Prevalence of Alzheimer's disease and related dementias among veterans experiencing housing insecurity

Jutkowitz, Eric; Halladay, Christopher; Tsai, Jack; Hooshyar, Dina; Quach, Lien; O’Toole, Thomas; Rudolph, James L.

doi:10.1002/alz.12476

Cited by 15 publications

(23 citation statements)

References 41 publications

(72 reference statements)

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“…Keigher and colleagues (1992) also established that homeless patients were significantly more likely to be Black relative to the larger population. This finding was reiterated by Jutkowitz et al (2019, 2021a, 2021b) in homeless veteran populations. They also found that homeless veterans upon admission to a nursing home were younger (62.5 years vs. 75.3 years) and more likely to present with an alcohol abuse disorder (ARR = 2.18; 95% CI = 2.05–2.31) or drug use disorder (ARR = 3.03; 95% CI = 2.74–3.33), along with a non-specified mental health disorder diagnosis (ARR = 1.49; 95% CI = 1.45–1.54)…”

Section: Resultsmentioning

confidence: 80%

“…Jutkowitz et al (2019) established that homeless veterans were younger upon admission to skilled nursing facilities and were more likely to have dementia than their stably housed counterparts (adjusted risk ratio (ARR) = 1.14, 95% CI = 1.04–1.25). In another study (Jutkowitz et al, 2021b), it was established that the risk for dementia in all homeless veterans treated at VA facilities was 1.58 (CI = 1.51–1.66), while the ARR in at-risk veterans was 2.98 (95% CI = 2.81–3.16), compared to stably housed counterparts. Bennett and colleagues (2009) did not use a VA database to establish dementia.…”

Section: Resultsmentioning

confidence: 99%

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Associations between Homelessness and Alzheimer’s Disease and Related Dementia: A Systematic Review

et al. 2022

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The homeless population in the United States is rapidly aging, with a parallel increase in Alzheimer’s disease and related dementia (ADRD). During an evolving pandemic that jeopardizes employment and housing, assessing the relationship between ADRD and homelessness is critical since the latter is potentially intervenable. The objective of this study is to review the literature and determine whether there is an association between homelessness and dementia risk. A systematic review of existing studies was conducted through PubMED, SCOPUS, and EMBASE among others. Of the 228 results found, nine met inclusion criteria. Homeless studies mainly centered on veteran populations ( n = 6/9). There is a complex relationship suggesting homelessness as a risk for and consequence of ADRD but also co-occurrence with psychiatric disorders, substance abuse, and traumatic injuries. Future studies should employ enumeration surveys with modular longitudinal tracking and measure social determinants of health, discrimination, chronic stress, and mood disorders.

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Section: Resultsmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Associations between Homelessness and Alzheimer’s Disease and Related Dementia: A Systematic Review

et al. 2022

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“…A recent study of veterans revealed that the prevalence of Alzheimer disease and related dementias was higher among housing insecure veterans than those who were stably housed. 39 Epidemiologic studies have shown that those who are homeless experience higher rates of cardiovascular events, including stroke, compared with the general population. 40,41 Despite the plethora of research on the association between housing and health in general, more research is needed to explore the relationship between housing and neurologic conditions and whether interventions aimed at addressing housing affect neurologic health.…”

Section: Housingmentioning

confidence: 99%

Recommendations on Social Determinants of Health in Neurologic Disease

Towfighi,

Berger,

Corley

et al. 2023

Neurology

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Social determinants of health (SDOH) are increasingly recognized as important drivers of inequities in neurologic disease and outcomes. However, our understanding of the biopsychosocial mechanisms by which SDOH affect neurologic disease remains in its infancy. The most robust epidemiologic research has been on the associations between education, schooling, and place-based social determinants on cognition, dementia, and cerebrovascular disease later in life. Further research is needed to more deeply understand the complex interplay of SDOH on neurologic disease. Few SDOH screening tools have been validated in populations with neurologic disease. In addition, comparison across studies and populations is hampered by lack of standardized common data elements. Experiences of populations historically underrepresented in research should be centered in future research studies, and changes should be made in recruitment expectations and measurement choices. For research on inequities, it is critical to support and incentivize institutional infrastructure to foster meaningful engagement with populations affected by research. Finally, it remains to be seen whether individual-level health or behavioral interventions or place-level, systemic or policy interventions to reduce population burden will be most effective in reducing inequities in neurologic disease and outcomes. Although numerous clinical trials have focused on addressing downstream SDOH such as health literacy and health behaviors (e.g., medication adherence, physical activity, diet), few have addressed upstream, structural determinants which may have a more profound impact on addressing inequities in neurologic disease. Ultimately, further research is needed to determine which specific SDOH should be targeted and how, when, and by whom they should be addressed to improve neurologic outcomes.

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“…21 ), including a recent publication in this journal 22. Our definition also overlaps substantially with the Chronic Conditions Data Warehouse definition of "Alzheimer's disease or related disorders or senile dementia" (https://www2.ccwdata.org/web/guest/conditioncategories-chronic), which is used for monitoring Centers for Medicare & Medicaid Services (CMS) data.…”

mentioning

confidence: 99%

Alzheimer's disease and related dementias among aging veterans: Examining gene‐by‐environment interactions with post‐traumatic stress disorder and traumatic brain injury

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Sherva

Zhang

et al. 2022

Alzheimer's & Dementia

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Introduction Post‐traumatic stress disorder (PTSD) and traumatic brain injury (TBI) confer risk for Alzheimer's disease and related dementias (ADRD). Methods This study from the Million Veteran Program (MVP) evaluated the impact of apolipoprotein E (APOE) ε4, PTSD, and TBI on ADRD prevalence in veteran cohorts of European ancestry (EA; n = 11,112 ADRD cases, 170,361 controls) and African ancestry (AA; n = 1443 ADRD cases, 16,191 controls). Additive‐scale interactions were estimated using the relative excess risk due to interaction (RERI) statistic. Results PTSD, TBI, and APOE ε4 showed strong main‐effect associations with ADRD. RERI analysis revealed significant additive APOE ε4 interactions with PTSD and TBI in the EA cohort and TBI in the AA cohort. These additive interactions indicate that ADRD prevalence associated with PTSD and TBI increased with the number of inherited APOE ε4 alleles. Discussion PTSD and TBI history will be an important part of interpreting the results of ADRD genetic testing and doing accurate ADRD risk assessment.

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Prevalence of Alzheimer's disease and related dementias among veterans experiencing housing insecurity

Cited by 15 publications

References 41 publications

Associations between Homelessness and Alzheimer’s Disease and Related Dementia: A Systematic Review

Associations between Homelessness and Alzheimer’s Disease and Related Dementia: A Systematic Review

Recommendations on Social Determinants of Health in Neurologic Disease

Alzheimer's disease and related dementias among aging veterans: Examining gene‐by‐environment interactions with post‐traumatic stress disorder and traumatic brain injury

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