Dementia care and mortality in people experiencing homelessness: a matched cohort study

Introduction — People experiencing homelessness are disproportionately affected by dementia, yet little is known about their dementia care and mortality rates after a diagnosis.

Methods — Homeless (n = 559) and housed (n = 2002) individuals newly diagnosed with dementia were matched on age, sex, diagnosis date, and health region within the province of Ontario, Canada. Dementia care, long-term care admissions, health service use, and mortality rates within 1 year of diagnosis were compared between groups.

Results — Homeless individuals were more often admitted to long-term care and less often received cholinesterase inhibitors. They also had higher rates of unscheduled emergency department visits, hospital bed days without acute care needs, and mortality compared to housed individuals.

Discussion — Individuals experiencing homelessness have higher use of hospital-based services and elevated mortality. They are also more frequently admitted to long-term care, reinforcing the importance of developing integrated care models that combine health care, social services, and housing support.

Highlights

• Homeless individuals diagnosed with dementia face higher mortality and care gaps.
• Most are not placed in long-term care within a year of diagnosis.
• Tailored care models linking health care, housing, and social services are needed.