Homeless Individuals Research Articles

Prevalence and distribution of Lewy pathology in a homeless population.

The homeless population experience significant inequalities in health, and there is an increasing appreciation of the potential of lifestyle factors in the development of neurodegenerative diseases, including Parkinson's disease. We performed a study on the prevalence and distribution of pathological alpha-synuclein deposition throughout the central and peripheral nervous systems in a homeless population. Forty-four homeless individuals consecutively available for autopsy were recruited. Immunohistochemistry was performed using 5G4 antibody recognizing disease-associated forms of alpha-synuclein, complemented by phospho-synuclein antibody on autopsy tissues collected from 18 regions of the brain and spinal cord, as well as the right and left olfactory bulb, the cauda equina, the extramedullary portion of the vagus nerve, and 27 sites of peripheral organs. The study cohort consisted of 38 males and 6 females, median age 58 years (range 32-67). Lewy-related pathology was present in the brains of three male cases. One showed Braak stage 2 (60 years old), and two stage 4 (56 and 59 years old). One of the Braak stage 4 cases had Lewy-related pathology in the spinal cord, the cauda equina, and the extramedullary portion of the vagus nerve. Examination of 27 sites of peripheral organs found that all three cases with Lewy-related pathology present in the brain were devoid of peripheral organ alpha-synuclein pathology. Multiple system-type alpha-synuclein pathology was not found. Our study, representing a snapshot of the homeless population that came to autopsy, suggests that alpha-synuclein pathology is prevalent in the homeless supporting further study of this vulnerable population.

Lower limb ulcers in people experiencing homelessness

The homelessness crisis in Poland poses a serious challenge to the state, with the number of homeless individuals exceeding 30,000 in 2019. In this paper we highlight one of the most common surgical issue of people experiencing homelessness – venous leg ulcers – and present current treatment guidelines. Homeless individuals, particularly exposed to inadequate living conditions, poor hygiene, and circulatory disorders, are at high risk of developing them. Venous ulcers are chronic wounds with prolonged and complex healing processes.They arise due to venous hypertension associated with chronic venous insufficiency and thrombosis. Often, specialized treatment is necessary, which is a challenge for homeless individuals due to difficulties in accessing regular care.The treatment of venous leg ulcers involves a multi-stage process. The gold standard for managing venous leg ulcers is compression therapy, which reduces edema and venous reflux. The TIME strategy outlines the approach to chronic wound management, emphasizing the importance of initial wound cleansing (surgically, enzymatically, or larvotherapy), infection prevention, maintaining proper moisture and wound edge preparation. This requires the use of suitable antiseptics, dressings, and wound hygiene.People experiencing homelessness face specific issues that necessitate a holistic approach, which includes health education, nutrition, and rehabilitation.

Drug-related deaths among housed and homeless individuals in the UK and the USA: comparative retrospective cohort study.

The UK and USA currently report their highest number of drug-related deaths since records began, with higher rates among individuals experiencing homelessness. Given that overdose prevention in homeless populations may require unique strategies, we evaluated whether substances implicated in death differed between (a) housed decedents and those experiencing homelessness and (b) between US and UK homeless populations. We conducted an internationally comparative retrospective cohort study utilising multilevel multinomial regression modelling of coronial/medical examiner-verified drug-related deaths from 1 January 2012 to 31 December 2021. UK data were available for England, Wales and Northern Ireland; US data were collated from eight county jurisdictions. Data were available on decedent age, sex, ethnicity, housing status and substances implicated in death. Homeless individuals accounted for 16.3% of US decedents versus 3.4% in the UK. Opioids were implicated in 66.3 and 50.4% of all studied drug-related deaths in the UK and the USA respectively. UK homeless decedents had a significantly increased risk of having only opioids implicated in death compared with only non-opioids implicated (relative risk ratio RRR = 1.87, 95% CI 1.76-1.98, P < 0.001); conversely, US homeless decedents had a significantly decreased risk (RRR = 0.37, 95% CI 0.29-0.48, P < 0.001). Methamphetamine was implicated in two-thirds (66.7%) of deaths among US homeless decedents compared with 0.4% in the UK. Both the rate and type of drug-related deaths differ significantly between homeless and housed populations in the UK and USA. The two countries also differ in drugs implicated in death. Targeted programmes for country-specific implicated drug profiles appear warranted.

Homelessness in Sierra Leone: An Overview of Social Work Intervention in Helping Homeless Population

The article looks at the key causes of the rise in homelessness as well as Social Work intervention strategies in helping homeless people in Freetown. In many nations, homelessness has been a long-standing social issue. How to help homeless individuals live independently is a dilemma encountered by those who work and volunteer in homeless shelters. The study looked at problems with homelessness among children, teens, adults, the elderly, women, and veterans over the previous years in this brief study. According to the findings, family circumstances, housing, unemployment, and mental illness are the main causes of homelessness. Initial instances of these issues result in homelessness, which in turn makes them worse. Effective community interventions and policies are needed to prevent and reduce homelessness, including drug rehabilitation facilities job support, and affordable housing.

Exploring Homelessness Among Students in Merced County, CA

This comprehensive review paper aims to explore the effects homelessness has on students’ mental health and access to resources in Merced County, CA. By conducting interviews and meticulously analyzing multiple articles, this study investigates the impact of community mapping, support groups, and their connections with community-based research. The findings reveal a myriad of distinct factors that may lead to the plight of homelessness, while simultaneously illuminating potential avenues for assisting homeless individuals. Furthermore, this review paper delves into the impact of homelessness on mental health and education, highlighting the complex issue of student homelessness and the significance of promoting social mobility within the community.

Unconditional cash transfers reduce homelessness

Homelessness is an economic and social crisis. In a cluster-randomized controlled trial, we address a core cause of homelessness-lack of money-by providing a one-time unconditional cash transfer of CAD$7,500 to each of 50 individuals experiencing homelessness, with another 65 as controls in Vancouver, BC. Exploratory analyses showed that over 1 y, cash recipients spent fewer days homeless, increased savings and spending with no increase in temptation goods spending, and generated societal net savings of $777 per recipient via reduced time in shelters. Additional experiments revealed public mistrust toward the ability of homeless individuals to manage money and demonstrated interventions to increase public support for a cash transfer policy using counter-stereotypical or utilitarian messaging. Together, this research offers a new approach to address homelessness and provides insights into homelessness reduction policies.

Examining the Potential Impact of Restricting Low-Income Housing Tax Credit Housing for Individuals With Certain Criminal Convictions in Texas

Because housing is central to the recovery of individuals with experiences of homelessness and incarceration, it is important to consider how U.S. policies denying housing to residents with criminal histories can adversely affect racial and ethnic minorities and individuals with a history of homelessness. The state of Texas passed a rule specifying certain criteria that Low-Income Housing Tax Credit (LIHTC) supportive housing providers must use to screen tenants using criminal history. A retrospective cohort of 600 LIHTC supportive housing residents was used to estimate the potential impact of the rule. Based on this sample, the rule would have resulted in significantly higher proportions of Black and chronically homeless individuals being denied housing compared to the proportions of White and low-income individuals, respectively, who would have been denied housing. With the exception of drug convictions, there was no significant difference in recidivism between residents who would have been affected by the rule and unaffected residents who also had criminal justice involvement within a comparable time frame before move-in.

Predictors and consequences of homelessness in whole-population observational studies that used administrative data: a systematic review

BackgroundHomelessness is a complex societal and public health challenge. Limited information exists about the population-level health and social care-related predictors and consequences of persons with lived experience of homelessness (PEH). Studies that focus on population subgroups or ad hoc questionnaires to gather data are of relatively limited generalisability to whole-population health surveillance and planning. The aim of this study was to find and synthesise information about the risk factors for, and consequences of, experiencing homelessness in whole-population studies that used routine administrative data.MethodWe performed a systematic search using EMBASE, MEDLINE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO research databases for English-language studies published from inception until February 2023 that reported analyses of administrative data about homelessness and health and social care-related predictors and consequences. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.ResultsOf the 1224 articles reviewed, 30 publications met the inclusion criteria. The included studies examined a wide range of topic areas, and the homelessness definitions used in each varied considerably. Studies were categorised into several topic areas: Mortality, morbidity and COVID-19; health care usage and hospital re-admission; care home admission and shelter stay; and other (e.g. employment, crime victimisation). The studies reported that that the physical and mental health of people who experience homelessness was worse than that of the general population. Homeless individuals were more likely to have higher risk of hospitalisation, more likely to use emergency departments, have higher mortality rates and were at greater risk of needing intensive care or of dying from COVID-19 compared with general population. Additionally, homeless individuals were more likely to be incarcerated or unemployed. The effects were strongest for those who experienced being homeless as a child compared to those who experienced being homeless later on in life.ConclusionsThis is the first systematic review of whole-population observational studies that used administrative data to identify causes and consequences associated with individuals who are experiencing homelessness. While the scientific literature provides evidence on some of the possible risk factors associated with being homeless, research into this research topic has been limited and gaps still remain. There is a need for more standardised best practice approaches to understand better the causes and consequences associated with being homeless.

A scoping review examining the association of housing quality and psychosocial well-being following homelessness: an ecological systems perspective

ABSTRACT Housing quality (HQ) has been previously associated with health and quality of life. Although HQ is an important factor in preventing homelessness, little is known about the range and breadth of this body of literature. To identify existing studies, we conducted a scoping review guided by the question: “in what ways has housing quality been associated with psychosocial well-being following homelessness in existing peer-reviewed literature?” using the framework proposed by Arksey & O'Malley and PRISMA-ScR guidelines. Our search was deployed in eight databases. A total of 713 titles and abstracts were screened following the removal of duplicates, and 32 articles were included in narrative synthesis. Six themes emerged from our data analysis of included articles: 1) quality of housing affecting well-being; 2) feeling forced to live in unsafe and poor-quality housing due to no other options; 3) HQ mediated by housing first; 4) determinants of HQ; 5) standardized measures of HQ; and 6) HQ is de-emphasized in research and practice following homelessness. Our findings demonstrate that HQ is associated with psychosocial well-being at micro, meso, exo, and macro systems levels for persons experiencing homelessness. We argue addressing HQ following homelessness is a key homelessness prevention strategy.

Healthcare-Seeking Behaviors of Homeless Substance Users During the COVID-19 Lockdowns in Gauteng, South Africa: A COREQ-Based Report

Substance use continues to be a social problem globally. Around the world, approximately 275 million people use drugs, including 15% of South Africans, with over 36 million succumbing to drug disorders. In the Gauteng Province, about 55% of autopsies of deceased medicolegal cases (2003–2012) showed the presence of one or more illicit drugs in Pretoria. Most research shows that around one-third of people who have problems with alcohol and drugs are homeless. Evidence suggests that homeless people are often denied access to even the most essential assistance, including healthcare. This study assessed the healthcare-seeking behaviors of homeless substance users during the COVID-19 lockdowns in Gauteng, South Africa. A qualitative approach using an exploratory design assessed referrals based on those suffering from symptoms of COVID-19 during the lockdown period between 2020 and 2022. Data were collected from 25 homeless substance users in the City of Tshwane, Gauteng, through unstructured interviews. Three themes based on the study objectives included the types of healthcare services consulted, the determinants of health-seeking behaviors, and challenges experienced while seeking healthcare. Of the twenty-five participants, aged twenty-one to fifty, thirteen suffered from COVID-19 symptoms. Five used formal healthcare systems and eight used informal healthcare systems. Older participants access healthcare services, while less of the younger population use them. Barriers that are encountered while seeking medical services entail marginalization, stigmatization, and a lack of social support. Despite the formidable barriers posed by homelessness and substance use, homeless individuals demonstrated remarkable resilience in their efforts to access healthcare services during the COVID-19 lockdowns. This study highlights the importance and urgent need for harm reduction strategies and policy development for long-term service provision to this population, as well, as the literature on equity, diversity, and inclusion as a foundation for the rights of marginalized populations and groups. Future research directions should focus on harm reduction among this population group of homeless substance users.

Sensing the State: The Importance of Making the Researcher’s Citizen-State Relationship Explicit within Qualitative Research

In this article, I challenge the tendency towards underreported engagement with one’s own positionality vis-à-vis the state and note that qualitative manuscripts offer a unique opportunity to engage in liberatory practices by articulating this specific aspect of positionality on the page. To provide empirical evidence of the value of identifying and reckoning with the scholar’s relationship with the state, I use an autoethnographic approach to articulate the explanatory power of considering of my own state relationship within the research analysis and writing processes. I show that early findings from a qualitative research endeavor led me to view citizen coproduction practices that targeted homeless individuals as overly deterministic rather than distinctively malicious and tied to systems of state violence. In writing the manuscript that was relevant to this research endeavor, I engaged with my positionality vis-à-vis the state directly within the document which enhanced the validity of my final findings. As the qualitative research process is particularly suited for this liberatory practice, I conclude with some loose guidance for other researchers seeking out ways to identify their own relationship with the state and place it within the manuscript.

Toward a Policy Framework to Improve the Health Care of Homeless Individuals

Toward a Policy Framework to Improve the Health Care of Homeless Individuals

Volunteer experiences at a hospice for homeless individuals during the COVID-19 pandemic

Context Volunteers provide important social support for homeless people. While motivations of the volunteer population for homeless people have been studied, little is known about volunteers for a hospice targeting the homeless population. Objectives The purpose of this study is to describe volunteer experiences and motivation at a hospice for homeless people during the COVID-19 pandemic. Methods This study was conducted at a hospice for homeless individuals in Fall 2021. Data were collected by six virtual focus groups in November and December 2021. There were 21 participants. The recordings of the focus groups were automatically transcribed via ZOOM. The data were analyzed based on themes. Results This study has highlighted three main findings. First, honoring a loved one and being engaged in the community were two main reasons individuals began volunteering at the hospice center. Second, volunteers faced many challenges during the COVID-19 pandemic, including a slow start, increased use of technology, and constant change in volunteers’ responsibilities due to safety reasons. During this time however, volunteers felt much support from the program staff. Third, interactions with staff, other volunteers and residents were the main reasons driving volunteer motivation. Conclusions This project examined the under-studied subject of volunteers’ experiences at a hospice for homeless people and provided insight in this topic. While the COVID-19 pandemic affected volunteering at a hospice for homeless people, support from the program staff and leadership helped sustain volunteer motivation.

Healthcare Disparities Among Homeless Patients Hospitalized With Gastrointestinal Bleeding: A Propensity-Matched, State-Level Analysis.

Examine outcomes among homeless patients admitted with gastrointestinal (GI) bleeding, including all-cause mortality and endoscopic intervention rates. Hospitalizations among homeless individuals have increased steadily since at least 2007 but little is known about GI outcomes in these patients. The 2010-2014 Healthcare Utilization Project (HCUP) State Inpatient Databases from New York and Florida were used to identify adults admitted with a primary diagnosis of acute upper or lower GI bleed. Homeless patients were 1:3 matched with nonhomeless patients using a propensity-score greedy-matched algorithm. The primary outcome (all-cause in-hospital mortality) and secondary outcomes (30-day readmission rates, endoscopy utilization, length of stay, and total hospitalization costs) were compared. We matched 4074 homeless patients with 12,222 nonhomeless patients. Most hospitalizations for homeless individuals were concentrated in 113 (26.4%) of 428 hospitals. Homeless adults were more likely to be younger, male, African American or Hispanic, and on Medicaid. They experienced significantly higher odds of all-cause inpatient mortality compared with nonhomeless patients admitted with GI bleeding (OR 1.37, 95% CI 1.11-1.69). Endoscopy utilization rates were also lower for both upper (OR 0.62, 95% CI 0.55-0.71) and lower (OR 0.76, 95% CI 0.68-0.85) GI bleeding, though upper endoscopy rates within the first 24 hours were comparable (OR 1.11, 95% CI 1.00-1.23). Total hospitalization costs were lower ($9,715 vs. $12,173, P<0.001) while 30-day all-cause readmission rates were significantly higher in the homeless group (14.9% vs. 18.4%, P<0.001). Homeless patients hospitalized for GI bleeding face disparities, including higher mortality rates and lower endoscopy utilization.

Homelessness in the district of Nipissing of Ontario, Canada before, at the onset and during the COVID-19 pandemic: a trend analysis (2018–2021)

BackgroundHomelessness is a growing social concern experienced across Canada. In Ontario, specifically in the District of Nipissing, the issue has become larger with an increasing number of homeless individuals. Previous research has described the demographic composition of the homeless population both in the Nipissing District of Ontario and in the city of North Bay. However, no studies have examined homelessness in this region before, at the beginning and during the COVID-19 pandemic. This research investigates structural and individual-level barriers and factors that are associated with becoming homeless or remaining homeless.MethodsThis study utilizes data from the 2018 (n = 147), 2020 (n = 254), and 2021 (n = 207) homelessness enumeration surveys, conducted in the District of Nipissing, Ontario by the District of Nipissing Social Services Administration Board. This study employs quantitative, descriptive analyses to examine trends and socio-demographic variations in the reasons of homelessness, barriers to housing, episodic and chronic homelessness before, at the beginning, and during the COVID-19 pandemic.ResultsThe results revealed a rise in the proportion of male homeless (57% vs. 64%), and first-time homelessness among those aged 35–44 (3%, vs. 15%) and 55–64 (1% vs. 5%) at the onset and during the pandemic. The sleep location of homeless individuals was also influenced by the pandemic, where emergency shelter use dropped to half during 2020–2021(33% vs. 17%), while the use of locations (hotel/motels) where proper pandemic protocols and social distancing were possible increased sharply from 2 to 12% of homeless individuals. With the onset of the pandemic, chronic homelessness and one-episodic homelessness increased, suggesting that individuals are becoming homeless and staying homeless for prolonged periods. The barriers to housing during the pandemic were largely addiction, substance use and the inaccessibility of safe and secure rental units, while the corresponding barriers before the pandemic were mainly low income.ConclusionsThe rise in male homelessness, age at first-time homelessness and interpersonal conflict causing homelessness at the onset and during the pandemic suggest that policy makers need to focus on providing homeless supports to these groups of homeless populations at the time of pandemic.

Determinants of health-related quality of life (HRQoL) among homeless individuals during the COVID-19 pandemic.

Thus far, there is very limited knowledge regarding homeless individuals during the COVID-19 pandemic, particularly related to the health-related quality of life (HRQoL). Thus, our aim was to evaluate HRQoL and to clarify the determinants of HRQoL among homeless individuals during the COVID-19 pandemic in Germany. Data were taken from the national survey on psychiatric and somatic health of homeless individuals during the COVID-19 pandemic-NAPSHI (n = 616). The established EQ-5D-5L was used to quantify problems in five health dimensions, and its visual analogue scale (EQ-VAS) was used to record self-rated health status. Sociodemographic factors were included in regression analysis. Pain/discomfort was the most frequently reported problem (45.3%), thereafter anxiety/depression (35.9%), mobility (25.4%), usual activities (18.5%) and self-care (11.4%). Average EQ-VAS score was 68.97 (SD: 23.83), and the mean EQ-5D-5L index was 0.85 (SD: 0.24). Regressions showed that higher age and having a health insurance were associated with several problem dimensions. Being married was associated with higher EQ-VAS scores. Overall, our study findings showed a quite high HRQoL among homeless individuals during the COVID-19 pandemic in Germany. Some important determinants of HRQoL were identified (e.g., age or marital status). Longitudinal studies are required to confirm our findings.

Rehabilitating Homeless: Dataset and Key Insights

This paper presents a large anonymized dataset of homelessness alongside insights into the data-driven rehabilitation of homeless people. The dataset was gathered by a large non-profit organization working on rehabilitating the homeless for twenty years. This is the first dataset that we know of that contains rich information on thousands of homeless individuals seeking rehabilitation. We show how data analysis can help to make the rehabilitation of homeless people more effective and successful. Thus, we hope this paper alerts the data science community to the problem of homelessness.

Contradictions Within the Swedish Welfare System: Social Services’ Homelessness Strategies Under Housing Inequality

Sweden has seen a rise in homelessness alongside its strained housing market. References are increasingly being made to structural problems with housing provision, rather than individual issues. Housing has been organized through the local social services, which are responsible for supporting homeless people. With a foundation in housing studies, this article analyzes the Swedish social services’ challenges and actions in a time in which affordable housing is in shortage, and housing inequality a reality, through the lens of social services. The focus is on the intersection between the regular housing market and housing provision (primary welfare system), the social services needs‐tested support (secondary welfare system), and the non‐profit and for‐profit organizations (tertiary welfare system), with emphasis on the first two. The article is based on interviews with people working for the City of Malmö and illustrates how the housing shortage problem is moved around within the welfare system whilst also showing that social services’ support for homeless individuals appears insufficient. Social services act as a “first line” gatekeeper for those who have been excluded from the regular housing market. Moreover, recently implemented restrictions aim to make sure that the social services do not act as a “housing agency,” resulting in further exclusion from the housing market. The article highlights how the policies of the two welfare systems interact with and counteract each other and finally illustrates how homeless individuals fall between them. It highlights the need to link housing and homelessness in both research and practice to gain a deeper understanding of the complexities of housing markets and how homelessness is sustained.

OPTIMISATION OF A DESIGN-TO-FABRICATION FRAMEWORK FOR INDIVIDUALISED HOMELESS HOUSING DESIGN IN MELBOURNE, AUSTRALIA

AbstractDigital design tools and technologies offer new opportunities for designers to generate a diverse range of design solutions. Previous research have discussed the multifaceted use of such technologies for 1) rapid visualisations, 2) generating design options, and 3) predicting design solutions. However, such research have focused more on simplifying design for fabrication and less on the integration of individual needs in design processes. This research adopts a human-centric design approach to merge user-to-design and design-to-fabrication processes. Through a scoping review on homelessness, design, and fabrication, we contribute a user-design-fabrication framework devised for the specific and dynamic needs of homeless individuals living in Melbourne, Australia. Our findings suggests that to optimise digital design processes for individuals with specific and dynamic needs, designers need to understand, translate, and embed the social, design, and fabrication complexities of a design problem. Future research should therefore test the real-world application of our user-design-fabrication framework and evaluate the impact of such digital design processes, for the provision of more individualised homeless housing design solutions.

Seroprevalence of arthropod-borne bacterial infections in homeless individuals in Hamburg in 2020

PurposeThe number of homeless people in Germany is steadily increasing. Due to their often precarious living conditions, this specific population may be increasingly exposed to ectoparasites that can transmit various pathogens. To assess the prevalence and thus the risk of such infections, we analyzed the seropositivity of rickettsiosis, Q fever, tularemia and bartonellosis in homeless individuals.MethodsA total of 147 homeless adults from nine shelters in Hamburg, Germany, were included. The individuals underwent questionnaire-based interviewing, physical examination, and venous blood was drawn between May and June 2020. Blood samples were analyzed for antibodies against rickettsiae (Rickettsia typhi and R. conorii), Coxiella burnetii, Francisella tularensis and bartonellae.Results and conclusionA very low seroprevalence of R. typhi and F. tularensis infection was found (0–1%), while antibodies against R. conorii and C. burnetii were more common (7% each), followed by a relatively high seroprevalence of 14% for bartonellosis. Q fever seroprevalence was associated with the country of origin, whereas bartonellosis seroprevalence was associated with the duration of homelessness. Preventive measures targeting ectoparasites, especially body lice, should be put in place continuously.