Digital Interventions for Older People Experiencing Homelessness: A Systematic Scoping Review (Preprint)

Abstract

Older people experiencing homelessness (OPEH) can have mental and physical indicators of ageing several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Emerging literature suggests digital interventions could positively impact the health and well-being of People Experiencing Homelessness (PEH) [1]. However, the increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation that warrants further research. Limited efforts have been made to synthesise the available literature on digital interventions for OPEH.

This scoping review examined the usage, range, and nature of digital interventions available to OPEH and organisations that support OPEH.

The scoping review was conducted following Arksey and O’Malley’s proposed methodology [2], the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews [3] and recent guidelines from the Joanna Briggs Institute [4]. We searched 14 databases (Including Medline, Embase, PsycINFO, CINAHL and Association for Computing Machinery Digital Library (ACMDL)). Grey literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis.

A total of 19915 records were identified through database and grey literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined participant age group of over 50 or the mean participant age was over 50. Nine of ten studies were published in the USA. Study design included descriptive studies [5, 6], uncontrolled pilot studies [7-11] and pilot randomised controlled trials (RCT)[12-14]. No studies aimed to deliver an intervention exclusively to OPEH or organisations that supported OPEH. Four types of intervention were identified: telecare for PEH, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion and Cognitive Behavioural Therapy (CBT). Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for OPEH, and all ten studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organisational and peer support.

Our findings highlight a paucity of evaluated digital interventions targeted at OPEH. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for OPEH. Further research on digital interventions that provide services and support OPEH is required. Future interventions must address the barriers OPEH face when accessing digital technology with the input of those with lived experience of homelessness.

Not applicable