Health care for the homeless: a family medicine perspective.

Many factors contribute to the health problems of homeless persons, including exposure to adverse weather, trauma and crime, overcrowding in shelters, unusual sleeping accommodations, poor hygiene and nutritional status, alcoholism, drug abuse and psychiatric illness. It is common for homeless adults to have skin ailments, respiratory infections, traumatic injuries and chronic gastrointestinal, vascular, dental and neurologic disorders. Homeless children may have respiratory, ear and skin diseases, as well as special problems, including failure to thrive, developmental delay, neglect and abuse. Important questions to ask during history-taking include questions about sleeping conditions, sources of food, past psychiatric problems and substance abuse, and sources of social support. Special attention should be given to examination of the skin, teeth and feet. Supplemental food, immunizations, psychologic counseling and social service referrals should be considered for homeless pediatric patients.