International Journal on Homelessness · Oct 7, 2026
Impact of Shelter Settings on Cognitive Decline in Unhoused Older Adults
By Ross H, Dzenga P, Squires A et al.
Introduction: Older adult homelessness is a growing problem worldwide. Older adults in large congregate homeless shelters have high rates of positivity on dementia and mild cognitive impairment screening, suggesting possible cognitive decline. Congregate shelters can be challenging for older adults, with poor sleep quality exacerbating cognitive decline. In contrast, non-congregate shelters are thought to afford a more restful sleeping environment that may improve cognition. However, very little is known about cognitive performance among unhoused older adults after moving from congregate to non-congregate shelters. Method: Using the Montreal Cognitive Assessment (MoCA), we screened unhoused older adults in a large emergency congregate shelter and re-screened after they voluntarily transitioned to a non-congregate shelter. Result: Older adults with higher MoCA scores (≥23) in a congregate shelter had lower scores after moving to a non-congregate shelter, whereas individuals with lower MoCA scores (<23) in a congregate shelter had higher scores after moving to a non-congregate shelter. Conclusion: These findings suggest that social aspects of a congregate setting may afford cognitive protections for some that are lost in a non-congregate setting, offsetting the positive impacts of improved sleep conditions in a non-congregate shelter. With this in mind, homeless services providers may incorporate social programming particularly in non-congregate settings as a proactive measure to forestall cognitive decline.