Literature review
Homelessness, health status and emergency department use: An integrated review of the literature

https://doi.org/10.1016/j.aenj.2007.07.003Get rights and content

Summary

Background

Homeless people have complex health care needs, and they have difficulty accessing and utilising health services appropriately. These factors are associated with living in poverty, and in particular, residing in poor quality transient housing. Due to the complexity of their social disadvantage a flexible and timely response is required by emergency departments that extend beyond the traditional models of health care. The purpose of this integrated literature review was to identify the key risk factors that impact on the health service utilisation of people who experience homelessness.

Methods

The review of literature extended from 1980 to 2005, examining peer review journal articles as well as unpublished community and hospital based reports.

Results

The risk factors identified included: mental illness, drug misuse, violence, social isolation, dual diagnosis, cognitive impairment and chronic illness.

Conclusions

Social isolation and poverty impact on health status and the way health services are utilised. There is a need for early recognition and referral to appropriate services for this at risk population.

Section snippets

Significance

Homeless people experience difficulties in accessing health services and health service providers have limited resources, flexibility and understanding to help the homeless. As a result of these difficulties, “the homeless have more health impediments and disabilities, and experience higher mortality and morbidity rates than the general population.”3 Individuals who are economically and socially disadvantaged suffer from a range of medical conditions due to increased susceptibility to risk

Methodology

The literature review was conducted by a computerised search on Medline, Proquest, CINHAL, Psych Info and Web of Science between the years of 1980–2005 in English. Key words used in the search were, homeless/homelessness, health, mental illness, drug and alcohol misuse, dual diagnosis, chronic disease, medication non-adherence (non-compliance), malnutrition, violence, social isolation (exclusion), poverty, policy, access, risk screening (assessment) tool, infectious disease and cognition. In

Results

The literature review revealed a number of areas of importance which impacted on homeless people's health and access to health services. Analysis of health policy revealed an increased focus on homelessness due to political interest in ED length of stay and waiting times. Homeless people were shown to be high users of ED and therefore became a focus in policy and program funding to address ED demand.

The definition and prevalence of homelessness was also identified as an issue revealing the

Discussion

Our review of the literature reveals that few attempts have been made to develop a risk assessment tool to identify homeless people and none to identify the risk of re-presentation. In conjunction with identifying key risk factors that impact on homeless people a mechanism in ED to assist clinical staff to implement early identification and referral is needed.

Access to health services for homeless people is influenced by many issues such as health service policies which include: admission

Conclusion

The utilisation of ED by homeless people is not about inappropriate use but about how homeless people manage their health issues and survive a chaotic life style. A life style that does not respond to organised appointments, waiting lists and waiting times with exclusion criteria. The lack of access to adequate finances, transport, and multiple health needs, poor compliance to instructions on medication and treatments reveals a very vulnerable group. Their response is mostly crisis driven,

Competing interests

Dr. Marie Gerdtz is an Associate Editor of AENJ and has had no part in the peer review or editorial process relating to this paper.

Funding

Financial support was provided through the Australian Research Council Linkage Project Scheme, project number: LP0453587. Financial support was also provided by St Vincent's Health.

Acknowledgements

I would like to acknowledge St Vincent's Health, The University of Melbourne and the Australian Research Council for their financial and organisational support making this study possible. I would also like to thank Dr. Andrew Dent, Director of Emergency, St Vincent's Hospital, who has given expert clinical supervision for this project.

This Manuscript has been peer reviewed.

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