Traumatic Brain Injury in Homeless People Is Underappreciated

Posted on July 31, 2022

Researchers have found that the lifetime prevalence of either moderate or severe TBI was 22.5%. At the same time, the lifetime prevalence of any severity of traumatic brain injury in homeless and marginally housed individuals was 53.1%.

More than half of homeless people and others who live in unstable housing situations suffer traumatic brain injury at some time in their life. According to an analysis of studies from six countries, including the US and Canada, this rate far exceeds the general population. 

A study published on December 2, 2019, in The Lancet Public Health, proposes that TBI is an often-overlooked concern in the homeless population. Traumatic brain injury puts people at risk for poorer health and functioning amidst already challenging life situations.

It is becoming clearer that TBI can be both a cause and consequence of homelessnessTBI. It can put a person at increased risk for neurologic and psychiatric conditions, which can become part of a cascade of causes that lead to vagrancy. Moreover, living in a shelter or on the street puts a person at risk for assault, falls, and other violent acts.

The recent study on TBI and homelessness should be of interest to neurologists. They treat patients in acute phases of TBI, perhaps in the absence of such information on their everyday living status. Being homeless or moving around (leading a nomadic life) may make it difficult for a TBI patient to adhere to a medication regimen or follow up on hospital discharge instructions. 

Sometimes it happens that neurologists may see a homeless person for a neurologic condition and be unable to make the connection that the person experienced a past head injury that may be relevant to what is currently going on.

Assessing the history of homeless and marginally housed TBI patients might be relevant to all-inclusive testing as they may often have compound comorbidities.

Dr. Panenka spoke to Neurology Today and expected that new discoveries on TBI and homelessness might increase empathy among the public and health care providers alike, who may blame a homeless person's problematic behavior on drug or alcohol addiction or severe mental health complications that are far beyond treatable.

The fallout from TBI, including memory, concentration,  and mood issues, is puzzling enough for those who are connected to the medical system and have a support network. Still, it is a completely different equation for people who are barely surviving and have nowhere to go. 

The new Lancet Public Health study noticed an expected six million people experience homelessness yearly in the European Union and the US. It is also evident that homeless individuals are more likely to have various physical such as HIV, and hepatitis C and mental health problems, including depression and drug and alcohol dependence. 

According to researchers, it has been hard to assess the reliability of estimates of TBI among homeless and marginally housed individuals, partly due to fluctuating definitions of homelessness and differences in sampling methods. Homeless people may not essentially seek medical attention for a head injury, so medical records are lacking.

TBI is steadily linked with poorer self-reported physical and mental health, memory concerns, increased health service use, and criminal justice system involvement in homeless individuals.

Considering the high incidence of TBI and the significant number of homeless persons found to have evidence of traumatically-induced lesions visible with MRI. They said if visible findings are identified on imaging, the patient can be connected with the necessary medical and social services. Clinicians may consider lowering the threshold for referral for neuroimaging specialists after head injury in homeless and marginally housed patients," the researchers stated.

Furthermore, imaging findings may enhance the patient-caregiver relationship, e.g., by increasing understanding of puzzling behaviors that can be attributed to damage visible on neuroimaging. The study stated the availability of more stable housing for vulnerable populations might lower the occurrence of TBI, even though more study is needed.