Medical comorbidity and receipt of medical care by older homeless people with schizophrenia or depression

Objective: Few studies have examined medical comorbidity among middle-aged and older homeless people with schizophrenia. This study compared the number of physical health problems and receipt of physical health care services among older homeless people with schizophrenia, and those with major depression. Methods: The study was conducted at St. Vincent de Paul Village, a homeless shelter in San Diego, California, with an on-site free medical and psychiatric clinic. Data from the psychiatric clinic log for a one-year period were used to identify 47 shelter users older than age 45 with schizophrenia and an age- and gender-matched comparison group of 47 shelter users with major depression. A physician reviewed the patients' charts to obtain data for a comparison between groups of the number of clinic visits for medical problems, receipt of various components of the physical examination and preventive screening studies, and number of chronic medical disorders. Results: The patients with schizophrenia had fewer medical visits and fewer documented medical problems than those with depression. They were also less likely to receive a detailed physical examination, cholesterol level screening, and screening for colon cancer. The documented rates of several chronic medical problems, including diabetes, arthritis, and hypertension, were lower among the shelter residents with schizophrenia. Conclusions: Middle-aged and older homeless people with schizophrenia received less primary and preventive health care and were treated for fewer chronic medical problems than a comparison group with depression.