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Abstract INTRODUCTIONOlder 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. METHODSDementia 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. RESULTSIn 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. DISCUSSIONOlder 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. 

Previous homelessness research examined common pathways into homelessness, yet not much is known about how people navigate through services while experiencing homelessness. This study explored the service pathways of homeless individuals in the U.S. context, which show their connection with multiple organizations and their lived experiences of using services over time. We conducted 12 semi-structured in-depth interviews to grasp the history of service pathways, including the number of organizations, time gaps between services, and referral patterns. We also conducted participant observation shadowing with a subset of the study participants to understand how they interact with caseworkers. The length of service pathways varied, from less than five years to more than two decades. On average, participants went through at least three and up to eight organizations. Regarding service experiences, systemic- and individual-level themes were drawn for negative or positive experiences, such as strict organizational policies and the caseworker’s demeaning attitudes (negative), or supportive organizational culture and strong employee competencies (positive). The findings of this study provide deeper insights into homeless populations’ service trajectories and their experiences throughout the service-navigating process.