Homelessness, immigrant status, poverty and dementia: Identifying rehabilitative and care needs at the margins of society

Objective: In most Western societies dementia is increasingly viewed as a costly public health issue that requires concerted responses from policymakers, researchers, clinicians, and advocates. Currently, most investments are made into genetic research in the hope to identify the biological root causes of dementia. So far little attention has been directed towards individuals living with dementia who experience social marginalisation. The aim of this study was to review the current evidence base for addressing the rehabilitative and care needs of three dementia population subgroups: impoverished adults, homeless adults, and first generation immigrants.

Methods: (a) Secondary data analyses of the National Health Interview Survey 2005/2006 (NHIS), (b) rapid evidence review of the literature, involving MEDLINE, CINAHL, PUBMED, PSYCINFO (1996-2007), (c) Nexis UK media search for stories at the intersection of dementia and homelessness, immigrant status and poverty in US and UK newspapers since 1996.

Results: The merged dataset included 159 individuals who self- or proxy identified as having dementia. Around 5% had experienced homelessness. The rapid evidence review produced 48 publications with virtually no intervention studies. US media reports focused primarily on loss of services for illegal immigrants, drug benefit coverage, caregiver strains. UK media discussed economic burden, community support, abuse in nursing care, and dignity in the care of impoverished older adults with dementia.

Conclusion. Dementia care for socially marginalised groups is a highly under-researched area. The evidence base is lacking for culturally sensitive care environments. Interventions are critically lacking that consider the compound needs of this heterogeneous clinical population.