Running Head: Populations

Populations at Risk
Kyle Lynch
Wayne State University

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The elderly community is a community which faces risks on a

day to day basis.

Kay Smith (pseudonym) is a ninety three year

old woman who lives away from her family in an assisted living
facility.

Kay faces several risks in her daily life.

Some of

these risks include depression, her physical health, and abuse

and neglect.

As a result of her age and health, Kay relies on

others for most things.

certain risks.

Relying on others puts individuals at

This is not only true for Kay, but is also true

for all members of the elderly community.

Elderly individuals are at particular risk for depression.
Being depressed can also pose certain risks to elderly
individuals.

According to Cynthia G. Cahoon, author of

Depression in Older Adults writes:

Depression affects an estimated 15% to 19% of Americans ages
65 and older living in a variety of settings, yet the
illness often goes unrecognized and untreated. Known risk
factors for older adults include having chronic medical
conditions, physical or cognitive functional decline,
polypharmacy, experiencing multiple losses, and social
isolation (2012).
Depression poses risks for elderly individuals.

It is common for

healthy people who develop depression to experience physical

symptoms.

Cahoon also writes:

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Many illnesses that are common in older adults are known to

be associated with depressive symptoms. One frequently cited
older study found that even older adults with few or no
physical comorbidities had a significantly increased risk of
developing a disability in activities of daily living when
they developed depressive symptoms (2012).
Feeling depressed not only effects the mental state of the
person, but it also effects their quality of life.

Along with

effecting a persons mental state and quality of life, depression

can also effect an elderly persons physical health.

One of the

major systems effected by depression is the cardiovascular

system.

Several studies have identified health factors

associated with depression which negatively affect the

cardiovascular system, particularly the heart.

Cahoon continues:

Depression is associated with reduced physical activity; one

recent study found it was low levels of physical activity in
depressed patients, rather than other depression symptoms,
that increased their risk of cardiovascular mortality.19
Another recent study found that severe depression was
associated with an unhealthy diet (dietary risk factors
included comparatively low levels of polyunsaturated fatty
acids, low fiber intake, and low carbohydrate intake) and
other risk factors for acute myocardial infarction (2012).

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Depression is a major risk that not only Kay faces, but the
entire elderly community faces.
As people age, their physical health changes.
several health risks.

The elderly face

There are several chronic conditions that

people face as they age.

Steven R. Counsell talks about these

conditions in his article, A new tool to support expert care for

multiple chronic conditions.

Counsell writes:

Heart disease. Diabetes. Arthritis. Hypertension. These are

some of the chronic conditions that many of our patients
encounter as they age. It is convenient here to separate
them with punctuation marks, but we know that the clinical
reality is quite different. Most people 65-years-old or
older live with at least three (if not more) of these or
other chronic concerns. (2015).
As we age changing health is something that we face.

Elderly

individuals are at a higher risk of developing chronic health

conditions.

As a person manages increasing health conditions,

they often find that treatments can have an effect on treatments

for other conditions.

This risk of adverse side effects is a

risk that elderly people face.

Counsell continues:

We as healthcare professionals have increasing access to an

array of guidelines for addressing them, but here too
guidance may be limited to individual conditions that are
easy to isolate on paper but are less neatly categorized in

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practice. If an older adult with multimorbidity were to take

all the medications that standard guidelines recommend, for
example, that patient might face significant risks for
adverse events and harmful side effects (2015).
Finding the perfect balance of treatments to control health
conditions in the elderly can prove to be difficult for both the
doctor and the patient.

Counsell states: As we continue to

expand our knowledge of and proficiency in caring for older

people, we are recognizing in new and important ways that
treatment options canand perhaps shoulddiffer from one patient
to the next (2015).

Finding this delicate balance of health

management is something that is difficult as a patients health

needs are continually changing.

Ongoing health changes are a

major risk that the elderly face.

Another risk facing the elderly population is abuse and
neglect.

Many times elderly people find themselves in a

vulnerable situation, as their abilities decrease.

As a person

loses the ability to care for themselves, they have to depend on

others more for care.

Elderly individuals are often scared to

report abuse. Carmel Bitondo Dyer the author of Neglect

Assessment in Elderly Persons explains:
THE American Medical Association defines neglect as the
failure to provide the goods or services necessary for
functioning or to avoid harm (1). Neglect connotes the

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refusal or failure to provide life necessities such as food,

water, clothing, shelter, personal hygiene, medicine,
comfort, personal safety, and other essentials (2). Persons
who experience neglect are among the most frail and
vulnerable of our society (2005).
Elder abuse is something that is too common in our society.
Nicholas Castle author of Elder Abuse in Assisted Living writes:
Elder abuse should be uncommon, but we have evidence indicating
that this is not the case (2011).

Old people face risks to

their safety and their well-being.

Neglect is a form of abuse.

Neglect is one form of elder mistreatment that also includes

physical abuse, sexual abuse, and exploitation. One can
neglect himself (self-neglect) or be neglected by a
caregiver. A caregiver may be a family member, a friend, or
an employee of the elder or of a nursing or other type of
facility, or an entity responsible for providing care (Dyer,
2005).
While not every elderly individual will experience these forms of
abuse or neglect, the risk is still there.
weak, and vulnerable.

Elderly people are

These things and the increase in reliance

on others are factors that lead to the risk of being abused or

neglected.
These risks are risks that the entire elderly population
face.

Kay being a member of this population, is at risk for

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these same factors.

7
Kay faces the potential for depression.

She

faces the potential to develop depression as a result of her

declining health and her social isolation.

Cahoon Writes:

Depression can affect older adults living in any setting.

Among those in long-term care facilities, the prevalence of
some level of depressive symptomatology has been estimated
at anywhere from 6% to 44%. The prevalence of depression is
also very high in patients receiving home health care
services. Studies have indicated that one in seven such
patients meet the diagnostic criteria for major depression,
and as many as one in three have some level of clinically
significant depression (2012).
Kay is also at risk of experiencing declining physical health.
As this occurs it is crucial that Kay, like other elderly
individuals, finds a doctor who is competent and able to manage
several health conditions at one time.

Counsell stated: More

flexible approaches to care are essential to balancing a

patient's clinical needs with his or her psycho-social
preferences that deserve to be known and respected (2015).

This

is not only true for Kay, but it is also true for elderly
individuals facing declining health. As a person ages, their
physical appearance changes.
signs of abuse and neglect.

These changes can sometimes hide

Dyer writes:

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To the untrained eye, the neglected elder may simply look

like a frail older person who is just quite sick. Since the
findings may be masked, and the elder unable or unwilling to
report the neglect, screening in health care settings is a
must (2005).
Kay is especially at risk for this, as her appearance has changed
dramatically.

Kay appears to be frail and old, which could

inhibit peoples ability to recognize if Kay were being

neglected.

The elderly population is at risk for several

factors. Some main factors elderly individuals are at risk for

are depression, physical decline, and abuse and neglect.

Kay

being part of this community, is at risk for all of these

factors.
During a visit with her social worker Kay expressed that she
was helped to the rest room by her aide, and the aide forgot her
in the rest room for over an hour.

Kay stated that she pushed

her help button repeatedly and no one came to help her.

Growing

frustrated, Kay finally got herself up from the toilet and in to

her wheelchair.

When Kay told this story to her social worker,

she explained that she did not want to report this incident
because she was afraid that the aide workers would take it out on
her if they knew that she told on them.
states:

The NASW Code of Ethics

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Social workers should protect the confidentiality of all

information obtained in the course of professional service,
except for compelling professional reasons. The general
expectation that social workers will keep information
confidential does not apply when disclosure is necessary to
prevent serious, foreseeable, and imminent harm to a client
or other identifiable person. In all instances, social
workers should disclose the least amount of confidential
information necessary to achieve the desired purpose; only
information that is directly relevant to the purpose for
which the disclosure is made should be revealed (2008).
After hearing this information, the social worker informed Kay
that he was obligated to report this incident because she was put
in danger.

The social worker also explained to Kay that if this

happened to her, then it could happen to another resident.

When

the social worker made the report, he was sure to ensure privacy
as much as possible.

The code also states:

Social workers should take precautions to ensure and

maintain the confidentiality of information transmitted to
other parties through the use of computers, electronic mail,
facsimile machines, telephones and telephone answering
machines, and other electronic or computer technology.
Disclosure of identifying information should be avoided
whenever possible (2008).

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The social worker did this by speaking directly to his supervisor

in a private setting where he could ensure that no one could over
hear what happened to his client.

A social worker is obligated

to promote the well-being of their client.

The Code states:

Social workers primary responsibility is to promote the

well-being of clients. In general, clients interests are
primary. However, social workers responsibility to the
larger society or specific legal obligations may on limited
occasions supersede the loyalty owed clients, and clients
should be so advised. (Examples include when a social worker
is required by law to report that a client has abused a
child or has threatened to harm self or others.)(2008).
While the social worker wanted to keep his client happy, he knew
that he was obligated to make a report about Kay being neglected.
In the end, Kay agreed that the social worker should make a
report of the incident.

This is just one of the ethical dilemmas

that the elderly population, including Kay, face.

Working with

this population, it is important to remember what the risk

factors of the elderly population are.

There are many ethical

dilemmas one may face when working with individuals within the
elderly population.
The elderly population is a population that faces several
risks.

One of these risks is the potential for depression.

This

comes from changes that happen beyond ones control, as well as

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11

being isolated from others including family.

Another risk posed

to elderly individuals is decreased physical health.

Elderly

individuals are at risk of things such as heart disease,

diabetes, arthritis, and hypertension.

These physical issues are

not limited to elderly individuals, but do effect a large portion

of this population.
neglect and abuse.

Finally, elderly individuals are at risk of

Many people do not realize that an elderly

person is being neglected.

Often times, it takes a trained eye

to identify an old person experiencing abuse.

Kay smith is an elderly woman who is at risk for all of
these factors.

Kay lives alone and is isolated from her family.

This poses a risk for depression.

in her physical health.

Kay has been seeing a change

She has been fighting cancer, and has

had several deep vein thromboses.

Her increase in age has had an

effect on her health which has been obvious to her and her
family.

Kay has seen her appearance change recently from a

healthy older woman, to an old frail woman.

These changes pose a

risk because it would be difficult to tell if Kay was being

abused or neglected.

All of these risks are real.

risks facing the elderly population, as well as Kay.

These are the

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References

Cahoon, C. G. (2012, November 1). Depression in Older Adults.

Retrieved May 26, 2016, from
http://up7af9tu5s.search.serialssolutions.com/?
ctx_ver=Z39.88-2004
Castle, N. (2013, February 08). Elder Abuse in Assisted Living.
Retrieved May 28, 2016, from
http://jag.sagepub.com.proxy.lib.wayne.edu/content/32/2/248.
full
Code of Ethics (English and Spanish) - National Association of
Social Workers. (2008). Retrieved May 29, 2016, from
https://www.socialworkers.org/pubs/code/code.asp
Counsell, S. (2015, July 01). A new tool to support expert care
for multiple chronic conditions. Retrieved May 27, 2016,
from http://up7af9tu5s.search.serialssolutions.com/?
ctx_ver=Z39.88-2004
Dyer, C. (2005). Neglect Assessment in Elderly Persons. Retrieved
May 29, 2016, from
http://biomedgerontology.oxfordjournals.org.proxy.lib.wayne.
edu/content/60/8/1000
K. Smith, personal communication, 2016