Utilization of foot care services among homeless adults: Implications for advanced practice nurses

Abstract

To increase use of foot care programs among homeless adults, services must be offered during the day time when they are not competing to secure nightly shelter. Foot care programs should be innovative and tailored to their unique needs and address concern for sensitivity to feet, sock, and shoe condition; cost; specific services provided; competing needs; source of care; and how to access these services.

Foot Conditions among Homeless Persons: A Systematic Review

“…[11], [12], [16], [17], [19], [20], [23], [24] One study recruited homeless individuals from a volunteer health service outreach association, [25] and another study recruited homeless individuals from a community kitchen. [18] Ten (59%) studies included participants from more than one location (e.g. shelters, clinics).…”

“…[13] In one study of homeless adults who used foot care services, 56% reported a history of diabetes, hypertension, peripheral vascular disease or a combination of the three. [18] In one study of 299 homeless shelter residents, approximately 9% self-reported having diabetes with 5% having diabetes mellitus type 2 and 4% having diabetes mellitus type 1. [19] However, 16% of participants reported numbness, 21% had tingling in their feet, and 21% had swollen feet suggesting that some individuals may have had undiagnosed diabetes.…”

“…[19] One study found that homeless individuals walked a median of 5 miles daily. [18] Foot pain was reported by 56% of participants in one study, with 12% reporting they had pain all the time. [19] Homeless individuals were more likely to report pain in their feet when walking compared to housed participants (mean 2.0 vs. 1.7 on scale of 1–4, p = 0.003) and were more likely to report functional limitations when walking uphill (functional status score 6 vs. 8, p = 0.001).…”

“…[19] A survey conducted with 100 homeless adults examined foot hygiene attitudes and practices. [18] 52% of participants believed they needed foot care and 92% believed healthy feet were important and wanted to learn about how to maintain healthy feet. However, only 68% had access to clean water, 70% to soap, 56% to a towel, 44% to a nail clipper, 31% to a nail file, and 15% to a mirror.…”

“…In one study, 25% of homeless respondents reported being seen in the ED for a foot-related concern. [18] Another study found that 31% of homeless participants had visited a health professional for a foot problem. [19] Several studies reported that 20–21% of individuals who presented with a foot concern required further follow-up due to the severity of their condition.…”