Outcomes/Effectiveness Research

Prior traumatic brain injury is very common among homeless people and is linked to poorer health

About 5,000 people in Toronto, Ontario, are homeless each night and about 29,000 people use shelters each year. More than half (53 percent) of this homeless group have a history of a traumatic brain injury and 12 percent have suffered a moderate or severe traumatic brain injury. More than two-thirds of this homeless population had suffered the injury before they became homeless, according to a new study. Traumatic brain injury is a head injury that leaves the individual dazed, confused, disoriented, or unconscious, with moderate or severe injuries resulting from unconsciousness that lasts 30 minutes or longer. These injuries often lead to cognitive impairment, attention deficits, lack of inhibition, impulsivity, and emotional instability. They also seriously affect the overall health of homeless persons, notes Stephen W. Hwang, M.D., M.P.H., of St. Michael's Hospital in Toronto.

Dr. Hwang and colleagues found that a history of moderate or severe traumatic brain injury was associated with three times greater likelihood of seizures, 2.5 times greater risk of developing mental health problems, nearly twice the odds of drug problems, and poorer physical health status (8.3 points lower on a status scale) and poorer mental health status (6 points lower on a mental health scale).

These findings underscore the need for clinicians to routinely ask patients who are homeless about a history of traumatic brain injury. Given the dose-response relation between injury severity and current health, clinicians should assess injury severity based on how long the patient says they were unconscious, admission to hospital after the injury, collateral history, and medical records. Brief neuro-psychological screening can provide valuable information on cognitive function. People with moderate or severe cognitive impairment may be eligible for disability benefits or referral to rehabilitation or other appropriate community services.

The study was supported in part by the Agency for Healthcare Research and Quality (HS14129). More details are in "The effect of traumatic brain injury on the health of homeless people," by Dr. Hwang, Angela Colantonio, Ph.D., O.T. Reg., Shirley Chiu, M.A., and others, in the October 7, 2008, Canadian Medical Association Journal 179(8), pp. 779-784.

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