Homelessness and Dementia: An Unspoken and Complicated Epidemic in America
By Dr. Ganesh Babulal
As the global population grows, older adults (age 65 years or older) will also increase in size, along with cases of Alzheimer’s disease and related dementias (commonly referred to as dementia). Dementia is an umbrella term that describes a group of symptoms that characterizes difficulty with memory, thinking, communication, and ability to complete daily activities. Age is one of the most significant risk factors for dementia, but numerous other risk factors exist.
Homelessness is a well-established risk factor for numerous health outcomes, including communicable and infectious diseases, mood or psychiatric disorders, substance abuse disorders, and some chronic conditions (cardiovascular or pulmonary). Prior studies suggest that homeless persons mainly visit hospitals for emergency conditions or problems. As a result, they often receive delayed diagnoses for a range of issues because they do not have access to or cannot afford routine annual or preventative checkups. Some studies also suggest that homeless adults present with more significant cognitive impairment, but there is limited evidence on how this may influence dementia prevalence.
Our systematic review revealed that the relationship between homelessness and dementia was complicated because other chronic conditions or disorders (e.g., mental illness, addiction, brain injuries) may come into play. However, the current research suggests that homelessness is a risk factor for dementia. Equally, if a person is diagnosed with dementia, they are also at risk of homelessness. Six of the nine studies were conducted in veteran populations or those who use Veterans Affairs for care. As a result, we only understand dementia risk among a small percentage of the aging homeless population. More importantly, we found that Black Americans were disproportionately higher in both veteran and non-veteran homeless persons, emphasizing health disparities as core issues impacting access to timely diagnosis and treatment.
These findings highlight a significant gap in the literature. We know very little about homeless adults who are non-veterans because it is challenging to track them since they do not have routine medical care (e.g., Veterans Affairs). Additionally, homelessness is often an exclusion criterion for many research studies since they cannot maintain communication using conventional methods (e.g., home address and phone number). Payment for participation in research studies (primarily if federally funded) requires a social security number and a receiving address for the payment to be sent. Homelessness is a chronic, systemic, and societal issue and is projected to double over the next four years in the United States. The COVID-19 pandemic has compounded this issue since more homeless persons go uncounted because counties halted their counts due to the risk of disease transmission.
There is a critical need to develop novel, alternative ways to improve the annual Point-in-Time Count of unsheltered homelessness. Community clinics, federally qualified health centers, and standard hospital systems (acute, long-term, private, public, and teaching) should also increase dementia screening in homeless populations to improve the accuracy of dementia prevalence. Neurologists, psychiatrists, neuropsychologists, and geriatricians are often the practitioners and experts in dementia diagnosis. A coordinated approach across these disciplines may improve the precision of screening and assessments within this underserved and vulnerable population.
Article Details
Associations between Homelessness and Alzheimer’s Disease and Related Dementia: A Systematic Review
Ganesh M. Babulal, Rohan Rani, Paris Adkins-Jackson, Adam C. Pearson, and Monique M. Williams
First Published Online June 24, 2022
DOI: 10.1177/07334648221109747
Journal of Applied Gerontology
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