Health problems of homeless people

 

Health problems of homeless people

Homeless people are at relatively high risk for a broad range of acute and chronic illnesses.

General Health Problems of Homeless Adults

Traumatic Disorders

Contusions, lacerations, sprains, bruises, and superficial burns are more commonly reported in the homeless population Homeless people are at high risk for traumatic injuries for a number of reasons. They are frequently victims of violent crimes such as rape, assault, and attempted robbery. In addition, primitive living conditions result in unusual risks; for example, the use of open fires for warmth predisposes them to potential burns.

Disorders of Skin and Blood Vessels

Pustular skin lesions secondary to insect bites and other infestations are common among homeless people In addition, venous stasis of the lower extremities (i.e., poor circulation because of varicose veins) caused by prolonged periods of sitting or sleeping with the legs down predisposes homeless people to dependent edema (swelling of the feet and legs), cellulitis, and skin ulcerations. Recurrent dermatitis which is possibly related to inadequate opportunities to bathe or shower and which is associated with infestations with lice and scabies, is prevalent among the homeless population. Moreover, homeless people do have an increased frequency of bacterial cellulitis and other pustular skin lesions.

Respiratory Illnesses

Acute nonspecific respiratory diseases are commonly reported in populations of homeless people in shelters. Living in groups, crowding, environmental stresses, and poor nutrition may predispose homeless people to infections of the upper respiratory tract and lungs.

Tuberculosis has become a major health problem among homeless people .Characteristically, this has been a disease associated with exposure, poor diet, alcoholism, and other illnesses that can lead to decreased resistance in the host. Compared with nonhome less populations, these homeless individuals had a very high frequency of skin test reactivity and positive cultures. Because tuberculosis is spread by personal contact, these infections pose a potential public health problem to occupants of shelters and to the general population.

Miscellaneous Health Problems

Foot problems occur with a greater frequency among homeless people. These include superficial fungal infections and calluses, corns, and bunions that are apparently the result of trauma from ill-fitting shoes. Homeless people suffer from many dental problems. Reports of poor oral hygiene, cavities, gingival disease, and extractions with no prosthetic replacements appear to be extremely common among homeless people. These life-threatening problems are especially prevalent among alcoholic homeless people and those who abuse other drugs.

 

Mental Illness, Alcoholism, Drug Abuse, and Comorbidity of Homeless Adults

 

Many homeless adults suffer from chronic and severe mental illness. The visibility of mentally ill people has led to the creation of a stereotype for the entire homeless population; the earlier stereotype of the homeless alcoholic has been replaced in recent years with that of the mentally ill homeless person. Not only can homelessness be a consequence of mental illness, but a homeless life may cause and perpetuate emotional problems. To sort out these variables, it is necessary to distinguish among the various categories of psychiatric disorders. The major mental illnesses, principally schizophrenia and the affective disorders (bipolar and major depressive disorders), are unlikely to result from the trauma of homelessness. Psychiatric illnesses, such as the anxiety and phobic disorders and milder depressive reactions, can either be contributing factors in causing homelessness.

Acoholism and Alcohol Abuse

In whatever setting homeless adults are studied, alcoholism is the most frequent single disorder diagnosed.Severe and intractable alcohol disorders have historically been thought to be especially prevalent among homeless people. Early accounts often attributed the high frequency of alcohol problems among homeless men to their inherent shiftlessness and failure to obtain gainful employment. 

Illnesses Associated with Abuse of Drugs Other Than Alcohol

There are few concrete data describing the extent of drug abuse among homeless individuals. Most studies about the homeless combine alcohol and drug abuse together under the heading of substance abuse. Those that separate the two provide some minimal information about illicit drug use. One of the problems associated with drug abuse is AIDS and AIDS related complex. Whether this is more commonly encountered among homeless people who abuse drugs compared with the remainder of the drug-abusing population is not clear. Nevertheless, as the clinical syndromes associated with AIDS increase in the general population, especially among those who abuse parenteral drugs, it will be an increasing problem among the homeless as well.

Other illnesses more commonly encountered in patients who abuse parenteral drugs are hepatitis, skin infections, abscesses, thrombophlebitis, bacterial endocarditis, and tuberculosis.

Comorbidity

Finally, a point must be made about the comorbidity caused by mental illness, alcoholism and alcohol abuse, and illicit drug abuse. There is a growing concern among those who work with homeless people about clients with dual and multiple diagnoses. For example, the HCH data point to correlations among drug abuse, alcohol abuse, and mental illness. Among drug abusers, 42 percent of the men and 41 percent of the women who visited HCH projects and gave evidence of that diagnosis could also be classified as mentally ill; 59 percent of the male clients and 46 percent of the female clients who abused drugs also evidenced a problem with alcohol Sixty-four percent had been hospitalized for any treatment for mental illness, alcoholism, or drug abuse.