Traumatic Brain Injury in a Community-Based Cohort of Homeless and Vulnerably Housed Individuals

Schmitt, Toby A; Thornton, Allen E.; Rawtaer, Iris; Barr, Alasdair M.; Gicas, Kristina M.; Lang, Donna; Vertinsky, Alexandra T.; Rauscher, Alexander; Procyshyn, Ric M.; Buchanan, Tari; Cheng, Alex; Mackay, Sally; Leonova, Olga; Langheimer, Verena; Field, Thalia S.; Heran, Manraj K.S.; Vila‐Rodriguez, Fidel; O'Connor, Tiffany A; MacEwan, G. William; Honer, William G.; Panenka, William J.

doi:10.1089/neu.2017.5076

Cited by 21 publications

(20 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Traumatic brain injury in our sample is associated with abnormalities of neural connectivity and cross-sectional cognitive impairment, 37 and is now observed to be associated with steeper memory decline. A study of nearly 2.8 million people from Denmark found an increased risk of all-cause dementia in people with a history of traumatic brain injury.…”

Section: Discussionmentioning

confidence: 67%

“…Heavy alcohol consumption with increasing age is linked with greater impairment in learning, memory and motor functions, but not attention and executive functioning, and is considered to reflect a dual premature-accelerated model of cognitive ageing. 36 Traumatic brain injury in our sample is associated with abnormalities of neural connectivity and cross-sectional cognitive impairment, 37 and is now observed to be associated with steeper memory decline. A study of nearly 2.8 million people from Denmark found an increased risk of all-cause dementia in people with a history of traumatic brain injury.…”

Section: Individual-level Risk Factorsmentioning

confidence: 78%

See 1 more Smart Citation

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Homeless and precariously housed individuals experience a high burden of comorbid illnesses, and excess mortality. Cross-sectional studies report a high rate of cognitive impairment. Long-term trajectories have not been well investigated in this group. Aims To longitudinally assess risks for premature and/or accelerated cognitive ageing, and the relationship with early mortality in homeless and precariously housed people. Method This is a 9-year community-based study of 375 homeless and precariously housed individuals from Vancouver, Canada. Annual cognitive testing assessed verbal learning and memory, and inhibitory control. Linear mixed-effects models examined associations between clinical risk factors (traumatic brain injury, psychotic disorders, viral exposure, alcohol dependence) and cognitive change over 9 years. Cox regression models examined the association between cognition and mortality. Results Traumatic brain injury and alcohol dependence were associated with decline in verbal memory. Inhibitory control declined, independent of risk factors and to a greater extent in those who died during the study. Better inhibitory control was associated with a 6.6% lower risk of mortality at study entry, with a 0.3% greater effect for each year of life. For each one-point increase in the Charlson Comorbidity Index score at study entry, the risk of mortality was 9.9% higher, and was consistent across age. Adjusting for comorbidities, inhibitory control remained a significant predictor of mortality. Conclusions Findings raise the possibility of a premature onset, and accelerated trajectory, of cognitive ageing in this group of homeless and precariously housed people. Traumatic brain injury, alcohol dependence and cognition could be treatment priorities.

show abstract

Section: Discussionmentioning

confidence: 67%

Section: Individual-level Risk Factorsmentioning

confidence: 78%

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Proximal traumatic events may also exacerbate risk, and together, these risk factors may have additive or synergistic effects on expression of psychosis in adulthood [ 28 , 29 ]. Among precariously housed individuals, traumatic brain injury (TBI) is reported in a meta-analysis to have a prevalence of over 50%, with over 20% being of at least moderate severity [ 25 , 26 , 30 ]. TBI is associated with paranoid delusions and hallucinations, even years after the injury [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background The “trimorbidity” of substance use disorder and mental and physical illness is associated with living in precarious housing or homelessness. The extent to which substance use increases risk of psychosis and both contribute to mortality needs investigation in longitudinal studies. Methods and findings A community-based sample of 437 adults (330 men, mean [SD] age 40.6 [11.2] years) living in Vancouver, Canada, completed baseline assessments between November 2008 and October 2015. Follow-up was monthly for a median 6.3 years (interquartile range 3.1–8.6). Use of tobacco, alcohol, cannabis, cocaine, methamphetamine, and opioids was assessed by interview and urine drug screen; severity of psychosis was also assessed. Mortality (up to November 15, 2018) was assessed from coroner’s reports and hospital records. Using data from monthly visits (mean 9.8, SD 3.6) over the first year after study entry, mixed-effects logistic regression analysis examined relationships between risk factors and psychotic features. A past history of psychotic disorder was common (60.9%). Nonprescribed substance use included tobacco (89.0%), alcohol (77.5%), cocaine (73.2%), cannabis (72.8%), opioids (51.0%), and methamphetamine (46.5%). During the same year, 79.3% of participants reported psychotic features at least once. Greater risk was associated with number of days using methamphetamine (adjusted odds ratio [aOR] 1.14, 95% confidence interval [CI] 1.05–1.24, p = 0.001), alcohol (aOR 1.09, 95% CI 1.01–1.18, p = 0.04), and cannabis (aOR 1.08, 95% CI 1.02–1.14, p = 0.008), adjusted for demographic factors and history of past psychotic disorder. Greater exposure to concurrent month trauma was associated with increased odds of psychosis (adjusted model aOR 1.54, 95% CI 1.19–2.00, p = 0.001). There was no evidence for interactions or reverse associations between psychotic features and time-varying risk factors. During 2,481 total person years of observation, 79 participants died (18.1%). Causes of death were physical illness (40.5%), accidental overdose (35.4%), trauma (5.1%), suicide (1.3%), and unknown (17.7%). A multivariable Cox proportional hazard model indicated baseline alcohol dependence (adjusted hazard ratio [aHR] 1.83, 95% CI 1.09–3.07, p = 0.02), and evidence of hepatic fibrosis (aHR 1.81, 95% CI 1.08–3.03, p = 0.02) were risk factors for mortality. Among those under age 55 years, a history of a psychotic disorder was a risk factor for mortality (aHR 2.38, 95% CI 1.03–5.51, p = 0.04, adjusted for alcohol dependence at baseline, human immunodeficiency virus [HIV], and hepatic fibrosis). The primary study limitation concerns generalizability: conclusions from a community-based, diagnostically heterogeneous sample may not apply to specific diagnostic groups in a clinical setting. Because one...

show abstract

“…This speculation is supported by the fact that only a minority of people who enter shelters in NYC have previously accessed available homelessness prevention services . Prior research has suggested high rates of traumatic brain injury and cognitive impairment among people who are homeless, which may have also been somewhat contributory to our findings, although we did exclude patients who were not able to understand the study informed consent process.…”

Section: Discussionmentioning

confidence: 99%

“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Doran

Ran²,

Castelblanco

et al. 2019

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: Emergency departments (EDs) frequently care for patients who are homeless or unstably housed.One promising approach taken by the homeless services system is to provide interventions that attempt to prevent homelessness before it occurs. Experts have suggested that health care settings may be ideal locations to identify and intervene with patients at risk for homelessness, yet little is known even about the basic characteristics of patients who might benefit from such interventions.Methods: We conducted in-depth, one-on-one qualitative interviews with ED patients who had become homeless within the past 6 months. Using a semistructured interview guide, we asked patients about their pathways into homelessness and what might have prevented them from becoming homeless. Interviews were digitally recorded and professionally transcribed. Transcripts were coded line by line by multiple investigators who then met as a group to discuss and refine codes in an iterative fashion.Results: Interviews were completed with 31 patients. Mean interview length was 42 minutes. Four main themes emerged: 1) unique stories yet common social and health contributors to homelessness, 2) personal agency versus larger structural forces, 3) limitations in help from family or friends, and 4) homelessness was not expected.Conclusions: These findings demonstrate gaps in current homeless prevention services and can help inform future interventions for unstably housed and homeless ED patients. More immediately, the findings provide rich, unique context to the lives of a vulnerable patient population commonly seen in EDs.

show abstract

Traumatic Brain Injury in a Community-Based Cohort of Homeless and Vulnerably Housed Individuals

Cited by 21 publications

References 41 publications

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

Cognitive decline and mortality in a community-based sample of homeless and precariously housed adults: 9-year prospective study

Associations of substance use, psychosis, and mortality among people living in precarious housing or homelessness: A longitudinal, community-based study in Vancouver, Canada

“It Wasn't Just One Thing”: A Qualitative Study of Newly Homeless Emergency Department Patients

Contact Info

Product

Resources

About