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EMSWORLD.com | APRIL 2016 33 EMS1604 For More Information Circle 28 on Reader Service Card it may not be possible to differentiate which mental illness the patient has, providers will need to remain aware of this potential, especially if the patient is incoherent or presenting with an altered mental status. Half of homeless patients with mental illness also abuse alcohol and/or drugs. Because of this potential, providers should remain aware of the various signs and symptoms associated with mental illness and/or substance abuse, such as slurred speech, incoherent conversations and ataxia. 7–10 L i f e s t y l e C o n s i d e r a t i o n s Lack of access to well-balanced meals hampers the ability of the homeless to maintain a healthy diet. In some cases, the food that is available for the homeless (e.g., at shelters) may be high in salt, sugar and starch and may lack needed nutrients. This can lead to nutritional insufficiencies that can potentially influence underlying conditions or result in complications such as electrolyte imbalance and fluid retention. 5 Lack of housing for the homeless negatively impacts the ability to care for oneself. For example, wound care can be problematic for the person who has limited access to clean water and bandages, which leads to the potential for infection. The ability to store medicine or dispose of used syringes in a biohazard container may not be possible. Access to prescription medication refills, compliance with medications and the overall ability to monitor the homeless patient's condition may be very difficult. Dental and oral hygiene may be compromised if toiletries are not available. A lack of oral hygiene potentially lowers the individual's immune/defense system and has also been shown to be a potential contributor to atherosclerosis, endocarditis and stroke. 6 Sexually transmitted infections (STIs) occur more frequently among the homeless compared to the general population, especially in females. This is due in part to limited reproductive health services, prostitution and "survival sex," which is intercourse in exchange for food, drugs and temporary shelter. 15,19,20 The HIV infection rate among the homeless is also greater than the general population. This has been attributed to limited access to condoms, survival sex, prostitution, sexually transmitted infections and intravenous drug use. The pregnancy rate for homeless women is twice that of the general population. 15,19,20