PROVIDENCE, RI — Veterans who are at risk of being homeless to have significant greater risk of having Alzheimer’s disease and related dementias compared to other veterans.
A new study noted that housing insecure veterans are aging, but it is not clear how often those veterans have Alzheimer’s disease and related dementias (AD/ADRD).
To remedy that, a study team led by researchers from the Providence, RI, VAMC, Brown University School of Public Health in Providence and the VA National Center on Homelessness in Tampa, FL, calculated the prevalence of AD/ADRD diagnoses in 2018 among veterans that experienced homelessness, were at risk for homelessness or were stably housed.
In the report in Alzheimer’s & Dementia, researchers focused on use of acute care services—emergency department, hospitalizations, psychiatric hospitalizations—and any long-term care—nursing home and community based—by housing status among veterans with an AD/ADRD diagnosis.1
Results indicated that the overall prevalence of AD/ADRD diagnoses for homeless, at-risk and stably housed veterans was 3.66%, 13.48% and 3.04%, respectively. “Housing insecure veterans with AD/ADRD used more acute care, and were more likely to have a nursing home admission compared to stably housed veterans,” the authors pointed out. “At risk, but not homeless veterans, were more likely to use U.S. Department of Veterans Affairs-paid home and community-based care than stably housed veterans.”
A research brief two years ago from the VA National Center on Homelessness in Veterans noted that the age of onset for most dementias begins at 65 with earlier onset being infrequent. “However, in homeless populations, cognitive impairment and functional decline have been found to have a notable prevalence in individuals as early as ages in the 50s,” wrote John A. Schinka, PhD. “No research to date has determined whether these cases might represent, in part, early onset of dementia or whether they reflect the direct cumulative impact of factors such as alcohol abuse, head injury, and chronic health conditions. This determination is difficult, as many of the conditions found in the homeless population are also risk factors for dementia, such as hypertension, diabetes, poor nutrition, and smoking.”
The brief also described how the homeless veteran population is aging and is also characterized by numerous modifiable risk factors for dementia. “However, in the veteran homeless population these factors remain potent because of barriers to health care access or poor compliance,” Schinka suggested. “This risk profile may be heightened by the potential for accelerated biological aging, a primary hypothesized factor for early mortality in homeless veterans. In view of these possibilities, the VA has initiated training throughout its housing programs to assist program staff to identify symptoms of dementia, screening veterans for target indicators, and initiate comprehensive medical evaluations when warranted.”
- Jutkowitz E, Halladay C, Tsai J, Hooshyar D, Quach L, O’Toole T, Rudolph JL. Prevalence of Alzheimer’s disease and related dementias among veterans experiencing housing insecurity. Alzheimers Dement. 2021 Nov 10. doi: 10.1002/alz.12476. Epub ahead of print. PMID: 34757668.