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Can Fam Physician. 2009 Nov;55(11):1110-1111.e6.

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

Author information

1
Pender Community Health Centre, 59 Pender St W, Vancouver, BC V6B 1R3. david.joyce@utoronto.ca

Abstract

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.

PMID:
19910602
PMCID:
PMC2776807
[Indexed for MEDLINE]
Free PMC Article
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