Systematic review finds sparse evidence for community frailty interventions in homelessness

A systematic review found only three studies evaluating community-based interventions for managing frailty among people experiencing homelessness, leaving substantial uncertainty about which approaches can improve health and which outcomes they affect. The studies assessed a frailty health-promotion programme, a combined group exercise and nutrition programme, and a residential respite service using a geriatric care model. None provided unequivocal evidence of benefit: the randomised trial did not show a statistically significant advantage for the frailty-specific programme, the mixed-method exercise study found minimal, non-significant differences in physical tests, and the single-arm cohort study reported improvements in several measures.

Frailty is described in the review as a state of vulnerability to adverse outcomes, marked by progressive decline in physical health and increased risk of adverse health outcomes. People experiencing homelessness are described as having extremely poor health outcomes, including lower life expectancy, a high level of chronic illness and a significant rate of frailty. The researchers searched seven databases using terms relating to homelessness, frailty and community care.

Search results were deduplicated, and abstracts were screened before full texts. Included studies underwent risk-of-bias assessment, data extraction and narrative synthesis. An advisory group comprising people with lived experience of homelessness was consulted at various stages of the project.

The review was therefore designed to examine the available evidence systematically, although the small number of eligible studies limited the strength of conclusions that could be drawn. The randomised controlled trial tested a frailty health-promotion programme against a general health-promotion programme. At the three-month follow-up, participants in the control group who received the general programme had better outcomes, but the differences were not statistically significant.

That pattern does not establish that the general programme was more effective, nor does it demonstrate that the frailty-specific programme lacked benefit. Instead, the trial did not produce a statistically significant result favouring the intervention under comparison, and the review does not provide a basis for a clinical recommendation from this finding alone. A mixed-method study examined a programme that combined group exercise with nutrition support.

Among participants classified as pre-frail or frail, follow-up physical tests showed minimal differences that were not statistically significant. As a result, the findings cannot establish that the programme meaningfully improved physical performance in this subgroup. The third included study was a prospective, single-arm cohort study of a residential respite service with a geriatric care model.

Improvements were observed in a number of measures at six months. Because every participant received the service and there was no comparison group, the study cannot determine whether the service caused the observed changes. Across the three studies, the evidence was limited by the small number of eligible publications, differences in intervention designs, outcome measures and methodological approaches, and the short or non-comparative follow-up in parts of the evidence base.

The review identifies the need for larger samples, longer follow-up periods and interventions designed around the distinctive needs of people experiencing homelessness. More qualitative research is also needed to understand the challenges involved in managing frailty and to inform the development of services for this underserved population. Overall, the review shows a major gap in evidence rather than a settled answer about whether community-based interventions can work.

The interventions differed substantially in their content, from health promotion to exercise, nutrition and respite care, and each study had limitations that restricted firm conclusions. The most direct comparative test did not find a statistically significant advantage for the frailty-specific programme, while the cohort study reported improvements without a comparison group.

Subject of Research: Systematic review of community-based frailty management interventions for people experiencing homelessness

Article Title: Community-based interventions for managing frailty among people experiencing homelessness: a systematic review

Article References: Palipane, N., Callahan, E., Hudson, B., Shulman, C., Rogans-Watson, R., Dawes, J., Armstrong, M., Broderick, J., Walters, K., & Bhanu, C. (2026). Community-based interventions for managing frailty among people experiencing homelessness: a systematic review. BMC Public Health. https://doi.org/10.1186/s12889-026-29493-5

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29493-5

Keywords: frailty, homelessness, community care, systematic review, health promotion, exercise, nutrition, respite care, risk of bias, public health, Community-based, interventions