Cardiovascular Disease and Homelessness

Abstract

Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.

Health Literacy and Self-Rated Health among Homeless Adults

“…As hypothesized, individuals who were health literate reported better selfrated health compared to those who were only somewhat/a little bit/not at all confident completing medical forms by themselves. Results are consistent with previous studies conducted amongst domiciled samples linking health literacy with self-rated health (Fernandez, Larson, & Zikmund-Fisher, 2016;Marques et al, 2018) and extend these findings to a group with a (Baggett, Liauw, & Hwang, 2018;Chang et al, 2015;Roncarati et al, 2018). Based on our current results, we propose that special attention and intervention is needed among homeless individuals with poor health literacy levels to improve their ability to understand and process health information, which may ultimately impact their self-rated health.…”

Clinical Pharmacy Intervention for Persons Experiencing Homelessness: Evaluation of Patient Perspectives in Service Design and Development

“…Participants in these public involvement sessions said that they would trust pharmacists to prescribe medicines to them. Cardiovascular diseases, mental health and substance misuse issues are often undiagnosed and under-treated [6,10,11], and pharmacists have the potential to address these issues.…”

“…Homeless populations also experience reduced prescribing of medicines, and face barriers to accessing and managing their medicines. Cardiovascular diseases, mental health and substance misuse issues are often undiagnosed and under-treated [9][10][11]. Therefore, they have an increased rate of use of unscheduled care, with high resource and cost implications to healthcare services.…”

Alarmierungen der Berliner Notfallrettung zu obdachlosen Frequent Usern

“…So stellen beispielsweise Herz-Kreislauf-Erkrankungen die häufigste Todesursache bei Obdachlosen dar. Neben dem mangelhaften Zugang zu gesundheitlichen Präventionsangeboten und einer fehlenden Kontrolle von Risikofaktoren sind auch zusätzliche psychosoziale Stressoren wie Depressionen oder Alkohol-und Drogenkonsum zu nennen [2]. Insbesondere konnten unter Obdachlosen eine hohe Rate an unkontrolliertem arteriellem Hypertonus, aber auch eine erhöhte Prävalenz von Diabetes mellitus festgestellt werden [3,4] Langjährige Obdachlosigkeit stellt einen eigenständigen Faktor dar, der das Sterberisiko von Obdachlosen erhöht [5].…”