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

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 Methods: The review of literature extended from 1980 to 2005, examining peer review journal articles as well as unpublished community and hospital based reports.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