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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

On Friday, November 23, 2018, the Mental Health INcubator for Disruptive Solutions (MINDS) of London-Middlesex welcomed community members and stakeholders at Innovation Works for an update on the work of the MINDS team and announced the generous contributions of the Ontario Trillium Foundation. 

Local MPPs Peggy Sattler (London West) and Terence Kernaghan (London North Centre), with OTF Grant Review Team member Chris Harding were on hand to congratulate the MINDS members, including Pillar Nonprofit Network, and hear more about how the $75,000 OTF Grant will contribute to the mental health of transitional aged youth in the London and Middlesex region. 

As a research project through Lawson Health Research Institute, MINDS is taking a unique approach to improving the mental health of the community’s transitional age youth – people ages 17 to 25. 

A key aspect is to successfully work in partnership with youth to make sense of and address this complex challenge. 

“Today’s youth are unlike any generation before,” explains Dr. Arlene MacDougall, Director and Principal Investigator for MINDS. “Many of our processes, structures, models and concepts that we have used to serve, educate, employ, care for and communicate with youth in the past are no longer appropriate, relevant or effective for the youth of today.”

Dr. MacDougall is also Director of Research and Innovation for mental health care at St. Joseph’s Health Care London and Assistant Director for mental health research at Lawson. 

Youth today are more diverse, connected and educated. Although many are reaping benefits from these qualities, others are facing significant challenges such as finding a full time job, being social excluded, negative effects of digital life including cyberbullying and physical health challenges like rising obesity. 

“Evidence from acute care and community sectors shows an increase in the number and acuity of mental health and addiction challenges experienced by our local transitional age youth,” states Dr. MacDougall. “We see this as a persistent and ‘wicked’ challenge – it is difficult to define and many factors contribute to it.” 

Over the last few years, across Canada and locally, there have been higher rates of emergency visits and inpatient hospitalizations for youth with mental disorders; an increase in the number of youth seeking help for mental illnesses; and, youth experiencing increased rates of anxiety, depression and suicidal thoughts and attempts. 

“We have been listening to local youth and their adult allies. We are hearing from youth with lived experience of mental illness and those who do not have a lived experience. And we are working on making sense of the upstream social drivers and components of poor mental health for transitional age youth,” explains Dr. MacDougall.

“On the flip side, we are exploring the potential action areas, levers and opportunities for shifting our community and our system to promote youth mental and emotional wellbeing – reaching them sooner and in the way they need.” 

As a social innovation lab, MINDS will use a collective impact framework to develop and test high impact solutions. This provides a structured process and creative environment where the team can prototype radical but possible innovations, while merging with youth-led participatory action research. 

“The collective impact framework enables us to can tackle deeply entrenched and complex social problems. It is an innovative yet structured approach to making collaboration work across government, business, philanthropy, non-profit organizations and citizens to achieve significant and lasting social change.” 

MINDS has the support of a diverse network of key individuals and partnering organizations including cross-sectoral service providers, community leaders, mental health advocates and youth from the region. This includes Lawson, St. Joseph’s, London Health Sciences Centre, Western University, mindyourmind, Goodwill Industries and CMHA Middlesex. The project has also received funding support from St. Joseph’s Health Care Foundation.

“We are thrilled that many partners in the community are coming together to look for disruptive solutions that will create a lasting impact for youth,” explains Dr. MacDougall. “To the best of our knowledge, this is the first social innovation lab dedicated to improving community mental health to be established in Canada.

The Ontario Trillium Foundation (OTF) is an agency of the Government of Ontario, and one of Canada’s leading granting foundations. OTF awarded more than $120 million to some 700 projects last year to build healthy and vibrant communities in Ontario.