Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data

Abstract

Background: Although the poor health of people experiencing homelessness is increasingly recognised in health discourse, there is a dearth of research that has quantified the nature and magnitude of chronic health issues and morbidity among people experiencing homelessness, particularly in the Australian context. Methods: Analysis of the medical records of 2068 “active” patients registered with a specialist homeless health service in Perth, Western Australia as of 31 December 2019. Results: Overall, 67.8% of patients had at least one chronic physical health condition, 67.5% had at least one mental health condition, and 61.6% had at least one alcohol or other drug (AOD) use disorder. Nearly half (47.8%) had a dual diagnosis of mental health and AOD use issues, and over a third (38.1%) were tri-morbid (mental health, AOD and physical health condition). Three-quarters (74.9%) were multimorbid or had at least two long-term conditions (LTCs), and on average, each patient had 3.3 LTCs. Conclusions: The study findings have substantial implications from both a health risk and healthcare treatment perspective for people experiencing homeless. The pervasiveness of preventable health conditions among people experiencing homelessness also highlights the imperative to improve the accessibility of public health programs and screening to reduce their morbidity and premature mortality.

Multiple Long-Term Conditions (MLTC) and the Environment: A Scoping Review

“…As Guthrie et al 2012 [ 11 ] (p. 1) comment, managing MLTC is challenging as: ‘Clinical decision making is more difficult in people with multimorbidity because clinicians and patients often struggle to balance the benefits and risks of multiple recommended treatments and because patient preference rightly influences the application of clinical and economic evidence’. There are also substantial health and social costs for individuals with MLTC, who are more likely to experience severe illness and complication rates, increased physical and mental disability, lower quality of life and risk of social vulnerability including homelessness, unemployment and poverty [ 12 , 13 , 14 ].…”

Multiple Long-Term Conditions (MLTC) and the environment: A scoping review

“…It is estimated that by 2035 around 17% of the UK's population will have four or more chronic conditions, which is almost double the current prevalence (9•8%) (4). There are also substantial health and social costs for individuals with MLTC, who are likely to experience more severe illness and complication rates, increased physical and mental disability, lower quality of life and risk of social vulnerability including homelessness, unemployment and poverty (5)(6)(7).…”

PROTOCOL: The experiences of adults experiencing homelessness when accessing and using psychosocial interventions: A systematic review and qualitative evidence synthesis

“…Homelessness is a traumatic experience, which can have a devastating effect on those experiencing it. Several studies, some of which are cited below, have highlighted that more visible and extreme forms of homelessness are often associated with adverse childhood events (Koh & Montgomery, 2021), extreme social disadvantage (Mabhala et al, 2017), physical, emotional and sexual abuse (Green et al, 2012; Henny & Kidler, 2007), neglect (Mar et al, 2019), low self‐esteem (Seale et al, 2016), poor physical and mental health (Vallesi et al, 2021), and much lower life expectancy compared to the general population (ONS, 2019). People experiencing these more extreme and visible forms of homelessness often experience severe and multiple disadvantages (Bramley et al, 2020) and need significant levels of professional and service support (Dobson, 2019).…”