Grant: Travel Awards - Institute Community Support

Importance: Individuals who have experienced homelessness have increased risk factors that are associated with dementia. Understanding the prevalence and risk of dementia in homeless adults has important implications for ensuring appropriate resources are placed towards dementia prevention and healthy aging. Objective: To estimate the 1) lifetime prevalence of dementia (primary outcome) and 2) risk or incidence of dementia (secondary outcomes) among homeless adults. Data sources: We systematically searched the databases MEDLINE, PsycINFO, Embase, CINAHL, Cochrane Central, and Social Works Abstracts September 2024. We included studies that investigated the prevalence of dementia among individuals experiencing homelessness. Data extraction and synthesis: Titles, abstracts, and full text screening was done in duplicate. Authors independently completed data extraction and risk of bias assessments in duplicate. We meta-analyzed the prevalence of dementia for our primary outcome. For our secondary outcome of the risk of dementia, we meta-analyzed the odds and incidence of dementia comparing homeless to housed individuals. Results: A total of 1585 citations were retrieved, with 102 studies undergoing full-text review and 35 studies included in the final review. There were 504,732 individuals who experienced homelessness, with an average age of 63.08 and female percentage of 10.64. The prevalence of dementia was 6.99 (95% confidence interval 4.56, 10.54). Among those who experienced homelessness, compared to housed individuals, the odds of dementia were 1.03 (0.58, 1.81), while the incidence of dementia was 1.54 (0.52, 4.50). Significance: This meta-analysis suggests that the prevalence of dementia was higher in people who have experienced homelessness than population-based averages from studies of individuals in the same age range. Appropriate supports and integrated care models are required in homeless individuals diagnosed with dementia.