industry & policy anecdotally , people were saying that they felt 50 – 80 per cent of their client groups were showing some sort of change in their cognition .
Not all of the changes in cognition would be attributed to a dementia , but the figures at this particular moment in time are something which we ’ re trying to fine up a little bit more through the outcomes of this paper , and through the better collaboration between the homelessness service sector and ourselves along with the dementia and aged-care health sector .
Some of the risk factors that we see , which are associated with people who have been living with homelessness , or experiencing homelessness , or even those that are at risk of homelessness , they can be very different to what the general population may see . For example , there are certain risk factors that really raised the risk of developing a dementia in later life . These risk factors include things like having a poor diet , particularly a diet deficient of vitamin B group , [ and ] physical inactivity is quite a major issue in people who are experiencing homelessness . We also have things like alcohol , and smoking , and the effects that they have on the body .
The other thing as well is that lots of people who are living with homelessness , because of the environmental and social influences upon them , are often living with chronic health conditions , and some of those conditions , such as cardiovascular disease , will certainly raise the risk of developing a dementia in later life . Other things we look at closely are the higher levels of people who have diabetes and respiratory conditions .
All of these raise the risk for people who are living in marginalised , disengaged lifestyles , in terms of having a dementia .
What additional challenges do homeless people with cognitive impairment face when it comes to engaging with healthcare ? It is very difficult , because some people might be living a fairly transient lifestyle , but to have some sort consistency of engagement with health services can be difficult , just purely from that aspect alone . For other people , it can be about how they prioritise things within their own living circumstance . So for example , they will be prioritising things like , how do they get a meal that day ? How do they wash their clothes ? How do they have shelter ? Where do they seek out warmth or cooling ?
Traditionally , the healthcare advocacy that people experiencing homelessness can have can be quite poor , and may require quite a high level of advocacy .
What were some of the comments from people working in the dementia , aged care , homelessness or health sectors that struck you ? One of the comments I received during the course of scoping for the backgrounds of this paper included direct comments from people who are experiencing homelessness . Some of their viewpoints were around the fact that it was hard for them to make hospital appointments , even if that had been arranged at that point . It was difficult for them to get the access to health professionals , and feel comfortable in what they perceived to be institutionalised healthcare systems . They were largely quite suspicious about that , they were unsure of the intentions , and they were very alarmed that it would be a reflection of their lifestyles . That became an immediate barrier for a lot of people who were living with homelessness .
Some of the support workers in the homelessness sector were finding that other things were being prioritised for people in terms of their healthcare . Their immediate needs around things such as mental health took a big priority , and lots of referrals around behaviours which may be associated with a change in cognition were often referred through mental health services as well . To ensure the correct engagement was very difficult . Access to the specialists that were dealing with cognitive assessment was a pathway which wasn ’ t obvious for lots of those sector workers to make a referral into .
In terms of other barriers , people are unsure about the financial capacity to link into services . There ’ s basically a lack of access to good and appropriate agedhealthcare services for people experiencing homelessness , and who may have a dementia due to financial barriers as well . In our experience through the comments that we were receiving from the sector , they were saying there ’ s only a small proportion that would likely be assessed for a dementia . It really is because of this disengagement , and also a lack of understanding as well from everybody involved .
What are some of the knowledge gaps you hope to address through the new discussion paper ? There were some very obvious knowledge gaps , because there were lots of assumptions made about dementia . [ For example ] that it is purely a condition which affects older people , that dementia is Alzheimer ’ s disease and only Alzheimer ’ s disease .
There were a lot of knowledge gaps around how dementia can impact behavioural aspects of how a person lives and manages . Also , if somebody has an acquired brain injury , or a mental health condition , and has cognitive changes , it ’ s about teasing out some of those aspects so that people can make appropriate referrals . One of the things the paper is aiming to do is see workers from the homelessness sector develop an improved awareness and understanding of the range of cognitive impairment , and of course with dementia .
At the same time , we hope that workers from the dementia , health and aged-care services will show more of an understanding around providing care in the context of someone who has experienced long-term homelessness , and that they will commit to gaining an improved understanding of their unique service and care needs , and be responsive to those needs as well . It is really quite different when someone has to live with entrenched homelessness , of how we actually provide the care and support that they should be receiving , both to move them through cognitive assessment and through to a timely dementia diagnosis , if that ’ s appropriate .
What are some key steps that need to be taken to improve support for homeless people with dementia ? I think the biggest step we are aiming for is to see far greater prospects of collaboration , and that will ultimately help to ensure people who are experiencing homelessness , or who may be living at high risk of homelessness , and who may have a dementia , receive the most appropriate support , and that the referrals that they get are for the conditions that are actually affecting them . That is one of the key steps . In order to do that , there would be a number of other steps , and so it requires this partnership by way of providing cross-sector knowledge , this transfer of knowledge between the sectors , and appreciation and understanding . And it requires the aged-care sector to take on board the unique considerations , and design programs and services that are inclusive . I think that these are going to be important steps to ensure that somebody who has lived with entrenched homelessness will be able to have appropriate assessments and good dementia care . ■
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