Introduction:
Vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness. It may also include rural residents, who often encounter barriers to accessing healthcare services. The vulnerability of these individuals is enhanced by race, ethnicity, age, sex, and factors such as income, insurance coverage (or lack thereof), and absence of a usual source of care. Their health and healthcare problems intersect with social factors, including housing, poverty, and inadequate education (AJMC, 2006).
For this blog posting my focus will be on the elderly, as a vulnerable group, and how they can better be served.
Elderly as a vulnerable population:
What makes elderly a vulnerable? First, I would like to highlight that age by itself does not automatically means the person is vulnerable. There are, definitely, many older adults in their sixties, seventies, and eighties who are in a good physical and mental state, living independently, taking care of themselves, and even enjoying different activities, and fulfilling social lives. However, as people get older, for a lot of them physical and mental impairments could make it difficult to take care of themselves. There are internal and external factors that can contribute to vulnerability and risk.
Internal risk factors include: • Increasing age. • Female gender. • Medical comorbidities. • Substance abuse. • Mental illness. • Cognitive impairment. • Sensory impairment. • Impairment in activities of daily living (ADL). • Malnutrition. External risk factors include: • Lack of social network. • Dependence on a care provider. • Living alone. • Lack of community resources. • Inadequate housing. • Unsanitary living conditions. • High-crime neighborhood. • Adverse life events. • Poverty (S. Culo, 2011).
How can the aging population be better served and taken care of?
As suggested by S. Culo, 2011, in-depth personalized assessment should be performed to identify the risk factors, and red flags. The essential component of risk assessment includes an examination of an individual’s strengths, resources, and willingness to accept intervention. As for red flags, vulnerable older adults should be screened for cognitive deficits and mistreatment. The presence of certain indicators should raise suspicion of abuse or neglect. Clinical assessment should include comprehensive geriatric assessment in form of client interview, physical examination, and review of medical history and medication usage. Laboratory and radiographic studies may be clinically indicated. Basic cognitive testing and screening for psychiatric disorders is recommended. It is important to explore potential financial, physical, emotional, and sexual abuse.
After the assessment was performed, the options for interventions should be offered. Vulnerable older adults need to be involved as much as possible in decision making. An individual’s autonomy should only be infringed upon with significant justification. S. Culo, 2011, explains that the goals of intervention in cases of vulnerability are to promote autonomy, ensure safety, reduce morbidity and mortality, maximize function, and improve quality of life. Individuals should be offered support and assistance such as home care, day programs, ongoing medical follow-up, housekeeping, meal delivery, and transportation programs. Hospitalization and facility placement may be required, depending on the needs of the individual, and should be used as a last resource. Capable adults who refuse intervention should be offered information regarding services that are available. D. Beales, 2013 also suggested the need to recruit trained volunteer visitors, to give health education and brief the elderly about benefits and entitlements, as well as providing companionship and help with different tasks.
Conclusion:
As the baby boomers getting older, health care workers will meet more and more older adults who are vulnerable due to physical, cognitive, financial, or other impairments. The management of these populations is often complex and requires the multidisciplinary team collaboration. It is of a great importance to perform proper assessment of risk factors and other indicators, in order to implement proper interventions. The goal of interventions should be to promote autonomy, reduce morbidity, and most importantly increase the quality of life for aging adults.
References:
Beales, D. (2013). Community Care of Vulnerable Older People: Cause for Concern. British Journal of General Practice, p. 549-550.
Culo, S. (2011). Risk Assessment and Intervention for Vulnerable Older Adults. BC Medical Journal, p. 421-425.
Comments