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homeless patient

Epidemiology: - 46% with psychosis - 53% with major depression - 54% had substance use disorders - 45% had alcohol use disorders - 46% report history of traumatic brain injury [2] Complications: 1) alcoholism 2) infection a) tuberculosis b) pneumonia (poor prognostic factor) c) HIV infection (homeless shelters high risk) 3) domestic violence 4) cognitive impairment (72%) 5) increased risk of early death - 5-year mortality in older California homeless is 3.5 times higher than that in the general population [6] Management: - screen for cognitive impairment, mobility impairment, urinary incontinence, & falls [1] - consider simplified treatment regimens - medications once a day that do not have to be taken with food (if possible) - integrate smoking cessation into treatment of addiction [1] - hepatitis A vaccine [5]

General

housing problem

References

  1. Fazel S et al The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, Volume 384(9953):1529-1540, 25 October 2014 PMID: 25390578 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961132-6/abstract - Hwang SW. Burns T Health interventions for people who are homeless. The Lancet, Volume 384(9953):1541-1547, 25 October 2014 PMID: 25390579 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961133-8/abstract
  2. Stergiopoulos V et al. Neurocognitive impairment in a large sample of homeless adults with mental illness Acta Psychiatr Scand 2015 Jan 21 PMID: 25604122
  3. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis. 2001 Sep;1(2):77-84. PMID: 11871479
  4. Stratigos AJ, Stern R, Gonzalez E et al Prevalence of skin disease in a cohort of shelter-based homeless men. J Am Acad Dermatol. 1999 Aug;41(2 Pt 1):197-202. PMID: 10426888
  5. Doshani M, Weng M, Moore KL, Romero JR, Nelson NP. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. MMWR Morb Mortal Wkly Rep 2019;68:153-156 https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a6.htm
  6. Brown RT et al. Factors associated with mortality among homeless older adults in California: The HOPE HOME study. JAMA Intern Med 2022 Aug 29; [e-pub]. PMID: 36036902 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2795475