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In Canada, about 235,000 people experience homelessness each year. The number of homeless people, and the length of time they spend homeless, continues to rise. Homelessness is not a choice and anyone can become homeless. 

Although the root cause is poverty, some underlying issues are poor physical or mental health; violence or abuse in the home; lack of employment or income; and, a shortage of affordable housing. 

A group of researchers at Lawson Health Research Institute (Lawson), working at both London Health Sciences (LHSC) and St. Joseph’s Health Care London (St. Joseph’s), are committed to tackling the issue of homelessness from within hospital walls, where some patients face the risk of being discharged into homelessness. 

“Many of our patients with lived experience of homelessness were saying that their journey started with a hospital discharge,” says Lawson clinician researcher Dr. Cheryl Forchuk. “Often, they were experiencing major transitions in their lives and then experienced a hospital stay. Normally a relatively short visit, they aren’t able to gather the information and make a plan to be able to leave the hospital with somewhere to stay.”

On September 10, Adam Vaughan, Canadian MP and Parliamentary Secretary (Housing and Urban Affairs), on behalf of the Honourable Jean-Yves Duclos, Minister of Families, Children and Social Development, announced that Lawson will receive $223,572 from the Homelessness Partnering Strategy’s (HPS) Innovative Solutions to Homelessness funding stream to support the project “No Fixed Address Version 2 Expansion” research project. 

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“This is a brilliant approach. It supports an augmented duty of care where hospitals have the means to transfer people into stable settings where they can continue to heal and move towards self-sufficiency,” says Parliamentary Secretary Vaughan. 

Taking place at London Health Sciences Centre, this research will further refine the No Fixed Address strategy for reaching and supporting patients during the crucial transitional period when they are being discharged from the hospital and re-integrated into the community. 

“Lawson’s expanded No Fixed Address research project is the first evaluation anywhere of a strategy to reduce the number of patients being discharged into homelessness. There is almost no literature on any aspect of this troublesome issue,” explains Dr. Forchuk who is the study’s Principal Investigator. Dr. Forchuk is also the Beryl and Richard Ivey Research Chair in Aging, Mental Health, Rehabilitation and Recovery and Assistant Director at Lawson.

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This project is an extension of three previous studies conducted by Dr. Forchuk’s research team, which developed and tested this novel approach. They demonstrated the efficacy, feasibility and cost-effectiveness of using the No Fixed Address strategy in acute and tertiary psychiatric care in the London region, at both LHSC and St. Joseph’s. In the first phase, they found that the interventions used prevented homelessness in 95 per cent of cases. 

The researchers are now taking a solution proven to have worked in the mental health units and applying it in selected medical departments at LHSC. Through the study, the services will be available to all patients in those units who are at risk of homelessness. There have already been 17 patients who have accessed this support since the project got underway this summer. 

Three community partners from London are supporting implementation of the strategy - Canadian Mental Health Association Middlesex, Ontario Works in the City of London and the Salvation Army’s Housing Stability Bank. They will provide assistance in areas like securing appropriate private-sector housing, provision of income and employment supports, and financial assistance. 

“In many ways London, Ontario is the high water mark of solving and tackling homelessness. This community has a lot of be proud of given the way that the municipality is stepping up to the plate and how many different organizations are working together towards a common goal,” says Parliamentary Secretary Vaughan. 

This kind of collaboration showcases the important partnership between the Canadian Government, research-intensive hospitals and community organizations to translate innovative solutions from the research stage to the front line of care. 

“The hope is that the findings will be even more robust, leading to the development of a best-practice model of hospital discharge that can be adopted throughout Canada. This will reinforce the need for a systemic change in the way hospital discharges occur and ensuring the person is transitioning to a secure housing arrangement,” says Dr. Forchuk. 

Learn more about the Government of Canada’s Homelessness Partnering Strategy. 

News Coverage

• CBC London - Helping medical patients in London avoid homelessness when they leave hospital 
• CTV London - Expanded research hopes to break the cycle of homelessness that psychiatric patients sometimes face when discharged
• Global News, AM 980 - Program that finds housing for homeless patients in hospital gets $223K in federal funding
• London Free Press - 'Brilliant approach' to homelessness gets federal grant
   

Chaired by Dr. Manuel Montero-Odasso, Scientist at Lawson Health Research Institute, a group of 96 experts from 39 countries and 36 societies and agencies in Geriatric Medicine and Aging have come together to develop the “World Guidelines for Falls Prevention and Management for Older Adults: A Global Initiative.”

Published in Age and Ageing, the official journal of the British Geriatric Society, the guidelines provide recommendations to clinicians working with older adults to identify and assess fall risks.

“The global population is aging. Thanks to social and medical advances, some chronic conditions are diminishing proportionally. This is not the case for falls,” says Dr. Montero-Odasso, who is also a Geriatrician at St. Joseph’s Health Care London’s Parkwood Institute and a Professor at Western University’s Schulich School of Medicine & Dentistry. “Unfortunately, falls and related injuries among older adults are increasing and there is no sign of future decline.”

With new evidence and studies released since previous guidelines were published more than a decade ago, experts felt it was the right time for an update and an opportunity to incorporate a worldwide perspective

“Besides the rigorous methodology that 11 international working groups followed to provide new meta-analyses, including several new Cochrane collaborations, this World Falls Guidelines are, to the best of our knowledge, the first clinical practice guidelines in fall prevention to include a panel of older adults with lived experience in falls and mobility problems,” says Dr. Montero-Odasso. “They provided feedback, comments and opinions on our recommendations, making them considerably better and with wider applicability.”

Some key themes in the recommendations include: 

• Falls can be prevented, but it requires multidisciplinary management.
• Preventing falls has wider benefits for quality of life.
• Fall risk can be assessed by trained clinicians with simple resources. 
• A combination of interventions, including specific exercises to improve balance and strength, when delivered correctly, can effectively reduce fall risk in older adults.

Dr. Montero-Odasso says there was enough evidence to suggest that a global approach is needed to prevent falls in older adults and that “low risk does not mean no risk.” Even active older adults who are low risk should work on preventing loss of mobility and falls.

The next steps are for the guidelines to continue obtaining formalized endorsement of all the groups involved in the initiative and then for the guidelines to be fully implemented.

You can read the full guidelines here.