Identifying Cognitive Impairment in People Who Are Homeless in Metropolitan Australia: An Exploratory Study

Disabilities associated with cognitive impairment often remain undiagnosed in homeless groups, precluding them from accessing disability services and increasing the risk of long-term homelessness. This has been attributed to both under-reporting of cognitive problems by people accessing homelessness services and to under-identification of potential problems by the homelessness workforce. This exploratory study examined the frequency of self-reported direct indicators of potential cognitive impairment and associations between direct indicators and other reported variables, with the aim of considering whether currently collected data could potentially support the homelessness workforce to prioritize referral for formal cognitive assessment. Data from interviews with 14,495 people experiencing homelessness collected in metropolitan Australia between 2010 and 2022 were explored. Measures used as indicators of potential cognitive impairment were as follows: acquired brain injury (30%), developmental disability (25%), and memory and concentration problems (62%). Using each of these indicators as outcome variables, a series of binary logistic regressions examined associations between these indicators and other variables. Cumulative effects were observed with epilepsy and convulsions, exposure conditions (frostbite and heatstroke), alcohol and drug use, frequent accident and emergency department presentation, experiences of violence, history of trauma, not taking prescribed medications, and interviewer-observed cognitive function. Opportunities for the homelessness workforce to better identify and prioritize people potentially suitable for cognitive assessment using currently collected data should be further explored.