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Dementia in unhoused people was 1.9 times greater than the general population, with a higher prevalence for age groups younger than 85 years, according to new research from Lawson Health Research Institute and ICES.

In one of the first population-based studies of its kind and published in The Lancet Public Health, researchers compared dementia prevalence in people experiencing homeless with the general population and people living in low-income neighbourhoods in Ontario, Canada.

“Not only did we find that dementia was more common among unhoused individuals, but the difference was greatest between the ages of 55 to 64 years,” says lead author Dr. Richard Booth, Scientist at ICES and Lawson Health Research Institute, and Associate Professor and Arthur Labatt Family Research Chair in Nursing at Western University.

“There’s a strong link between homelessness and accelerated ageing, which may be one of the reasons people experience an earlier onset of the disease,” says Dr. Booth.

Using a prevalence ratio, the researchers found that within the ages of 55-74 years rates of dementia were 4 to 5 times higher than the general population and 3 to 3.5 times higher than the low-income group. There was a higher dementia prevalence in all age groups younger than 85 years among people experiencing homelessness in both males and females.

Unhoused people were younger on average, less likely to be female, and less likely to live in rural areas compared to the other two groups. They also had higher rates of health conditions associated with dementia, such as head trauma, neurological conditions, HIV, and mental health and substance-use disorders.

After adjusting for factors such as age, sex, residential area, and health conditions, the prevalence ratio for people experiencing homelessness was 1.7 times higher compared to the low-income group, and 1.9 times higher compared to the general population.

“Other research has outlined that the rates of homelessness in older adults are expected to double by 2030, which means that the number of people living with dementia could rise substantially,” says Dr. Booth. “Our findings suggest that unhoused individuals should be screened for dementia at younger ages, rather than waiting until age 65 as many guidelines suggest.”

The researchers also note the complexity of diagnosing dementia in an individual experiencing multiple, chronic health conditions, as cognitive symptoms can overlap. Because of the difficulty in obtaining a medical history and diagnosis in this population, the study could have underestimated the true prevalence of dementia.

“We hope this work serves to enhance the awareness of policy makers and practitioners of the increasing prevalence of dementia among people experiencing homelessness,” says study author Salimah Shariff, Staff Scientist with the Populations & Public Health Research Program at ICES, Associate Director of research operations and strategic partnerships at ICES Western, and Associate Scientist at Lawson. “As housing is a core determinant of health and essential to the sustainment of individuals’ health and wellbeing, access to permanent, supportive housing structures for people experiencing homelessness is also critical in preventing and slowing the progression of dementia in this population.”

This study was funded by the Public Health Agency of Canada.

FOR FURTHER INFORMATION PLEASE CONTACT:

Misty Pratt
Senior Communications Associate, ICES
@email 613-882-7065

A new study from Lawson Health Research Institute will be the first to explore Canadian Veterans’ beliefs about confidentiality in mental health care and whether those beliefs act as a barrier to seeking treatment for a type of trauma known as moral injury.

Moral injury describes psychological distress following events where a person performs, witnesses or fails to prevent acts that conflict with deeply held moral standards. Evidence suggests that moral injuries are on the rise among deployed members of the Canadian Armed Forces (CAF), and that those exposed to such events are at a higher risk of developing post-traumatic stress disorder (PTSD) and depression.

Through the study, researchers aim to understand barriers that might prevent military personnel from disclosing details of moral injury.

“A commonly reported barrier when seeking mental health treatment is a perceived lack of confidentiality,” explains Dr. Anthony Nazarov, Post-Doctoral Associate at Lawson. “Since some events that induce moral injuries are ethically ambiguous, it’s possible that military personnel may withhold details of their trauma or even avoid seeking help due to worries about confidentiality.” 

The two-year study will engage 200 Canadian Armed Forces Veterans to investigate their perceptions around the confidentiality of disclosing moral injuries in the mental health care and research settings. This will be accomplished not only by interviewing Veterans receiving care at St. Joseph’s Health Care London’s Operational Stress Injury Clinic, but also through online surveys made available to military personnel and Veterans across Canada. The research team will also interview mental health professionals to understand their perspectives on this topic. 

“Many Veterans seek help for mental health, and that’s great to see. We’ve come a long way in reducing stigma and barriers, but there’s more work to be done,” says Dr. Don Richardson, Lawson Associate Scientist, Director of the MacDonald/Franklin OSI Research Centre and Physician Lead at St. Joseph’s OSI Clinic. “It’s our duty as mental health researchers and clinicians to ensure that everyone who needs help seeks it. If Veterans do not feel comfortable disclosing certain details because of perceived mistrust related to privacy, we need to know why that is and what we can do to address this issue.“

“Through appropriate messages, it may be possible to dispel any false beliefs, increase trust in mental health professionals and, in turn, increase the number of veterans who choose to seek help,” notes Dr. Nazarov.

The study is being funded by Veterans Affairs Canada and St. Joseph’s Health Care Foundation’s Robert S. & Mary Gay, Donald, James, and Helen (Taylor) Gay Endowed Research Fellowship in Veterans Care.

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Above: Drs. Don Richardson and Anthony Nazarov