Homeless in poor mental, physical health.

Homeless in poor mental, physical health

Residents of most large U.S. cities see them almost daily, the sad-faced men and women without homes, the bearded man in a ragged coat mumbling to himself or the toothless woman begging for change at a subway. Recent studies reveal, not surprisingly, that homeless people suffer more physical and mental health problems than the general population. But the extent of their problems has surprised even the researchers.

People living outside have more problems than those living in shelters, according to a study by Lillian Gelberg of the University of California, Los Angeles' Division of Family Medicine. In 1985, Gelberg and six medical students left their white lab coats at home and sought out the homeless at beaches, parking lots and soup kitchens. The researchers examined 111 shelter residents, 212 at nonresidential centers for the homeless and 206 people living outdoors, and took blood from 454.

They discovered that two-thirds of their sample had physical symptoms serious enough to require immediate medical care. About half suffered from a chronic disease, a third were underweight or malnourished, and half had serious vision problems. The homeless proved poor judges of their own health. Nearly two-thirds of those with high blood pressure didn't know it. Those living outside had more foot problems, acute skin injuries and signs of protein malnutrition and were more likely to report alcohol and drug abuse. Gelberg and Lawrence S. Linn describe their findings in the Oct. 13 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

On the opposite coast, psychiatrist William R. Breakey and epidemiologist Pamela J. Fischer of the Johns Hopkins University School of Medicine in Baltimore found similar problems when they and colleagues interviewed 528 homeless men and women randomly selected from local missions, shelters and jails. Thorough physical examinations of 203 of the group revealed that women had an average of 9.2 health problems serious enough to require a physician's care; the men averaged 8.3. Nearly 80 percent of the women and 91 percent of the men had a psychiatric disorder, either active or in remission. Seventy-five percent of the men and 38 percent of the women reported problems with alcohol or drug abuse, according to a report in the Sept. 8 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

"It seems very likely that disorders that existed before people were homeless had a role in making the person more vulnerable," breakey says.

Nutritionally inadequate diets may contribute to the poor health of homeless adults, according to a study led by nutritionist Elisabeth Luder of the Mount Sinai School of Medicine in New York City. Luder and co-workers asked 55 homeless people waiting to visit a medical team at St. Vincent's Hospital and Medical Center of New York about their diets. Though 93 percent said they got enought to eat, Luder's team rated their diets inadequate, containing low levels of calcium, iron, B vitamins and zinc and high levels of sodium, saturated fat and cholesterol. Of 17 who gave blood samples, 16 had a total serum-cholesterol level greater than 200 milligrams per deciliter. And 25 percent of the subjects had enough body fat to rank among the top 5 percent of the U.S. population.

Luder says many soup kitchens serve nutritionally adequate meals but their patrons apparently don't choose balanced diets. Luder's study, described in the September-October PUBLIC HEALTH REPORTS, didn't include people living outdoors.

Gelberg says the Los Angeles survey demonstrates "we can't ignore people living outdoors. In L.A., there were 3,000 shelter beds for over 36,000 homeless people. By focusing on shelters, you're ignoring people who have more serious physical health problems."