Shut-In and Shut-Out of Society: The Vulnerable Elderly Population

Increasing concern over the impact of health problems associated with the elderly shut-in population has fostered the attention of communities and public health professionals across the country. However, despite the attempts of local and state services, many members of this group are being overlooked and basically forgotten. The objective of this project was to directly observe, record, and participate in the daily efforts of volunteers as they develop, organize, and implement services that aid in the healthcare maintenance of shut-in elderly.

Objectives were met by dedicating service hours to this vulnerable population and observing methods to improve their quality of living in the areas of healthcare, personal hygiene, nutritional settings, and ability to seek assistance with activities of daily living. These observations were aimed at diminishing the ever-increasing factors of morbidity and mortality in this aging group. Appropriate actions were organized and accomplished by the overall collaboration of community senior citizen programs and local hospital volunteer efforts.

Each member of this group was screened for specific needs and assistance was provided based on the member’s health condition and financial instability to receive healthcare services. Among the findings of this volunteer effort, the main observation concluded that the overall quality of life and health were improved for this vulnerable population. Positive impacts were noted with the interventions provided by public and private cooperation. Volunteers were in great demand and the supply of these dedicated servants was limited.

Funding also allowed for the varied services performed and this aspect of the program was also limited. While the time frame of this volunteer service was limited, valuable insight was gained by the participant for this vulnerable group. Concerns still remain that this group of elderly shut-ins will not receive the attention and sustained care they need to prevent further more complicated health issues. The adverse effects of moderate to severe health issues coupled with oneliness and bitter depression has become a standard of living for many elderly citizens in our country. Many of them are isolated and confined to the barriers of their home or skilled care facilities. They lack both the physical ability and financial ability to seek and address certain basic needs that all human beings need to survive. Health interventions must be made available to this group of deserving citizens at both the local community and higher government agency levels.

These elderly members share many chronic illnesses, such as congestive heart failure, diabetes, renal failure, and varied forms of cancer to name a few. All of them have been abandoned by their families for one reason or another in the past few years. Divorce, deaths, and emotional segregation have led them to a life of isolation and despair , thus leading to descention from their families or next of kin. Loss of family contact has forced them to be dependant upon the efforts of society and welcome whatever assistance with certain humility and grace.

Volunteers spend hundreds of hours with these elderly shut-ins to provide health need necessities and safety in both their home environment and outside activities. Transportation, meals, housekeeping tasks, pet care, and simple conversational time are awarded by the efforts of the volunteers. Many of the dedicated individuals are senior citizens and they can empathize with the current struggles that are faced by the ones they help. The members of this vulnerable group face many risk factors both physically and psychologically.

They suffer from various health issues with leads them to increased risk for falls and injury, malnutrition, skin breakdown, depression and increased suicide tendencies, heat and cold injury, and the isolation they all share increase the risk of premature death amplification with these health co- morbidities. Out of the 10 cases that were observed, 8 were of low socioeconomic financial standings and 2 were of middle income bracket level.

The 8 members were totally dependent upon Social Security benefits and welfare payments either from their own earned benefits or those left by deceased spouses. of the group were females and 7 were men, and 2 members were married. The other members were either divorced or left alone by death and geographic separation. All of the members were relocated to the Southern Middle Tennessee area at some point in their lives. They retired to this area or had been disabled and remained in this part of the country by force of fate. 4 members had their own private home, 2 lived in apartments, and 4 lived in an assisted living type of environment. None of the group had local family to support them in any capacity.

They were dependent upon the care they received from the community and volunteer efforts. Health Issues: Due to the isolation factors this group shared and the various physical health anomalies, many shared the same concerns about their health. The biggest fear shared between them was falls. They felt that they had inadequate contact with the outside world in the event they fell and were injured. The 10 subjects had many risk factors that justified their fears regarding falls. Most of the dwellings were inadequately equipped for the physical assisting devices they required.

According to Marquis (2004), falls are the number one health hazard for isolated elderly citizens living in substandard housing. The homes lacked adequate lighting, proper home maintenance updates, unnecessary clutter and storage in the homes, lack of emergency communicative devices (fall alert devices), and inability to contact someone closely located to the individual in the case of emergencies. Members of this group also suffered many psychological disparities. The biggest risk shared commonly was depression.

About 6 out of 10 members had been officially diagnosed with clinical depression, some of which had been diagnosed many years previously. They discussed the need for companionship and “just needing someone to talk to”. One of the members expressed that he had tried to commit suicide in the past and that he was tired of living with pain and loneliness. Based on findings by Howard (2007), this group has neither the resources nor physical ability to acquire help for their mental and emotional deficits and the possibilities of professional counseling in this area was next to impossible to being accomplished.

Complicated physical health issues inflamed the psychological problems and many of the seniors felt they had little to live for with such a poor quality of life compounded with the bitter factor of isolation. Health-related Goals 🙁 Healthy People 2010) According to the U. S. Department of Health and Human Services Healthy People 2010 goals, many focused efforts are being made toward the improvement of healthcare availability for the elderly shut-ins. One of these goals is to improve the accessibility to comprehensive, high quality health care services.

By influencing the access to resources for these elderly citizens, they will be enabled to receive better health care check-ups on a routine basis and stay within compliance of their particular health issues. This will hopefully increase their quality of life and determine a better outcome for illness-related disparities. A great deal of attention is being focused on the perception providers display toward the whole picture of care with these isolated individuals. “Many providers focus on the current health issues and treatments associated with the current state of health” (Benner 2005).

They do not assemble into consideration the problems these people have with inadequate supplies, living arrangements, and the ability to stay within compliant ranges that is necessary to aid in the treatment regimen prescribed. Another problem with this goal is the public sponsored availability limits for adequate transportation to medical treatment facilities/clinics for this group. There are many barriers to accomplishing this goal such as lack of public funding, lack of volunteers, and inconsistent organizing and communication with community leaders and public officials.

Bureaucracy is a major player in this area as well due to the fact that the funding need for this task never seems to be allocated in a structured or consistent manner. Too many times these seniors do not get the necessary treatment or care they need because of the political entanglement involved in this process. Another goal of Healthy People 2010 is to increase the number of states that report the maltreatment and neglect of the elderly. Tennessee has an appropriate record for tracking and reporting the maltreatment and abuse of elderly with efforts concerted by the Department of Health and local county departments.

According to Friedman (2008), the collaborative efforts also are maintained by certain health care facilities in regard to networking community services that cater to the needs of elderly members in the community. This is the case with the studies in this report as a joint endeavor with local senior centers and acute care facility networking together to create services volunteer based and free of financial obligation for these elderly members of society. The major set back to this goal is lack of involvement by many state and local agencies.

Many of the elderly shut-ins get lost in the loop of reporting and information gathering that establishes their feasible need for assistance. A great deal of these senior citizens would qualify for public assistance if they were known about and proper investigation was followed. About half of the cases in this report were not properly followed up with in a consistent manner to enable effective treatment regimens and follow-up care from their provider. The physician or home health agencies were not in direct communication or involved at all in the total care of these individuals.

The members of this vulnerable group were not adequately educated or informed of the resources available to them locally. They were basically at the mercy of society and obliged to go where they were told with no concern or query as to why this was happening. Many of them had questions about their health and they felt they had been slighted or ignored in getting a timely response. None of the members had access to a home computer, but they were unaware that the local public library provided courses to train use of the computer and internet.

The senior center also had proposals to add computers to their activities area for internet training and accessibility. Social work needs were overwhelming in this area of volunteer help and there were no apparent contacts with case workers which would have been a valuable source of information for these seniors. Isolated members are already shut-out to the outside world and their resources are more limited than ever and any source of knowledge would be beneficial, as stated by Isaac (2005).

The need for knowledge and resource acquisition is the greatest barrier in this group of seniors. The Healthy People 2010 goals are geared with good intention for the improvement of health care with the isolated elderly. The case in point may be to guard filtering of funds and resources as they trickle down to the state and local levels. Many times these important and powerful means (funding and resources) of accomplishment get lost in the bureaucracies and nothing gets done. The vulnerable elderly are once again left to pay the price with uncertainty and despair.

The Personal is Political” “The Personal is Political” stems from many associated political and historical themes throughout society. Many of which have been related to moving societal views from one extreme to another. The truest definition of this phrase would be to personally see the grimness of a given situation and encompass this with compassion as strongly as one would promote that same cause politically. On Capitol Hill, as in workplaces around the country, more and more families are dealing with elderly parents who need help because of chronic illness or disability.

And as it was with child care, the personal is becoming political. Measures to help with the cost of long-term care for the elderly and disabled, primarily through tax credits and deductions, are being advanced by both parties in Congress this year. As one Democratic strategist put it, ”The struggle is not figuring out that this is important to people. It’s what are you going to do, how are you going to find the money, and what are you willing to trade off for it? ” (New York Times, 2009).

Advocates describe most of these proposals as modest first steps, but hope that demographics and personal experience are finally beginning to do what years of lobbying did not: put the long-term-care issue back on the political agenda. Ethical enthusiasts are promoting more of a utilitarianistic approach to societal issues that plague this group of the vulnerable population. They believe that we are not promoting for the greater good of society and this group is a significant portion or member of society’s whole, as implicated by Thiroux (2009).

Nursing perspectives are in agreement with ethical concerns and tend to promote a growing effort to be more involved in the political arena as an advocating voice for the elderly. Founding principles commit nurses to the moral disciplines and ethical rights of these seniors. Nurses feel compelled to initiate better treatment regimens and comply with the whole picture of needs this group has for improved quality of living. New legislation has proven to be more sympathetic to the needs of seniors, but more consideration and follow-through is needed.

The President’s New Health Care Reform package is pending change to this area of health care and should give light to growing concerns this group of elderly citizens have in common. With all of the new legislation pending, it is not feasible unless there are safeguards and a check and balances system in place. Too much political involvement will tend to mire this change and stagnate the ability to improve the lifestyles of the elderly shut-ins. Society must be made aware of the changes that government officials are making and the population must be actively involved in the proper enforcement of the programs. It is clear in democracy is made by the people and for the people, and it is not made possible for some of the people. ” (Learning From the Founders, 2009)

Advocacy and Education: Our society tends to focus on the justification of a youthful element. Youth is glorified due to beauty, dress, and overall appearance. Once an individual ages and debilitating forces become evident, many times it is accepted as norm. For many individuals and families, taking care of the aged becomes a burden and many negative emotions are formed. The elderly may become emotionally isolated due to physical barriers or psychological issues.

Families may become segregated and these elderly citizens are left alone to deal with a life of illness and isolation. “Nurses can help as an intermediary source of compassion and health related wealth of information givers. ” (Friedman, 2008) The skills that nurses possess are not the only positive influence they have with these elderly individuals. They are a powerful source of networking that can yield healthcare resources from providers as well as other health care professionals, including social workers and case management.

Through teaching, compliance checks, and setting provider follow-up appointments, nurses weld a vast amount of responsibility in the success of elderly care. Politically, nurses are a powerful lobbying group. They may become involved in both state and national organizations to provide advocacy to clients and strength in numbers for a voice representing those who cannot speak for themselves. The American Nurses Association provides support for the advancement of healthcare and research for an ever growing population of senior citizens in the U. S. as well as abroad.

State and local associations collaborate with the ANA to continue this effort on a local scale. They provide community outreach organizations and promote the volunteers efforts of local citizens providing food, healthcare needs, and home health necessities for the aging population. Summarization and Projection: Will the goals of Healthy People 2010 be met for this vulnerable population? Only time will effectively prove this objective. A great deal of legislation as aforementioned is in the process of being enforced as well as current legislation that is on the decision making level.

Many of the Congressional members are seeing for the first time the “Personal is Political” motivation due to an ever increasing number of Americans living longer and presenting with health care needs. The goals stipulate that increased quality healthcare will be obtained and more accurate figures will be presented for effective care and consideration. With all of this legislation and attention toward the elderly in place, the conditions are stable for a favorable outcome. The elderly have suffered and needlessly faced many health problems and unnecessary deaths due to neglect and isolation.

They have endured the battles with time and the anomalies of aging. They have reached the point of highest human achievement with respect to wisdom and elevation of dignity in society. Society cannot and must not forget these valuable members of its whole. Ethically and morally we need to do what is right, and what is right is the active involvement we need to become a part of improving their quality of life. In America, all citizens are reserved the right of life, liberty, and the pursuit of happiness. Do these vulnerable elderly deserve anything less?

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