Application of the frailty framework among vulnerable populations to hospitalization outcomes of individuals experiencing homelessness in Long Beach, California

ABSTRACT

Background: Individuals experiencing homelessness have a high prevalence of infectious diseases that may result in hospitalization.

Objectives: This study uses risk factors at baseline to predict hospitalization at follow-up. This paper also presents the associations between reporting homelessness and selected infectious diseases.

Research design: Longitudinal study of baseline and follow-up conducted August 2000 through July 2014.

Subjects: 4916 Not experiencing homelessness mean age 37.9 years, 29% female, and 2692 experiencing homelessness age 42.1 years, 29% female received services from a research/service center in a low-income, high-crime area of Long Beach, CA.

Measures: Risk Behavior Assessment, Risk Behavior Follow-up Assessment, laboratory testing for hepatitis A, hepatitis B, hepatitis C, syphilis, chlamydia, and gonorrhea.

Results: Predictors of hospitalization at follow-up were ever use of crack cocaine, income from Social Security or disability, reporting homelessness, female, and those who identify as Black race/ethnicity.

Conclusions: Income from the safety net of Social Security or disability provides participants with experience that transfers to being able to obtain healthcare. A higher proportion of those experiencing homelessness, compared to those not experiencing homelessness, appear to be hospitalized at follow-up. Our findings support use of the Frailty Framework when working with individuals experiencing both homelessness and hospitalization.

KEYWORDS:

• Homelessness
• vulnerable populations
• public health
• substance use disorder
• frailty

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The project described was supported in part by Award Numbers R01DA030234 from the National Institute on Drug Abuse (NIDA), P20MD003942 from the National Institute of Minority Health and Health Disparities (NIMHD), and ID10-CSULB-008 from the California HIV Research Program (CHRP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIDA, NIMHD, or CHRP. The NIDA, NIMHD, nor CHRP had no role in the study design, collection or analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication.

Notes on contributors

Dennis G. Fisher

Dennis G. Fisher is Professor Emeritus of Psychology at California State University Long Beach.

Grace L. Reynolds

Grace L. Reynolds is Professor of Health Care Administration and Associate Dean for Faculty Affairs and Research in the College of Health and Human Services at California State University Long Beach.

Noushin Khoiny

Noushin Khoiny is a medical doctor and lecturer in the School of Nursing at California State University Long Beach.

Loucine Huckabay

Loucine Huckabay is Professor Nursing and Director of the School of Nursing at California State University Long Beach.

Debby Rannalli

Debby Rannalli is Assistant Professor of Nursing at California State University Long Beach.