Dementia and mild cognitive impairment screening in an emergency homeless shelter.

INTRODUCTION: Older adults represent the fastest growing segment of the homeless community. Little is known about the prevalence of dementia and mild cognitive impairment (MCI) in this population. METHODS: Dementia and MCI screening using the Montreal Cognitive Assessment (MoCA) was incorporated into the standard senior evaluation for adult clients aged ≥ 55 in a large emergency homeless shelter. RESULTS: In a 6-week period, 104 of 112 (92.9%) assessments were positive for dementia or MCI using a standard cutoff of 26, and 81 (72.3%) were positive using a conservative cutoff of 23. There was no significant difference in MoCA scores based on sex or education level, and no significant correlation between age and MoCA score. DISCUSSION: Older adults experiencing homelessness may have a high likelihood of dementia or MCI. Routine MoCA screening in older adults experiencing homelessness is feasible and can help to identify services needed to successfully exit homelessness.

Evaluation of Patient Satisfaction, Impact and Disability-Free Survival After a Surgical Mission in Madagascar: A Pilot Survey.

BACKGROUND: Billions of people worldwide lack access to safe affordable surgery. Surgical missions and non-governmental organisations (NGO) are vital in meeting this need, but long-term outcomes are rarely reported. Mercy Ships is a surgical NGO, and we aimed to measure disability-free survival, impact and patient satisfaction in Madagascar after a 7-month mission. METHOD: We aimed to evaluate 346 patients. Primary outcome measure was the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0); secondary outcomes were residual pain; changes in perception of shame and acceptance by society; and overall satisfaction with surgery. Linear regression used to determine association between covariates and each outcome measure. RESULTS: One hundred patients were uncontactable and 98 failed to attend, leaving 148 for final evaluation at a median duration of 8 months. Median WHODAS 2.0 was 2.1 % (range 0-25 %); 1 patient had a score of 25 % defined as disability. 32/148 had residual pain; average pain score of 1.8/5. Overall patient satisfaction was 4.7/5 (94 %). Median patient shame scores fell from 2.9/5 (58 %) to 0.3/5 (6 %) and median acceptance scores rose from 3.3/5 (66 %) to 4.8/5 (96 %) (both p ≤ 0.001) postoperatively. WHODAS 2.0 significantly correlated with gender and postoperative pain (both p ≤ 0.05). CONCLUSION: Surgical missions have a duty-of-care to evaluate outcomes, and WHODAS 2.0 is a quick, reliable method to ensure surgeries do no harm. Measurements of perception of shame, acceptance by society, patient expectation and satisfaction can also be reliably measured and should not be forgotten by surgical NGOs.

The Restorative Integral Support (RIS) Model: Community-Based Integration of Trauma-Informed Approaches to Advance Equity and Resilience for Boys and Men of Color.

Mental health and health promotion research and practice have consistently revealed the social and structural inequities that boys and men of color (BMoC) face. Moreover, scholarship highlights the importance of gender, especially the concepts of masculinity and manhood, in understanding inequities that are experienced. Providers and community leaders are finding culturally relevant ways to foster healing and restoration while addressing racial trauma and the adverse community environments tied to adverse childhood experiences (ACEs). This article introduces the restorative integral support (RIS) model to promote connectivity through networks and to acknowledge the contextual differences BMoC experience when suffering from trauma and adversities. RIS is a framework used to address adversities and trauma while increasing societal awareness and advancing equity. This community-based, multidimensional approach is offered to enhance individual, agency, community, and policymaking leadership, raising awareness of mental health concerns and trauma while offering a flexible guide to developing safe spaces and support for recovery from ACEs and trauma. This article offers an in-depth appreciation of the real-life contexts within which BMoC overcome histories of adversity and trauma, demonstrating how the RIS model is applied to advance structural transformation while fostering community resilience.