Identification of cognitive impairment and mental illness in elderly homeless men: Before and after access to primary health care.

OBJECTIVE

To describe the occurrence of mental health problems and cognitive impairment in a group of elderly homeless men and to demonstrate how clinical examination and screening tests used in a shelter setting might be helpful in identifying mental illness and cognitive impairment.

DESIGN

Cross-sectional study including face-to-face interviews and review of medical records.

SETTING

A community-based homeless shelter in an urban metropolitan centre (Toronto, Ont).

PARTICIPANTS

A total of 49 male participants 55 years of age or older. The average duration of homelessness was 8.8 (SD 10.2) years.

METHODS

Participants were admitted to a community-based shelter that offered access to regular meals, personal support and housing workers, nursing, and a primary care physician. Medical chart review was undertaken to identify mental illness or cognitive impairment diagnosed either before or after admission to the facility. The 15-item Geriatric Depression Scale (GDS-15) and the Folstein Mini-Mental State Examination (MMSE) were administered.

MAIN OUTCOME MEASURE

Previous or new diagnosis of mental illness or cognitive impairment.

RESULTS

Thirty-six of the participants (73.5%) had previous or new diagnoses. The most prevalent diagnosis was schizophrenia or psychotic disorders (n = 17), followed by depression (n = 11), anxiety disorders (n = 3), cognitive impairment (n = 8), and bipolar affective disorder (n = 1). A total of 37% of participants were given new mental health diagnoses during the study. The GDS-15 identified 9 people with depression and the MMSE uncovered 11 individuals with cognitive impairment who had not been previously diagnosed.

CONCLUSION

This study suggests that providing access to primary care physicians and other services in a community-based shelter program can assist in identification of mental illness and cognitive impairment in elderly homeless men. Use of brief screening tools for depression and cognitive impairment (like the GDS-15 and the MMSE) could be helpful in this highrisk group.