Upstream Tablet-Based Screening for Possible Dementia or Cognitive Impairment in Unhoused Older Adults

Abstract

Internationally and in the United States, adults aged 55 years and older are the fastest growing demographic of people experiencing homelessness, and dementia is thought to be a risk factor for homelessness. In a descriptive implementation study, a dementia and cognitive impairment screening program utilizing the tablet-based Montreal Cognitive Assessment (MoCA) was implemented in work processes of professionals across four homeless service agencies in Phoenix, Arizona. Using a sequential mixed methods design, the program’s feasibility and acceptability were evaluated by interviewing and surveying homeless services’ staff and unhoused older adults. In the implementation period of three months, 152 out of 203 (74.9%) screenings were positive for possible dementia or cognitive impairment but did not include diagnostic confirmation. Of the 203 undergoing screening, 86 completed the After Scenario Questionnaire (ASQ), and responses indicated satisfaction with the tablet technology’s convenience and ease of use. Staff interviews (n=5) revealed screening results can be used to understand clients’ needs to connect them with medical and social supports. Principal study limitations are low response rates to the ASQ and staff interviews. Screening is feasible and acceptable in community-based settings, offering opportunities to identify clients with cognitive vulnerability in efforts to resolve older adult homelessness.