Aging security is partially supported by: AARP Arizona

The number of people over the age of 50 who are becoming homeless for the first time is increasing. Evacuation center staff also see many elderly people who appear to have some form of dementia or mild cognitive impairment. Now, Maricopa County's largest shelter has begun testing its elderly clients for possible neurological conditions.

“The MoCA takes about 10 minutes and is the last part of the advanced assessment,” Primrose Njenga said as she explained the Montreal Cognitive Assessment (MoCA) to a 57-year-old man who requested anonymity. Story. They were sitting in a small office in the Central Arizona Shelter Services building (CASS) in downtown Phoenix. “And the only reason we use it is to see how best we can serve you. It's to see how your memory is working. .And it just adds tools to the way we serve you,” she explained.

“Then let's get started. Are you ready?”

“Hmm,” the man said.

“Okay, great,” Zenga said. “Have them draw a line from 1 to A. From A to 2. From 2 to B. From B to 3, and so on.”

Tim Agne/KJZZ

The 57-year-old CASS resident fills out a section of the MoCA asking for copies of the drawings.

MoCA is widely used to screen for early signs of mild cognitive decline and dementia. MoCA is not diagnostic and requires additional testing such as brain imaging.

MoCA is typically used in primary care settings and lists question Other tasks include drawing the hands of a clock, naming pictures of animals, and repeating a list of numbers and words.

Historically, it has not been used in facilities like CASS, the largest 600-bed shelter in Maricopa County.

91% positive test for dementia

Tim Agne/KJZZ

Primrose Jenga explains to CASS senior students the data her team has collected from managing MoCa.

Things changed in September, when Heather Ross and her team, including Jenga, began working with CASS to screen older clients for cognitive impairment. Ross is a professor of health care and technology policy at ASU.

She said a score of 26 or higher is considered normal.

“A score below 26 suggests you may have mild cognitive impairment or dementia,” says Ross. “And in a perfect world, where everyone had unlimited access to a full range of specialized medical services, that would be the trigger for a dementia workup, right?”

As of this interview, Ross and her team have tested 107 people. Of those, 91% tested positive for dementia, she said.

“It's not a diagnosis. It's just a screen. But it's shocking. That's too worrying, right?

In fact, only six people had a score of 26 or higher. Most scores he had were between 17 and 21.

“Are cognitive impairment and dementia independent risk factors for homelessness in older adults?”
— Heather Ross

“And here's the problem: Until now, no one has undertaken to screen for dementia or cognitive impairment in the homeless population.” There have been several papers asking if this is the case. But until now, no one has done this comprehensive testing of elderly people in shelters.”

So why now? Phillip Scharf He is the Chief Operating Officer of CASS.

“What we can say with confidence is that the number of people aged 55 and over experiencing homelessness is increasing 'significantly' year on year.” “From an actual data standpoint, he's up well over 30% over the last five years.”

And as the homeless population ages, a myriad of cognitive concerns arise. “So what we're seeing in shelters is people who are in acute behavioral health crises,” Schaaf said.

It comes from all sorts of things. From traumatic brain injuries to substance use disorders and dementia. Also, it can be difficult to keep an agitated or aggressive person confined to a shelter.

“What this is really helping us understand is what are the underlying conditions for that many people? And what we're discovering is that our subsets “That helps us understand why some of these behaviors occur in the same way that they occur,” he explained.

Sometimes it's as simple as a client not being able to remember where their CASS bed is. The client reacts with irritation. So, for Schaaf, MoCA is a starting point. It is expected that a diagnosis will then be made and support and services provided.

Tim Agne/KJZZ

Heather Ross explains the results of MoCA screening for older adults on CASS

reality and good intentions

But reality can get in the way of good intentions.

“So when we started this screening program, there was a big concern that if someone screened positive for dementia, how do we get them to a dementia specialist? ” Ross said.

That's because even with private insurance and plenty of family and community support, it can take weeks or months to see a specialist. So for this population, it means doing everything possible to keep them safe. One way to do that is to remove them from collective shelters. And that just happened late last month.

Lisa Groh is the CEO of CASS. “We are really grateful to be able to house 60 of our most vulnerable elderly people in a hotel. So, there’s a really big difference,” she told KJZZ.

And that “big difference” includes everything from your physical health to perhaps your MoCA score.

Schaaf said all residents were tested for dementia. It is scheduled to be shown again in a month's time.

“Because it helps us better understand not just the impact of mass shelters, but the real impact on mass shelters related to vulnerable, vulnerable and vulnerable 55-year-olds and overpopulation,” he said. Ta.

Tim Agne/KJZZ

Primrose Dzenga displays the distribution of scores for the CASS MoCA Screening for Older Adults

But even hotels where customers have their own rooms may not be enough for people with dementia.

“So we're trying to find a better placement for them,” Groh said. “There are dementia care facilities, but some of them are too expensive and it’s very difficult to refer people to them. We need to put these people into nursing homes.”

And perhaps there's an even bigger question Ross wants to answer. “Are cognitive impairment and dementia independent risk factors for homelessness in older adults?”

More research and time will tell. But answers won't come soon, given the rapid rise in elderly homelessness.

More stories from KJZZ