A Synopsis of AFP's "Care of the Homeless: An Overview"

A synopsis of:
Care of the Homeless: An Overview
DAVID L. MANESS, DO, MSS, and MUNEEZA KHAN, MD, University of Tennessee Health Science Center, Memphis, Tennessee Am Fam Physician. 2014 Apr 15;89(8):634-640.

     Homeless people are more likely to become ill, become hospitalized, or die at an early age. Homeless children have higher rates of asthma, iron deficiency, lead poisoning, ear infections, respiratory problems, GI issues, and emotional/behavioral issues. These patients may often present initially with advanced forms of common illnesses. It is critical to identify these people so that they can receive care tailored to their situation. Confidence, trust, and empathy must be developed with these relationships. Setting up referrals, follow ups, and monitoring lab results may be challenging. A case manager or patient advocate may help with logistics.
     Common diseases in the homeless include hypertension, diabetes, CHF, PVD, high cholesterol and CAD. Poor diet, excessive mental stress, alcohol/ drug abuse, and poor coping mechanisms can exacerbate these conditions. Lifestyle modification is especially tough in this group of individuals. Patients are also susceptible to acts or violence, rape, sexual abuse, and physical abuse. Mental illness and traumatic brain injury are other illnesses that are found in high rates in the homeless. Stable housing, cognitive rehabilitation, support services, and access to therapy are critical for an optimal outcome.
     Prevention, immunizations and periodic evaluations are as important in this population as they are in the general public. Tdap vaccinations should be offered if its been longer than 10 years. Influenza vaccination should be offered annually. Pneumococcal vaccinations should be offered appropriately. These patients should also be tested for HIV, hepatitis B and hepatitis C.  Tuberculosis should always be considered as part of a differential in a sick homeless patient.
     Foot and skin care are also important. These patients endure long periods of standing and walking, often times in old or poor fitting shoes, with unclean or wet socks. This is a great nidus for ulcerations, cellulitis, edema, and stasis. Education, early detection, proper fitting shoes, clean socks, and sanitary living conditions are helpful measures of prevention.
     The best way to provide services to these people is through a multidisciplinary PCMH style approach with outreach services and community programs. Having multiple services at one spot is an effective approach.