title: Identification of cognitive impairment and mental illness in elderly homeless men: Before and after access to primary health care.
abstract: OBJECTIVE
  To describe the occurrence of mental health problems and cognitive impairment in a group of elderly homeless men and to demonstrate how clinical examination and screening tests used in a shelter setting might be helpful in identifying mental illness and cognitive impairment.
  
  
  METHODS
  Cross-sectional study including face-to-face interviews and review of medical records.
  
  
  METHODS
  A community-based homeless shelter in an urban metropolitan centre (Toronto, Ont).
  
  
  METHODS
  A total of 49 male participants 55 years of age or older. The average duration of homelessness was 8.8 (SD 10.2) years.
  
  
  METHODS
  Participants were admitted to a community-based shelter that offered access to regular meals, personal support and housing workers, nursing, and a primary care physician. Medical chart review was undertaken to identify mental illness or cognitive impairment diagnosed either before or after admission to the facility. The 15-item Geriatric Depression Scale (GDS-15) and the Folstein Mini-Mental State Examination (MMSE) were administered.
  
  
  METHODS
  Previous or new diagnosis of mental illness or cognitive impairment.
  
  
  RESULTS
  Thirty-six of the participants (73.5%) had previous or new diagnoses. The most prevalent diagnosis was schizophrenia or psychotic disorders (n = 17), followed by depression (n = 11), anxiety disorders (n = 3), cognitive impairment (n = 8), and bipolar affective disorder (n = 1). A total of 37% of participants were given new mental health diagnoses during the study. The GDS-15 identified 9 people with depression and the MMSE uncovered 11 individuals with cognitive impairment who had not been previously diagnosed.
  
  
  CONCLUSIONS
  This study suggests that providing access to primary care physicians and other services in a community-based shelter program can assist in identification of mental illness and cognitive impairment in elderly homeless men. Use of brief screening tools for depression and cognitive impairment (like the GDS-15 and the MMSE) could be helpful in this highrisk group.
authors.affiliation: Pender Community Health Centre, 59 Pender St W, Vancouver, BC V6B 1R3. david.joyce@utoronto.ca
authors.forename: David P
authors.initials: DP
authors.lastname: Joyce
authors.forename: Marjolaine
authors.initials: M
authors.lastname: Limbos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006297:Health Services Accessibility / Q000458:organization & administration*; D006703:Ill-Housed Persons / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009017:Morbidity; D009864:Ontario / Q000453:epidemiology; D010349:Patient Compliance; D011320:Primary Health Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies