Musculoskeletal Injuries and Conditions Among Homeless Patients

Abstract

Introduction: The purpose of this study was to analyze existing literature on musculoskeletal diseases that homeless populations face and provide recommendations on improving musculoskeletal outcomes for homeless individuals. Methods: A comprehensive search of the literature was performed in March 2020 using the PubMed/MEDLINE (1966 to March 2020), Embase (1975 to April 2020), and CINHAL (1982 to 2020) databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for accuracy of reporting, and the Newcastle-Ottawa Scale was used for quality assessment. Results: Twenty-nine articles met inclusion criteria. Seven studies observed an increased prevalence of musculoskeletal injuries among the homeless population, four observed increased susceptibility to bacterial soft-tissue infection, four observed increased fractures/traumatic injuries, three described increased chronic pain, and six focused on conditions specific to the foot and ankle region. Discussion: Homeless individuals often have inadequate access to care and rely on the emergency department for traumatic injuries. These findings have important implications for surgeons and public health officials and highlight the need for evidence-based interventions and increased follow-up. Targeted efforts and better tracking of follow-up and emergency department usage could improve health outcomes for homeless individuals and reduce the need costly late-stage interventions by providing early and more consistent care.

A scoping review of surgical care for people experiencing homelessness: prevalence, access, and disparities

“…Many studies discussed barriers or challenges PEH face when it comes to surgical care, including 48 primary studies, 19 , 31 , 34 – 36 , 39 – 41 , 43 – 45 , 47 – 50 , 54 , 55 , 57 – 64 , 66 , 69 , 72 , 73 , 75 , 79 – 81 , 86 , 91 , 96 , 98 , 100 , 102 – 105 , 107 – 109 , 111 , 112 , 114 , 116 9 abstracts, 37 , 38 , 42 , 52 , 77 , 84 , 101 , 106 , 118 5 literature reviews, 22 , 74 , 95 , 99 , 110 1 invited article, 51 1 magazine article, 70 1 thought piece, 92 1 ethical essay, 115 1 thesis, 71 and 1 historical analysis. 117 The majority of comments presented concerns regarding living conditions.…”

“…The lack of stable housing was described as a possible reason for leaving against medical advice, 57 readmission, 54 , 92 extended hospital stay, 55 , 58 , 67 , 87 , 93 , 94 and missing follow-up appointments. 36 , 64 , 79 , 95 – 97 In addition, authors commented on how the lack of a regular address leaves home nursing services inaccessible, 97 terminal care impossible, 49 and deters patients from procedures. 80 , 98 Furthermore, the need to find shelter and food can come as a priority over pursuing health care.…”

“… 36 , 41 , 43 , 60 , 75 , 92 , 99 , 100 , 103 , 111 , 112 Four studies mentioned their overreliance on visits to the emergency department. 41 , 75 , 95 , 103 Two studies commented on how a hospital’s limited funding, resources, space, and personnel can prevent PEH from receiving the care they need while admitted, 30 , 47 and 1 study commented on how PEH can experience more discharge concerns. 113 Lack of insurance was noted frequently, even in countries with public coverage but missed certain services.…”

“…Other factors contributing to the vulnerability of PEH were documented as additional challenges. These included marital status, 73 race and ethnicity, 73 residential history, 73 incarceration, 95 language, 116 immigration, 116 gender, 77 and education. 50 , 99 In particular, low income/poverty was the most reported contributing factor, with comments in 13 papers.…”

Ankle fracture surgery in patients experiencing homelessness: a national evaluation of one-year rates of reoperation

“…Despite the increased incidence of musculoskeletal injuries among homeless patients, 6 the impact of homelessness on surgical fracture care remains understudied. Recent findings highlight the considerable impact of social determinants of health disparities on orthopedic trauma surgery.…”