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The objective of this study was to determine the prevalence and characteristics of cognitive impairment in older people experiencing homelessness in the inner city of Sydney, Australia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Men and women experiencing homelessness aged 45\u2009years and over in the inner city were screened for cognitive impairment. Participants who scored 26 or below on the mini\u2010mental state examination and\/or were impaired on any one of the clock\u2010drawing test, the verbal fluency test and the trail\u2010making test, part B were then assessed with a semi\u2010structured interview, including the 21\u2010item Depression Anxiety Stress Scale and the 12\u2010item General Health Questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Screening of 144 men and 27 women aged between 45\u2009years and 93\u2009years identified cognitive impairment in 78%. Subsequently, high rates of mental and physical illness were identified, and 75% of subjects who were cognitively impaired performed poorly on frontal lobe tests. The trail\u2010making test, part B was the most sensitive measure of frontal function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrated that a large majority of older people experiencing homelessness, in the inner city of a high\u2010income country, showed impairment on tests of frontal lobe function, a finding that could have significant implications for any medical or psychosocial intervention. 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