This study evaluated cognitive function and factors associated with cognitive impairment in a cohort of older homeless adults. Researchers hypothesized that substance use and a history of traumatic brain injury would be associated with cognitive impairment.

Participants had a median age of 58 years [IQR 54–61], 76.7% were men, and 79.9% were African American. A quarter (25.1%) of participants met criteria for impairment on the 3MS; 32.9% met criteria for impairment on TMTB. In models adjusted for sociodemographic variables and health conditions, high-severity alcohol use was associated with global cognitive impairment (AOR 2.39, CI 1.19–4.79) and executive dysfunction (AOR 3.09, CI 1.61–5.92).

Older homeless adults displayed a prevalence of cognitive impairment 3–4 times higher than has been observed in general population adults aged 70 and older. Impaired cognition in older homeless adults could impact access to housing programs and the treatment of health conditions, including the treatment of alcohol use disorders.