Aged Care, Homelessness, and Brain Injury

Posted on August 26, 2022

Research study has shown that the presence of a brain injury is highly prevalent within the older homeless population—people experiencing homelessness report an exceptionally high rate of trauma exposure. Approximately fifty percent of homeless service users (58% of homeless men and 42% of homeless women) have a history of traumatic brain injury. 

The most common are acquired brain injuries (ABI) arising from long-term exposure to harmful levels of alcohol intoxication and/or head trauma. People living with multiple diagnoses, including mental illness, substance abuse, and ABI, often find it difficult to access appropriate services. 

These individuals can be slow to respond to questions and perform tasks due to slower thought processing speeds. They may have trouble negotiating complex systems due to cognitive or behavioral problems.

Older men and women from homeless and low socio-economic backgrounds often face a disadvantage concerning the fairness of access to quality health and aged care. Coupled with other significant social, health, and psychosocial challenges, these individuals are at greater risk of rapid decline in health and well-being with subsequent premature aging and mortality.

Service providers are frustrated with the lack of specialized long-term supported accommodation for older people, particularly older homeless people living with an acquired brain injury (ABI) and significant behaviors of unmet need. Although the incidence of ABI (particularly alcohol-related brain injury) is far wider than being confined to the homeless population, it is frequently misdiagnosed and very often misunderstood.

Consequently, many need aged care at younger ages than the general population. Although the group of people living with an acquired brain injury (ABI) constitutes only a small proportion of the total number of aged care residents living with some form of cognitive impairment, they present severe and ongoing challenges to support services. 

Most problematic is the frequency with which significant problems with impulse control, social skills, and self-awareness accompany the diagnosis of an ABI. Brain dysfunction due to trauma from multiple sources leads many service users to display preservative, high-risk behaviors that are often aggressive.

Commonly accompanying these injuries is an overlay of complex behavior that may further alienate the individual from social inclusion and accessing mainstream aged care support. People living with an ARBI (Alcohol-related brain injury) receive less empathy. They often attract more judgemental attitudes in the public view than people living with age-related dementias. People living with an ARBI and ongoing addiction are often preoccupied with activities directed toward procuring alcohol. 

In the absence of adequate funds, they often resort to whatever means possible to access alcohol, including criminal activity, aggressive stand-over tactics, begging, or selling possessions of any significant value. Vulnerable co-residents can easily fall prey to such behaviors, as can personnel who may not have the required skills to manage them.

Alcohol-related brain injury is caused by a combination of Thiamine (vitamin B1) deficiency, general cerebral shrinkage (secondary to alcohol consumption), and a range of other insults to the brain, including repeated head injury or assault. There is a growing body of research examining the effects of aging in association with long-term alcohol abuse; however, the increased complexity of these two factors in the homeless population has received little attention.

With a high percentage of people presenting with long and established histories of drinking, smoking, gambling, crime, and acquired brain injuries, few aged care services are willing or have sufficient expertise to allow clients their preferred lifestyle choice. Service providers are often challenged to support the diversity of needs exhibited within a single service setting because of the scarcity of trained staff and available resources. 

Consequently, for support services to deliver appropriate and effective care, they must possess knowledge of the underlying and often the multifactorial cause of the behavior and be skilled in delivering effective responses considering the limited cognitive capacity of individuals living its effects. The relationship between alcohol and drug use to homelessness is interactive and iterative in that it can be both a cause and an effect of homelessness