Caring for adults experiencing homelessness with diabetic foot ulcer: A scoping review

Abstract

BACKGROUND: The number of people experiencing homelessness (PEH) is rising annually on a global scale. Due to the circumstances of living in this population, they are impacted by health conditions, such as diabetes mellitus (DM) and are susceptible to developing a diabetic foot ulcer (DFU). However, there is still a lack of information about DFU in PEH in the literature. OBJECTIVE: This scoping review aims to identify and map what is available in the literature on DFU in PEH. METHODS: The Joanna Briggs Institute and PRISMA-ScR frameworks guided the literature review. The search was conducted in the following databases: MEDLINE, SCOPUS, Web of Science, CINAHL, Scielo, ProQuest, and Google Scholar. Inclusion criteria included articles published between 2014 and 2024 and written in English. Nine articles met the inclusion criteria and were published in six different countries: the United States of America, Canada, Australia, Italy, the United Kingdom and Pakistan. FINDINGS: The included articles explore the vulnerability of PEHs and how their environment and lifestyle can impact their health, which can be worsened if the PEHs also have a DM diagnosis. The included articles highlighted that PEHs experience inadequate assessment by healthcare professionals and foot exams, which can negatively impact the prognosis of the condition. Prevention, foot exams and volunteer health units are underscored as best practices for PEHs living with DMs to diminish the risk for complications such as DFU as a result of the DM diagnosis. However, the plan of care needs to be individualized and tailored to each person. As well, enhancement to health literacy, for health professionals and PEH, should be promoted for better adherence to treatment and identification of DFU in the early stages. CONCLUSION: The review identified what is known about DFU in PEH, such as management of DM, comprehensive health care, prevention, foot exams and health literacy. However, this scoping review identified a gap in the literature, expressed by the limited number of articles published on the topic under investigation, which can be improved in the future. It also highlighted that is important to improve healthcare professionals' knowledge to provide health literacy education, conduct a foot exam and evaluate the DM stage. This will help prevent further complications, as well to reach PEH. To assess their health, it is essential to first understand their environment and promote comprehensive care. For this, some volunteer healthcare units in Italy and the US have had great results identifying the risk for or the emergence of DFU and providing targeted and timely treatment.