之间的关联。
两名评审员独立检索了PubMed、CINAHL和PEDro数据库，以查找报告40岁及以上无家可归成年人老年综合征发生率的预后研究。两名评审员独立进行研究筛选。提取了无家可归成年人和社区居住对照者的年龄、人口统计学信息、日常生活活动（ADL）和工具性ADL（IADL）受限情况、虚弱状况以及过去一年的跌倒情况等数据。通过各研究计算风险比（RR）和95%置信区间（CI）来比较各组。
五项研究符合预定标准。荟萃分析显示，与有住房的成年人（平均年龄78岁）相比，无家可归成年人（平均年龄56岁）的ADL受限率（RR = 1.50，95% CI = 1.37 - 1.64）和IADL受限率（RR = 1.36，95% CI = 1.28 - 1.45）更高。无家可归者的跌倒发生率是有住房者的三倍（RR = 3.42，95% CI = 3.16 - 3.70）。异质性的虚弱数据未达到显著水平（RR = 2.59，95% CI = 0.90 - 7.46）。
无家可归的成年人过早出现老年综合征的风险增加。ADL和IADL受限率比平均年龄大20岁的有稳定住房的成年人高30% - 50%，跌倒发生率比平均年龄大4.5岁的对照组高三倍。这些结果强调了物理治疗师等医疗保健提供者应对无家可归成年人身体功能障碍的必要性。
