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Premature ageing in long-term homeless adults (PATH)

The number of homeless individuals in Dublin is rising. These individuals experience severe socio-economic
stress and health inequity with dramatic reductions in life-expectancy. The applicants for this proposal consist of
key stakeholders providing care tp homeless people in acute hospitals, primary care, voluntary sector residential
and day services and policy makers in housing and health. Together, we have generated preliminary data
demonstrating premature onset of chronic age-associated conditions such as multimorbidity, frailty, COPD and
dementia in homeless people in Dublin. Together, we recognise that premature ageing in homeless people is
poorly understood. Health services and homeless accommodations are not designed to meet the complex needs
of homeless individuals. This results in increased usage of unscheduled health care (ED visits and unscheduled
inpatient admissions) and associated costs and grossly inequitable outcomes.
We now propose to extend the internationally renowned Irish Longitudinal Study on Ageing (TILDA) to homeless
people. The applicants have a unique clinical network including primary care, voluntary and state sector bodies
serving the homeless, which will enable us to carry out this challenging study. The proposed study will have
several key deliverables. It will characterise physical and cognitive frailty in homeless people, measure the
prevalence and incidence of functional impairment and care needs, and inform the development of
integrated health and social care to meet the needs of homeless people in Dublin.
Finally, homelessness provides a clear human model of health inequities and premature ageing associated with
psychological and socioeconomic stress throughout the life course. Understanding the premature ageing seen in homelessness will give us insight into the pathways, processes and mechanisms via which social
exclusion gets “under the skin” to precipitate earlier ageing and will inform policies to deliver improved
health equity.