Community Mental Health Journal

, Volume 53, Issue 6, pp 688–694 | Cite as

Impact of a Community-Based Frailty Intervention Among Middle-Aged and Older Prefrail and Frail Homeless Women: A Pilot Randomized Controlled Trial

  • Benissa E. Salem
  • Jennifer Ma-Pham
  • Stephanie Chen
  • Mary-Lynn Brecht
  • Anna Liza Antonio
  • Masha Ames
Original Paper


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.


Homeless Pre-frail/frail Middle-aged/older women Community health workers 



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.


  1. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefPubMedGoogle Scholar
  4. 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.Google Scholar
  5. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 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.CrossRefPubMedGoogle Scholar
  7. 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.CrossRefPubMedGoogle Scholar
  8. 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.Google Scholar
  9. 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.CrossRefPubMedGoogle Scholar
  10. 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).CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. Rochon, J. (1998). Application of gee procedures for sample size calculations in repeated measures experiments. Statistics in Medicine, 17(14), 1643–1658.CrossRefPubMedGoogle Scholar
  13. 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.CrossRefPubMedGoogle Scholar
  14. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 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.CrossRefPubMedGoogle Scholar
  20. Sherbourne, C., & Stewart, A. (1991). The mos social support survey. Social Science & Medicine (1982), 32(6), 705–714.CrossRefGoogle Scholar
  21. 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.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Benissa E. Salem
    • 1
  • Jennifer Ma-Pham
    • 2
  • Stephanie Chen
    • 3
  • Mary-Lynn Brecht
    • 4
  • Anna Liza Antonio
    • 4
  • Masha Ames
    • 5
  1. 1.UCLA School of NursingUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Coherence Consulting IncLos AngelesUSA
  3. 3.Los Angeles County Department of Health Services (LACDHS)Los AngelesUSA
  4. 4.University of California, Los AngelesLos AngelesUSA
  5. 5.Glendale Adventist Medical CenterGlendaleUSA

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