Evaluation of Functional Cognition in People Experiencing Homelessness: A Scoping Review

The identified prevalence of cognitive impairment in people experiencing homelessness has placed a focus on the use of measures of cognition to predict functioning and ability to move successfully into housing. Functional cognition is the cognitive ability to perform daily life tasks, incorporating cognitive functioning, performance skills, and patterns. Given the increased research on cognitive status and functional skills within people experiencing homelessness, a scoping review was conducted to synthesize the existing literature and identify how functional cognition is evaluated in this population, and identify implications for homeless and housing services. This scoping review was conducted using the Joanna Briggs Institute protocol. Included studies assessed functional cognition, or assessed a component of cognition and related it to functional performance. Of 8,848 articles retrieved from the initial search, thirty-seven articles were determined to meet the inclusion criteria for data extraction. Categories for data extraction included functional domain addressed, tools used for assessment of cognition and/or function, and how reported outcomes were interpreted. Narrative analysis identified domains of cognition and function assessed, and relationships between cognition and function domains. Only the functional domain of Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) were found to have a consistent relationship between cognition and performance and primarily when performance-based assessments were used. Challenges with generalizing study findings broadly include: study populations do not reflect demographics of those experiencing homelessness; a variety of assessment tools for cognition and function are utilized; and the broad use of the term function encompasses several different areas of independent living in the community. Several studies identified that even with the presence of decreased cognition, those with the experience of homelessness are able to maintain housing when given individualized and appropriate supports. This scoping review indicates inconsistent methods to assess cognition and functional cognition within people experiencing homelessness. Performance-based assessments of ADL/IADL are more likely to identify the impact of cognition on function, while neurocognitive assessments are more beneficial to assess social/community integration. Findings indicate that to support the transition from homelessness to housing and increase the likelihood of housing stability; assessments should focus on identifying strengths and necessary/individualized ongoing supports