1
|
Booth RG, Dasgupta M, Forchuk C, Shariff SZ. Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis. Lancet Public Health 2024; 9:e240-e249. [PMID: 38553143 DOI: 10.1016/s2468-2667(24)00022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Cognitive decline in people experiencing homelessness is an increasingly recognised issue. We compared the prevalence of dementia among people experiencing homelessness to housed individuals in the general population and those living in low-income neighbourhoods. METHODS We conducted a population-based, cross-sectional, comparative analysis using linked health-care administrative data from Ontario, Canada. We included individuals aged 45 years or older on Jan 1, 2019, who visited hospital-based ambulatory care (eg, emergency department), were hospitalised, or visited a community health centre in 2019; and identified people experiencing homelessness if they had one or more health-care records with an indication of homelessness or unstable housing. Prevalence of dementia was ascertained as of Dec 31, 2019, using a validated case definition for Alzheimer's disease and related dementia that was modified to include diagnoses made at a community health centre. Poisson models were used to generate estimates of prevalence. Estimates were compared with Ontarians that accessed any of the same health-care services over the same time, overall (general population group), and among those who were in the lowest quintile of area-based neighbourhood income (low-income group). FINDINGS 12 863 people experiencing homelessness, 475 544 people in the low-income comparator group, and 2 273 068 people in the general population comparator group were included in the study. Dementia prevalence was 68·7 per 1000 population among people experiencing homelessness, 62·6 per 1000 population in the low-income group, and 51·0 per 1000 population in the general population group. Descriptively, prevalence ratios between people experiencing homelessness and the comparator groups were highest within the ages of 55-64 years and 65-74 years in both sexes, ranging from 2·98 to 5·00. After adjusting for age, sex, geographical location of residence (urban vs rural), and health conditions associated with dementia, the prevalence ratio of dementia among people experiencing homelessness was 1·71 (95% CI 1·60-1·82) compared with the low-income group and 1·90 (1·79-2·03) compared with the general population group. INTERPRETATION People experiencing homelessness experience a high burden of dementia compared with housed populations in Ontario. Findings suggest that people experiencing homelessness might experience dementia at younger ages and could benefit from the development of proactive screening and housing interventions. FUNDING The Public Health Agency of Canada.
Collapse
Affiliation(s)
- Richard G Booth
- ICES Western, London, ON, Canada; Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Monidipa Dasgupta
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Salimah Z Shariff
- ICES Western, London, ON, Canada; Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| |
Collapse
|
2
|
Blumberg MJ, Petersson AM, Jones PW, Jones AA, Panenka WJ, Leonova O, Vila-Rodriguez F, Lang DJ, Barr AM, MacEwan GW, Buchanan T, Honer WG, Gicas KM. Differential sensitivity of intraindividual variability dispersion and global cognition in the prediction of functional outcomes and mortality in precariously housed and homeless adults. Clin Neuropsychol 2024:1-24. [PMID: 38444068 DOI: 10.1080/13854046.2024.2325167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
OBJECTIVE To examine cognitive intraindividual variability (IIV) dispersion as a predictor of everyday functioning and mortality in persons who are homeless or precariously housed. METHOD Participants were 407 community-dwelling adults, followed for up to 13 years. Neurocognition was assessed at baseline and IIV dispersion was derived using a battery of standardized tests. Functional outcomes (social, physical) were obtained at baseline and last follow-up. Mortality was confirmed with Coroner's reports and hospital records (N = 103 deaths). Linear regressions were used to predict current social and physical functioning from IIV dispersion. Repeated measures Analysis of Covariance were used to predict long-term change in functioning. Cox regression models examined the relation between IIV dispersion and mortality. Covariates included global cognition (i.e. mean-level performance), age, education, and physical comorbidities. RESULTS Higher IIV dispersion predicted poorer current physical functioning (B = -0.46 p = .010), while higher global cognition predicted better current (B = 0.21, p = .015) and change in social functioning over a period of up to 13 years (F = 4.23, p = .040). Global cognition, but not IIV dispersion, predicted mortality in individuals under 55 years old (HR = 0.50, p = .013). CONCLUSIONS Our findings suggest that indices of neurocognitive functioning (i.e. IIV dispersion and global cognition) may be differentially related to discrete dimensions of functional outcomes in an at-risk population. IIV dispersion may be a complimentary marker of emergent physical health dysfunction in precariously housed adults and may be best used in conjunction with traditional neuropsychological indices.
Collapse
Affiliation(s)
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Canada
- Department of Psychology, University of the Fraser Valley, Abbotsford, Canada
| |
Collapse
|
3
|
Del Brutto OH, Rumbea DA, Costa AF, Patel M, Sedler MJ, Mera RM. Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study. Clin Neurol Neurosurg 2024; 236:108053. [PMID: 37992533 DOI: 10.1016/j.clineuro.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS Cognitive impairment is associated with mortality in the study population.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maitri Patel
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
| |
Collapse
|
4
|
Gicas KM, Benitah K, Thornton AE, Petersson AM, Jones PW, Stubbs JL, Jones AA, Panenka WJ, Lang DJ, Leonova O, Vila-Rodriguez F, Barr AM, Buchanan T, Su W, Vertinsky AT, Rauscher A, MacEwan GW, Honer WG. Using serial position effects to investigate memory dysfunction in homeless and precariously housed persons. Clin Neuropsychol 2023; 37:1710-1727. [PMID: 36790121 DOI: 10.1080/13854046.2023.2178513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
Background: Homeless and precariously housed persons exhibit significant memory impairment, but the component processes underlying memory dysfunction have not been explored. We examined the serial position profile (i.e., primacy and recency effects) of verbal memory and its neuroanatomical correlates to identify the nature of memory difficulties in a large cohort of homeless and precariously housed adults. Method: The sample included 227 community-dwelling homeless and precariously housed adults. Serial position scores (primacy, middle, recency) were computed using the Hopkins Verbal Learning Test-Revised. Paired sample t-tests were used to compare percent recall from each word list region. Age-adjusted correlations assessed associations between serial position scores and other cognitive domains (attention, processing speed, executive functioning). Regression analyses were conducted to examine regional brain volumes of interest (hippocampus, entorhinal cortex, dorsolateral prefrontal cortex [DLPFC]) and their differential associations with serial position scores. Results: The serial position profile was characterized by a diminished recency effect in relation to the primacy effect. Serial position scores positively correlated with sustained attention and cognitive control. Larger hippocampal volume was associated with better primacy item recall. DLPFC volume was not associated with serial position recall after adjustment for false discovery rate. There were no associations between regional brain volumes and recency item recall. Conclusion: Our results suggest that commonly reported memory difficulties in homeless and precariously housed adults are likely secondary to a core deficit in executive control due to compromised frontal lobe functioning. These findings have implications for cognitive rehabilitation in this complex and vulnerable group.
Collapse
Affiliation(s)
| | - Katie Benitah
- Department of Psychology, York University, Toronto, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Anna M Petersson
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Paul W Jones
- Department of Psychology, Simon Fraser University, Burnaby, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Andrea A Jones
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - Alexander Rauscher
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
- British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| |
Collapse
|
5
|
Maye JE, Van Patten R, Lykins HC, Vella L, Mahmood Z, Clark JMR, Twamley EW. Memory, fluid reasoning, and functional capacity in adults experiencing homelessness. Clin Neuropsychol 2023; 37:1441-1454. [PMID: 36154911 PMCID: PMC10039959 DOI: 10.1080/13854046.2022.2125906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVE In individuals experiencing homelessness, determinants of functional capacity (i.e. the ability to perform activities of daily living) are poorly understood. Identifying potentially modifiable correlates of functional capacity, such as cognitive abilities, may inform treatment targets to address independence and housing stability. This study aimed to identify the strongest neuropsychological predictors of variance in functional performance in 100 adults living in a homeless shelter. METHODS Participants completed a brief cognitive screening test, from which four composite scores were derived, as well as tests of processing speed, fluid reasoning, premorbid intellectual function, and performance-based functional capacity. We conducted a hierarchical linear regression to predict variance in functional capacity. RESULTS Beyond the impact of education and premorbid intellectual function, better memory and fluid reasoning predicted better functional performance. CONCLUSIONS Although our cross-sectional design does not permit causal inference, it is possible that interventions targeting memory and fluid reasoning may improve functional ability in individuals experiencing homelessness.
Collapse
Affiliation(s)
- Jacqueline E. Maye
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| | - Ryan Van Patten
- Department of Psychiatry and Human Behavior, Brown University
- VA Providence Healthcare System
| | | | - Lea Vella
- University of California San Francisco Health, Department of Quality and Patient Safety
| | - Zanjbeel Mahmood
- Research Service, VA San Diego Healthcare System
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Jillian M. R. Clark
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Mental Health Service, VA San Diego Healthcare System
| | - Elizabeth W. Twamley
- Research Service, VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California San Diego
| |
Collapse
|
6
|
Cho LL, Jones AA, Gao C, Leonova O, Vila-Rodriguez F, Buchanan T, Lang DJ, MacEwan GW, Procyshyn RM, Panenka WJ, Barr AM, Thornton AE, Gicas KM, Honer WG, Barbic SP. Rasch analysis of the beck depression inventory in a homeless and precariously housed sample. Psychiatry Res 2023; 326:115331. [PMID: 37437487 DOI: 10.1016/j.psychres.2023.115331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 07/01/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
The approach to analysis of and interpretation of findings from the Beck Depression Inventory (BDI), a self-report questionnaire, depends on sample characteristics. To extend work using conventional BDI scoring, the BDI's suitability in assessing symptom severity in a homeless and precariously housed sample was examined using Rasch analysis. Participants (n=478) recruited from an impoverished neighbourhood in Vancouver, Canada, completed the BDI. Rasch analysis using the partial credit model was done, and the structural validity, unidimensionality, and reliability of the BDI were studied. A receiver operating characteristic curve determined a Rasch cut-off score consistent with clinical depression, and Rasch scores were correlated with raw scores. Good fit to the Rasch model was observed after rescoring all items and removing Item 19 (Weight Loss), and unidimensionality and reliability were satisfactory. Item 9 (Suicidal Wishes) represented the most severe symptom. Rasch-based scores detected clinical depression with moderate sensitivity and specificity, and were positively correlated with conventional scores. The BDI in a community-based sample of homeless and precariously housed adults satisfied Rasch model expectations in a 20-item format, and is suitable for assessing symptom severity. Future research on depression in similar samples may reveal more information on using specific symptoms to determine clinical significance.
Collapse
Affiliation(s)
- Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chloe Gao
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada
| | - Olga Leonova
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fidel Vila-Rodriguez
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Donna J Lang
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - William J Panenka
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada; Department of Anesthesia, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, British Columbia, Canada
| | - Skye P Barbic
- Department of Occupational Science and Occupational Therapy, University of British Columbia, T325 - 2211 Wesbrook Mall, Vancouver, British Columbia, Canada.
| |
Collapse
|
7
|
Mantell R, Hwang YIJ, Radford K, Perkovic S, Cullen P, Withall A. Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants. Front Public Health 2023; 11:1086215. [PMID: 37006541 PMCID: PMC10061143 DOI: 10.3389/fpubh.2023.1086215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionOlder people experiencing homelessness (PEH) are a rapidly growing population at risk of accelerated aging and the early onset of geriatric conditions. One construct that shows promise in predicting age-related decline is frailty. Better understanding the rates and causes of frailty in PEH may improve understanding of its antecedents, thereby facilitating more targeted health and aged care service interventions. The aim of this study was to conduct a rapid review on the prevalence and determinants of frailty in adult PEH.MethodsWe conducted a rapid review of primary research papers studying PEH and frailty or frailty-related concepts.ResultsFourteen studies were included, which indicate that frailty presents earlier and at higher rates in PEH than community-dwelling cohorts. A notable difficulty for many aging PEH was early-onset cognitive impairment which was associated with a range of negative functional outcomes. Another recurrent theme was the negative impact that drug and alcohol use and dependence can have on the health of PEH. Further, psychosocial and structural determinants such as loneliness, living in an impoverished neighborhood and being female had statistically significant associations with frailty and functional decline in PEH.Discussion and implicationsPEH in their 40s and 50s can be frail and experience geriatric conditions, including cognitive impairment. Factors that have important relationships to frailty and functional decline in PEH include cognitive deficits, drug and alcohol dependence and loneliness, as well as upstream determinants such as gender and ethnicity. More targeted data and research on these factors, including cohort studies to better investigate their potentially causal effects, is important for researchers and practitioners assessing and treating frailty in PEH, particularly those interested in early intervention and prevention.Prospero registration IDCRD42022292549.
Collapse
Affiliation(s)
- Rhys Mantell
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- *Correspondence: Rhys Mantell
| | - Ye In Jane Hwang
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Kylie Radford
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
- School of Psychology, Faculty of Science, University of New South Wales (UNSW), Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Sydney, NSW, Australia
| | - Silvija Perkovic
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Patricia Cullen
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- The George Institute for Global Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- Ngarruwan Ngadju: First Peoples Health and Wellbeing Research Centre, University of Wollongong, Wollongong, NSW, Australia
| | - Adrienne Withall
- School of Population Health, Faculty of Medicine and Health, University of New South Wales (UNSW), Sydney, NSW, Australia
- UNSW Ageing Futures Institute, University of New South Wales (UNSW), Sydney, NSW, Australia
| |
Collapse
|
8
|
Gicas KM, Mejia-Lancheros C, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site. Psychol Med 2023; 53:362-370. [PMID: 33926584 DOI: 10.1017/s0033291721001550] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High rates of physical and mental health comorbidities are associated with functional impairment among persons who are homeless. Cognitive dysfunction is common, but how it contributes to various functional outcomes in this population has not been well investigated. This study examines how cognition covaries with community functioning and subjective quality of life over a 6-year period while accounting for the effects of risk and protective factors. METHODS Participants were 349 homeless adults (mean age = 39.8) recruited from the Toronto site of the At Home/Chez Soi study, a large Canadian randomized control trial of Housing First. Participants completed up to four clinical evaluations over 6 years. Factor scores were created to index verbal learning and memory (vLM) and processing speed-cognitive flexibility (PSCF). The primary outcomes were community functioning and subjective quality of life. Risk factors included lifetime homelessness, mental health diagnoses, medical comorbidity, and childhood adversity. Linear mixed-effects models were conducted to examine cognition-functional outcome associations over time, with resilience as a moderator. RESULTS Better vLM (b = 0.787, p = 0.010) and PSCF (b = 1.66, p < 0.001) were associated with better community functioning, but not with quality of life. Resilience conferred a protective effect on subjective quality of life (b = 1.45, p = 0.011) but did not moderate outcomes. CONCLUSIONS Our findings suggest a need to consider the unique determinants of community functioning and quality of life among homeless adults. Cognition should be prioritized as a key intervention target within existing service delivery models to optimize long-term functional outcomes.
Collapse
Affiliation(s)
- K M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - C Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - R Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - R Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - S W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - V Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Elliott J, Forchuk C, Sacco V, Hiebert B, Tong CE, Whate A, Bondy J, Stolee P. Responding to COVID-19 with integrative health and sheltering models for persons experiencing homelessness in Southern Ontario, Canada: protocol for a qualitative study exploring implementation and sustainability. BMJ Open 2022; 12:e069945. [PMID: 36600420 PMCID: PMC9772633 DOI: 10.1136/bmjopen-2022-069945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION COVID-19 has disproportionately impacted persons experiencing homelessness in Canada, who are at an increased risk of infection and severe outcomes. In response to the pandemic, several regions have adopted programmes that aim to address the intersecting nature of health and social challenges faced by persons facing homelessness. These programmes adopted during the pandemic may contribute to broader health and social impacts beyond limiting COVID-19 transmission, but the processes involved in developing and implementing these types of programmes and their sustainability after the pandemic are unknown. Our overall goal is to understand the processes of developing and implementing integrative health and sheltering initiatives in Ontario during COVID-19, as well as their sustainability post-pandemic. METHODS AND ANALYSIS This study will use a multiple case study design-two cases over 1 year-enabling us to investigate how integrative health and sheltering approaches have been implemented in two mid-sized cities in Ontario, Canada. Each case will offer a unique narrative; through cross-case analysis, the cases will highlight programme operations, successes and challenges. Data will be collected using semi-structured interviews with programme staff and managers, and document analysis. Project partners will be brought together to further explore and interpret findings, along with co-creating a sustainability action plan and policy documents. ETHICS AND DISSEMINATION Ethics clearance was obtained through the Western University Research Ethics Board and the University of Waterloo Office of Research Ethics. Findings will be disseminated through publications, conference presentations and lay summary reports.
Collapse
Affiliation(s)
- Jacobi Elliott
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St Joseph's Health Care London, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Veronica Sacco
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Bradley Hiebert
- Lawson Health Research Institute, London, Ontario, Canada
- Specialized Geriatric Services, St Joseph's Health Care London, London, Ontario, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Catherine E Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Alexandra Whate
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Paul Stolee
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
10
|
Babulal GM, Rani R, Adkins-Jackson P, Pearson AC, Williams MM. Associations between Homelessness and Alzheimer's Disease and Related Dementia: A Systematic Review. J Appl Gerontol 2022; 41:2404-2413. [PMID: 35750476 PMCID: PMC10018777 DOI: 10.1177/07334648221109747] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The homeless population in the United States is rapidly aging, with a parallel increase in Alzheimer's disease and related dementia (ADRD). During an evolving pandemic that jeopardizes employment and housing, assessing the relationship between ADRD and homelessness is critical since the latter is potentially intervenable. The objective of this study is to review the literature and determine whether there is an association between homelessness and dementia risk. A systematic review of existing studies was conducted through PubMED, SCOPUS, and EMBASE among others. Of the 228 results found, nine met inclusion criteria. Homeless studies mainly centered on veteran populations (n = 6/9). There is a complex relationship suggesting homelessness as a risk for and consequence of ADRD but also co-occurrence with psychiatric disorders, substance abuse, and traumatic injuries. Future studies should employ enumeration surveys with modular longitudinal tracking and measure social determinants of health, discrimination, chronic stress, and mood disorders.
Collapse
Affiliation(s)
- Ganesh M. Babulal
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, MO, USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rohan Rani
- Department of Molecular and Cellular Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | | | - Adam C. Pearson
- Peter & Paul Community Services, St. Louis, MO, USA
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Monique M. Williams
- Program in Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
- New Horizons PACE, St. Louis, MO, USA
| |
Collapse
|
11
|
Mullady SSS, Castellanos S, Lopez L, Aguirre G, Weeks J, King S, Valle K, Goode C, Tsoy E, Possin K, Miller B, Kushel M, Lanata S. Neurocognitive health of older adults experiencing homelessness in Oakland, California. Front Neurol 2022; 13:905779. [PMID: 35937073 PMCID: PMC9353024 DOI: 10.3389/fneur.2022.905779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background and objectives The homeless population in the US is aging. Cognitive impairment is prevalent in this population, yet little is known about the neurologic etiologies of such impairment. Addressing this gap in knowledge is important because homeless older adults with cognitive impairment due to neurodegenerative disease may need lifelong tailored support to obtain and maintain housing. In this study, we characterized the neurocognitive health of a sample of adults who experienced homelessness for the first time after age 50 using gold standard behavioral neurology examination practices. Methods We conducted a descriptive cross-sectional study of older adults who first experienced homelessness after age 50. We recruited our sample purposively from an ongoing longitudinal cohort study of adults who were aged 50 and over and homeless when they entered the cohort. For this sub study, we enrolled a convenience sample from those who reported their first episode of homelessness after age 50. We did not exclude individuals based on history of substance use. Neurologists conducted a structured neurocognitive history intake, neurological examination, neuropsychological evaluation, and functional assessment between November 2020 and February 2021. We screened all participants for neurocognitive disorders using gold standard clinical research diagnostic criteria. Results We evaluated 25 participants, most were men (76%) and Black (84%), with a median age of 61 years. The most common neurocognitive complaints included deficits in recent episodic memory (n = 15, 60%), executive functions (n = 13, 52%), and behavior/mood, with apathy being the most common complaint (n = 20, 80%). Neuropsychological testing revealed a high prevalence of socioemotional deficits (n = 20, 80%). Common neurological examination deficits included difficulties with coordination, such as impaired Luria task (n = 16, 64%), signs of distal peripheral neuropathy (n = 8, 32%), anosmia/hyposmia (n = 4, 21%), and signs of mild Parkinsonism (n = 5, 20%). The most common diagnoses were MCI (n = 7, 28%), bvFTD (n = 4, 16%), AD (n = 4, 16%), and DLB (n = 2, 8%). Discussion Our findings suggest that neurocognitive concerns and examination deficits are common among older homeless adults. Specific neurocognitive disorders may be overrepresented in this population, particularly frontotemporal disorders. Longitudinal studies involving brain biomarkers are needed to characterize the neurocognitive health of this vulnerable population more precisely.
Collapse
Affiliation(s)
- Sandeepa Satya-Sriram Mullady
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,*Correspondence: Sandeepa Satya-Sriram Mullady
| | - Stacy Castellanos
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Lucia Lopez
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Gloria Aguirre
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - John Weeks
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Stephen King
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Karen Valle
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Collette Goode
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Katherine Possin
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Miller
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Department of Internal Medicine, UCSF Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States,Serggio Lanata
| |
Collapse
|
12
|
O'Connor TA, Panenka WJ, Livingston EM, Stubbs JL, Askew J, Sahota CS, Feldman SJ, Buchanan T, Xu L, Hu XJ, Lang DJ, Woodward ML, Thornton WL, Gicas KM, Vertinsky AT, Heran MK, Su W, MacEwan GW, Barr AM, Honer WG, Thornton AE. Traumatic brain injury in precariously housed persons: Incidence and risks. EClinicalMedicine 2022; 44:101277. [PMID: 35252825 PMCID: PMC8888336 DOI: 10.1016/j.eclinm.2022.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Homeless and precarious housed persons are particularly prone to traumatic brain injuries (TBIs), but existent incidence rates are hampered by poor case acquisition. We rigorously documented TBIs in precariously housed persons transitioning in and out of homelessness. METHODS Between December 2016 and May 2018, 326 precariously housed participants enrolled in a longitudinal study in Vancouver, Canada were assessed monthly for TBI occurrences after education on sequelae. Over one participant-year, 2433 TBI screenings were acquired for 326 person-years and variables associated with odds of incident TBI were evaluated. FINDINGS One hundred participants acquired 175 TBIs, yielding an observed incidence proportion of 30·7% and event proportion of 53·7%. Of the injured, 61% reported one TBI and 39% reported multiple injuries. Acute intoxication was present for more than half of the TBI events assessed. Additionally, 9·7% of TBI events occurred in the context of a drug overdose. Common injury mechanisms were falls (45·1%), assaults (25·1%), and hitting one's head on an object (13·1%). In this community-based but non-randomly recruited sample, exploratory analyses identified factors associated with odds of an incident TBI over one year of follow-up, including: schizophrenia disorders (odds ratio (OR) = 0·43, 95% confidence interval (CI) 0·19, 0·94), role functioning (OR = 0·69, 95% CI 0·52, 0·91), opioid dependence (OR = 2·17, 95% CI 1·27, 3·72) and those reporting past TBIs (OR = 1·99, 95% CI 1·13, 3·52). INTERPRETATION Given the ubiquity of TBIs revealed in this precariously housed sample, we identify an underappreciated and urgent healthcare priority. Several factors modified the odds of incident TBI, which can facilitate investigations into targeted prevention efforts. FUNDING Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, William and Ada Isabelle Steel Research Fund, Simon Fraser University Vice-President Research Undergraduate Student Research Award and Simon Fraser University Psychology Department Research Grant.
Collapse
Affiliation(s)
- Tiffany A. O'Connor
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - William J. Panenka
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Emily M. Livingston
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | - Jacob L. Stubbs
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Julia Askew
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Charanveer S. Sahota
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
| | | | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Linwan Xu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - X. Joan Hu
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, BC, Canada
| | - Donna J. Lang
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Kristina M. Gicas
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Manraj K. Heran
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - G. William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- British Columbia Mental Health and Substance Use Services Research Institute
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Mental Health and Substance Use Services Research Institute
- Correspondence to: Allen E. Thornton, Human Neuropsychology Laboratory, Department of Psychology, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| |
Collapse
|
13
|
Oliveira GTA, Elsangedy HM, Pereira DC, de Melo Silva R, Faro HKC, Bortolotti H, Costa EC, Fontes EB. Effects of 12 weeks of high-intensity interval, moderate-intensity continuous and self-selected intensity exercise training protocols on cognitive inhibitory control in overweight/obese adults: A randomized trial. Eur J Sport Sci 2021; 22:1724-1733. [PMID: 34429030 DOI: 10.1080/17461391.2021.1969433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Growing evidence shows that aerobic exercise improves cognitive function. However, it is unclear how exercising at different exercise intensities affects cognitive inhibitory control in overweight/obese adults. Herein we compared the effects of 12 weeks of high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), and self-selected intensity training (SSIT) on cognitive inhibitory control in overweight/obese adults. A total of 64 adults (59.4% women, 31.3 ± 7.1 years, 29 ± 2.5 kg/m²) were randomized into three walking/running groups: HIIT, MICT and SSIT. All groups performed three exercise sessions per week on an outdoor running track for 12 weeks. Cognitive inhibitory control was assessed at baseline and after the exercising programs using a computerized version of the Stroop Color-Words test. The HIIT and SSIT resulted in a faster Stroop effect (i.e. enhanced performance) when compared to MICT (p=.018; p= .026), however, there were no significant differences between the HIIT and SSIT groups (p> .05). The enhanced Stroop effect was correlated with increases in cardiorespiratory fitness after HIIT (r= -.521, p= .018) and decreases in body fat after MICT (r= .671, p= .001). These findings may suggest that overweight/obese adults performing exercise interventions at higher intensities or self-selected intensity may enhance their cognitive ability to inhibit automated behavioral responses.
Collapse
Affiliation(s)
- Gledson Tavares Amorim Oliveira
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.,Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Raíssa de Melo Silva
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Henrique Bortolotti
- Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Eduardo Caldas Costa
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.,Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Eduardo Bodnariuc Fontes
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil.,Department of Physical Education, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
14
|
Maalouf M, Fearon M, Lipa MC, Chow-Johnson H, Tayeh L, Lipa D. Neurologic Complications of Poverty: the Associations Between Poverty as a Social Determinant of Health and Adverse Neurologic Outcomes. Curr Neurol Neurosci Rep 2021; 21:29. [PMID: 33948738 DOI: 10.1007/s11910-021-01116-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Increasing attention has been paid in recent decades to social determinants of health as a risk factor for disease development and disease severity. While traditionally heart disease, family history, lipid profile, and tobacco use have all been associated with increased risk of neurological disease, numerous studies now show that the influence of poverty may be just as strong a risk factor. This study summarizes the recent literature on poverty as it contributes to neurological disease. RECENT FINDINGS Children growing up in poverty have increased risk for cognitive deficits and behavioral disorders as reported by Noble et al. (Dev Sci. 9(6):642-54, 2006) and Farah et al. (Brain Res. 1110(1):166-74, 2006) as well as worse outcomes when it comes to epilepsy management and disease course as discussed by Camfield et al. (Epilepsia. 57(11):1826-33, 2016). In adulthood, as the number of social determinants of health increases, the incidence of stroke and severe stroke increases significantly as reported by Reshetnyak et al. (Stroke. 51:2445-53, 2020) as does exposure to neurologically significant infectious diseases and incidence of dementia as reported by Sumilo et al. (Rev Med Virol. 18(2):81-95, 2008) and Zuelsdorff et al. (Alzheimer's Dement. 6(1):e12039, 2020). Social determinants of health including poverty should be considered a risk factor for disease. More attention is needed from clinicians as well as from a public health perspective to address this disparity.
Collapse
|
15
|
Lei M, Rintoul K, Stubbs JL, Kim DD, Jones AA, Hamzah Y, Procyshyn RM, Gicas KM, Cho LL, Panenka WJ, Thornton AE, Lang DJ, MacEwan GW, Honer WG, Barr AM. Characterization of Bodily Pain and Use of Both Prescription and Non-Prescription Opioids in Tenants of Precarious Housing. Subst Use Misuse 2021; 56:1951-1961. [PMID: 34338612 DOI: 10.1080/10826084.2021.1958865] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
opioid use, which includes both prescribed and non-prescribed drugs, is relatively common amongst marginalized populations. Past research has shown that among those who use non-prescribed or diverted opioids recreationally, many were first exposed to the drug as prescribed pain medication. Objective: to better understand the relationship between pain and opioid use in tenants of precarious housing. Methods: in the present study, 440 individuals from a cohort living in homeless or precariously housed conditions in a neighborhood with high rates of poverty and drug use were interviewed for their bodily pain and opioid use. We examined the relationship between bodily pain levels, assessed using the Maudsley Addiction Profile questionnaire, and prescribed, non-prescribed and combined self-reported opioid use in the prior 28 days assessed using the Timeline Followback and Doctor-Prescribed Medication Timeline Followback questionnaires. Results: Analysis of the results indicated that sex (female), age (younger) and early exposure to opioids (≤ age 18) predicted current opioid use, but there was no association between current bodily pain levels and opioid use. Conclusions: these unexpected findings indicate the complex nature of the relationship between pain and opioid use in this population.
Collapse
Affiliation(s)
- Michelle Lei
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn Rintoul
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob L Stubbs
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David D Kim
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea A Jones
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yasmin Hamzah
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ric M Procyshyn
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kristina M Gicas
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Lianne L Cho
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Allen E Thornton
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Donna J Lang
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G William MacEwan
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - William G Honer
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alasdair M Barr
- Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
16
|
Abstract
SUMMARYHomelessness has long been associated with high rates of psychosis, alcohol and substance misuse, and personality disorder. However, psychiatric services in the UK have only recently engaged actively with homeless people. This article provides some background information about homelessness and mental illness and describes the elements of inclusion health and some of the models of service for homeless people that have been established over the past 30 years.
Collapse
|
17
|
Jones AA, Gicas KM, Seyedin S, Willi TS, Leonova O, Vila-Rodriguez F, Procyshyn RM, Smith GN, Schmitt TA, Vertinsky AT, Buchanan T, Rauscher A, Lang DJ, MacEwan GW, Lima VD, Montaner JSG, Panenka WJ, Barr AM, Thornton AE, Honer WG. Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada. PLoS Med 2020; 17:e1003172. [PMID: 32628679 DOI: 10.1371/journal.pmed.1003172] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 06/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The "trimorbidity" of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. METHODS AND FINDINGS A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1-8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner's reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05-1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01-1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02-1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19-2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09-3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08-3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03-5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one-third of participants grew up in foster care or were adopted, useful family history information was not obtainable. CONCLUSIONS In this study, we found methamphetamine, alcohol, and cannabis use were associated with higher risk for psychotic features, as were a past history of psychotic disorder, and experiencing traumatic events. We found that alcohol dependence, hepatic fibrosis, and, only among participants <55 years of age, history of a psychotic disorder were associated with greater risk for mortality. Modifiable risk factors in people living in precarious housing or homelessness can be a focus for interventions.
Collapse
|
18
|
Jones PW, Thornton AE, Jones AA, Knerich VM, Lang DJ, Woodward ML, Panenka WJ, Su W, Barr AM, Buchanan T, Honer WG, Gicas KM. Amygdala Nuclei Volumes Are Selectively Associated With Social Network Size in Homeless and Precariously Housed Persons. Front Behav Neurosci 2020; 14:97. [PMID: 32612516 PMCID: PMC7309349 DOI: 10.3389/fnbeh.2020.00097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The amygdala is a brain region comprised of a group of functionally distinct nuclei that play a central role in social behavior. In homeless and precariously housed individuals, high rates of multimorbidity, and structural aspects of the environment may dysregulate social functioning. This study examined the neurobiological substrates of social connection in homeless and precariously housed persons by examining associations between amygdala nuclei volumes and social network size. Methods: Sixty participants (mean age 43.6 years; 73.3% male) were enrolled from an ongoing study of homeless and precariously housed adults in Vancouver, Canada. Social network size was assessed using the Arizona Social Support Interview Schedule. Amygdala nuclei volumes were extracted from anatomic T1-weighted MRI data. The central and basolateral amygdala nuclei were selected as they are implicated in anxiety-related and social behaviors. The hippocampus was included as a control brain region. Multivariable regression analysis investigated the relationship between amygdala nuclei volumes and social network size. Results: After controlling for age, sex, and total brain volume, individuals with the larger amygdala and central nucleus volumes had a larger network size. This association was not observed for the basolateral amygdala complex, though subsequent analysis found the basal and accessory basal nuclei of the basolateral amygdala were significantly associated with social network size. No association was found for the lateral amygdala nucleus or hippocampus. Conclusions: These findings suggest that select amygdala nuclei may be differentially involved in the social connections of persons with multimorbid illness and social marginalization.
Collapse
Affiliation(s)
- Paul W. Jones
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Allen E. Thornton
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Andrea A. Jones
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Verena M. Knerich
- Department of Computer Science, Ludwig Maximilians University, Munich, Germany
| | - Donna J. Lang
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa L. Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William J. Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Wayne Su
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Alasdair M. Barr
- Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Tari Buchanan
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - William G. Honer
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kristina M. Gicas
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| |
Collapse
|