Marcel Slockers

55 Health status of homeless people measured by health problems would possibly lead to less registered substance abuse and drug-induced psychoses. The enormous increase in the number of homeless people in the past ten years justifies a new Action Plan for Social Support. A new action plan should include a focus on the specific needs of women and older people, as the proportion of these groups visiting the street doctor’s consultation hours has risen. Women experiencing homelessness are particularly vulnerable, as indicated by even shorter life expectancy than homeless males, as compared to the general population. 7,8 Older homeless people make relatively little use of secondary facilities, but they suffer much more often from cardiovascular diseases, visual problems and poor social support networks. 27,28 Multidisciplinary homeless assistance programmes should be more effective in reaching this particular group. When older people wander the streets and literally become homeless, it might be a sign of cognitive impairment. The fact that more older people are wandering the streets is possibly linked to the closure of nursing homes in Rotterdam. This points to the need for new and safe forms of supervised accommodation. Mental health care for homeless people needs significant improvement. The rise in the proportion psychiatric disorders such as ADHD and autism requires shelter facilities for homeless people with these disorders. Further research and more effective policies are required in order to stem the increase in the proportion of homeless soft drug users. Street doctors have observed where healthcare for vulnerable people in society is failing. Focussing on homeless people’s health problems might provide more insight into the health risks among people at risk of homelessness. Poorly managed diabetes, COPD or thyroid conditions make people more vulnerable and could contribute to becoming homeless. Initially, the street doctor’s consultation hours seemed to focus especially on acute elective care for hard drugs problems, alcohol abuse, HIV/AIDS and traumata. Sub- sequently, the street doctors seemed to focus more and more on secondary prevention as in regular GP practices. Increasing proportions of patients with registered hypertension and chronic diseases, such as diabetes, thyroid problems, COPD and oncological problems, suggest that the street doctor’s consultation hours are moving increasingly towards regular healthcare. However, specific patient-centred care for the classical clinical features of homeless patients at the street doctor’s consultation hours remains essential. Findings: a. at the street doctor’s consultation hours, there has been an increase in the proportion of homeless women over the last 12 years; previous research has shown even lower rates of survival for homeless women than for homeless men