People experiencing homelessness more likely to develop dementia at younger ages, study finds
London, ON, March 27, 2024 – 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.
The study, “Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis” was published in The Lancet Public Health.
Authors: Booth R, Dasgupta M, Forchuk C, Shariff S.
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario
ABOUT LAWSON HEALTH RESEARCH INSTITUTE
Lawson Health Research Institute is one of Canada’s top hospital-based research institutes, tackling the most pressing challenges in health care. As the research institute of London Health Sciences Centre and St. Joseph’s Health Care London, our innovation happens where care is delivered. Lawson research teams are at the leading-edge of science with the goal of improving health and the delivery of care for patients. Working in partnership with Western University, our researchers are encouraged to pursue their curiosity, collaborate often and share their discoveries widely. Research conducted through Lawson makes a difference in the lives of patients, families and communities around the world.
FOR FURTHER INFORMATION PLEASE CONTACT:
Misty Pratt
Senior Communications Associate, ICES
Misty.Pratt@ices.on.ca 613-882-7065
JOURNAL
The Lancet Public Health
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis
ARTICLE PUBLICATION DATE
27-Mar-2024
Delirium a ‘strong risk factor’ for dementia among older people
Delirium linked to triple the risk of dementia in older people, findings show
Delirium is a strong risk factor for dementia and death among older people, finds the largest study of its kind published by The BMJ today.
The findings show that, among hospital patients with at least one episode of delirium, the risk of receiving a new dementia diagnosis was three times higher than for patients without delirium and each additional episode of delirium increased that risk by 20%.
The researchers say their findings support the theory that delirium has a strong independent effect on dementia risk in this clinical population.
Delirium is a sudden change in a person’s usual mental state. Symptoms include agitation, confusion or being unable to stay focused when awake. Delirium is much more common in hospital patients and older people.
Previous observational studies have suggested an association between delirium and subsequent dementia, but study limitations leave the size and nature of this relationship unclear.
Yet as the global burden of dementia increases, it is of critical importance to confirm the extent to which delirium is a potentially modifiable risk factor.
To try and address these uncertainties, researchers in Australia analysed data from 626,467 patients aged 65 years and older with no dementia diagnosis who were admitted to hospital in New South Wales between January 2009 and December 2014.
Of these patients, 55,211 had at least one recorded episode of delirium and were matched to another 55,211 patients without delirium by age, sex, frailty, reason for being in hospital, length of stay in hospital and length of stay in the intensive care unit.
These 110,422 patients (average age 83; 52% women) were then followed-up for five years to see how many of them were diagnosed with dementia.
Collectively, 58% (63,929) of patients died and 17% (19,117) had a newly reported dementia diagnosis over the follow-up period.
The researchers found that patients with delirium had a 39% higher risk of death and three times the risk of being diagnosed with dementia than patients without delirium.
The relationship between delirium and dementia was stronger in men than women and each additional episode of delirium was associated with a 20% increased risk of developing dementia (a dose-response relationship).
These are observational findings, so cannot establish cause, and the authors acknowledge that hospital data may not be completely accurate. Nor can they rule out the possibility that other unmeasured factors may have affected their results.
However, this was a large, well-designed study with a long follow-up period, and results were similar after further analyses to test the strength of the associations, suggesting that they are robust.
“While our results are consistent with the hypothesis that delirium plays a causative part in dementia, they are not conclusive owing to the fundamental limitations of observational studies in determining causality,” they write. “Nevertheless, the results of this study provide valuable insights because prospective randomised controlled trials are unlikely to be conducted.”
“Delirium is a factor that could triple a person’s risk of dementia. Therefore, delirium prevention and treatment are opportunities to reduce dementia burden globally,” they conclude.
JOURNAL
The BMJ
METHOD OF RESEARCH
Observational study
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Delirium and incident dementia in hospital patients in New South Wales, Australia: retrospective cohort study
ARTICLE PUBLICATION DATE
27-Mar-2024
COI STATEMENT
All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from National Health and Medical Research Council: Partnership Centre for Health System Sustainability for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
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