Identifying And Addressing Vulnerability In The Elderly: A Case Study

Tereza is 64, she lives in a flat owned by a housing association, she lives alone and is estranged from her daughter. Tereza is a diabetic, she is in very poor health and she has limited mobility. Tereza rarely goes out. Her flat is in a poor condition, discarded food lies on the floor and each room is piled high with clothes and rubbish. The level of dirt in the house is extreme.

Tereza neglects her personal care, she is a heavy drinker and a chain smoker. She spends most of her time in one chair surrounded by the rubbish. There is a smell of urine as Tereza is incontinent when she drinks alcohol. Tereza has falls and has gone to hospital with fractures and burns. When ready for discharge from hospital, Tereza refuses to accept
follow up care offered to her. The neighbours are concerned that Tereza is not eating. The GP is also concerned and has requested support from adult social care, Tereza happily talks with (you) the health care worker from adult social care, when you visit, but she has not let (you) the worker into the flat; she states quite politely that she does not need help.

You can smell that the flat is very dirty from the doorway and you can see that Tereza is not well, as she is shaky and has said she is feeling awful. Tereza has some sores on her ankle that look infected, her clothes are filthy and her hair is matted she is holding on to the door frame, she lets you collect a chair for her to sit on in the doorway.Tereza has agreed that you can record what is being said and she seems aware what you are doing is assessing her safety and that you will tell some other people what you think about her safety, she does not know what safeguarding means. You think she may be at a point now to accept some support but you know she may still change her mind.Tereza has said she can’t reach the sink because it is piled high with rubbish. She would like to have a wash and would like her leg “to look and feel better” but she is still not letting you into the flat.

The concept of vulnerability in the elderly

The concept of vulnerability has been mainly prevalent among aged population, predominantly among old women as compared to old men. Vulnerability can be identified through assessing high risk groups or isolated individuals. Vulnerability among aged population, particularly old women is the result of multiple complex interactions; the individual is exposed to threats and failure to cope up with the exposed threats results in vulnerable outcomes for that individual (Nicholson et al. 2013).

Approach to a vulnerable individual involves through identification of the risk factors of the exposure to threat. In old age, coping capacities of an individual are integral in mitigating the chances of vulnerability; individual capacity, social protection and capital resources provide strength to deal with vulnerable threats and exposures in surroundings (Nicholson et al. 2013).

Different forms of abuse

Vulnerability is related to the discrete abusive outcomes which can increase an individual’s degree of vulnerability. Different forms of abuse and neglect have been the causal root of degrees of vulnerability among old population; sexual abuse, physical abuse, psychological abuse for example exposure threats to abandon an individual or withdrawal of support services from parents, domestic abuse, discriminatory abuse targeting age, religion, gender, disability, financial abuse, neglect (Jackson and Hafemeister 2013).

Forms of abuse like neglect and self-neglect involve both the vulnerable individual and the family members or care-giver. Neglect by others and self-neglect should not be confused; self-neglect is a behavioral negligence in which an individual does not pay heed to attend to the basic requirements of life (Lachs and Pillemer 2015).

This basic requirements may be in terms of proper clothing, proper personal hygiene, adequate dietary requirements and attending to the timed medical requirements. On the contrary, neglect can be an abuse by both the vulnerable individual and by the family or within the home. Poor hygiene and grooming like lack of cleanliness, body full of dirt, matted or unclean hair, malnourishment, foul smell of urine and faeces are some of physical signs to identify vulnerability (Iris, Conrad and Ridings 2014).

Neglect and Self-neglect

Neglect as abuse can be identified by a multitude of determining signs like failure to allow accessibility to foods and resources, isolation of a person and providing no access to the vulnerable individual’s families. Both intentional and unintentional forms of neglect can be a form of abuse. Intentional or wilful neglect is punishable according to Mental Capacity Act 2005 (White and Baldwin 2016).  Poor unhygienic surroundings and personal hygiene, sores and infections, uncared due to reluctance in taking medical care, untreated wounds or injuries and poor health conditions, lack of proper nutrition and failure to involve in social interactions.

Self-neglect involves lack of self-care which poses a threat to personal safety and wellbeing, inability to seek support from care providers, negligence of house maintenance and residing in filthy conditions with heaps of dirt and garbage all over, unkempt personal appearance, hoarding, not complying with health professionals for follow-up care as the identifying signs (Johannesen and LoGiudice 2013). The vulnerable people often lacks mental capacity to make their own decisions necessary for self-care and wellbeing.

Different forms of abuse and neglect

According to Mental capacity act 2005, the adult service providers engage and involve the vulnerable individuals to make decisions for themselves. It has been hypothesized that the older people in the community require the most attention for safeguarding; the older people suffer from physical vulnerability due to physical immobility and inability to take care of themselves, their children sometimes abandon them or stay away, their children often show intentional lack of café and support to these individuals (Burnes et al., 2015). In certain circumstances, the person is capable of taking decisions, however the decisions may pose lack of care and serious risk to the person’s state of wellbeing. In such cases, it is necessary to raise concern for that person and provide safeguarding services to enable the person live a healthy life.

In the given case study involving Tereza, a 64year old woman, both neglect and self-neglect has been evident in Tereza’s case. She is deficient in her physical abilities and therefore she is unable to clean her flat which shows a heap of garbage scattered throughout her flat. Tereza has been estranged by her daughter which is an example of neglect by her daughter. Lack of personal hygiene has been observed for Tereza; her filthy clothes and matted hair, infected ankles, widespread dirt and rubbish in her room are signs of self-neglect. Tereza reported that she felt awful in her garbage-covered room.

She expressed that she would like to have a complete wash of her flat in order to get rid of uncleanliness. She has physical immobility due to old age, however she has mental capacity to make decisions. It is only her physical immobility that has refrained Tereza from any cleanliness activity. Her mental ability allowed her to understand that my conversation with her would benefit her to attain safety in health issues.  Tereza has shared that she had no knowledge about safeguarding; this may however mean that she might be agreeing to receive support from health workers like me. However, she did not let me enter into her flat throughout the conversation, which may indicate that Tereza might change her mind thereafter about seeking support.

Safeguarding laws and principles

Elderly women who are at risk of vulnerability due to self-neglect or neglect by family or any form of abuse require support and protection to enable them to live in safe environment which is free from abuse and neglect. Initially neglect used to be included under elderly abuse. It can be said that safeguarding adults is necessary to meet the needs of the vulnerable elderly people and provide necessary support in order to help them lead a healthy life and undergo a healthy aging (Graham et al. 2016). Various acts and legislations have been made in order to safeguard adults. The Mental Capacity Act 2005 underlies five principles in order to protect those vulnerable individuals who lack mental capacity to take necessary relevant decisions.

The Act provides beneficial principles to enable these individuals to get involved in the decision making process and contribute as much as possible without causing any harm (Foster and Herring 2015). According to this Act, the care professionals should not assume a vulnerable person having mental capacity as always. They should take all adequate practical measures to enable vulnerable people to make their own decisions. The professionals should consider individual interests of the vulnerable without assuming about their mental capacities and encourage them to take active part in decision making (Series 2015). According to the Human Rights Act 1988, every individual has the right to live a healthy lifestyle and have respect for both their personal and family life (Tomuschat 2014).

Neglect and Self-neglect

The Care Act 2014 lays out beneficial responsibilities that are aimed to integrate both care and support to the vulnerable elderly population. The Act involves both health as well as social organisations to work in collaboration and promote healthy wellbeing within the communities. There are six key principles underlying any initiative on safeguarding adults. The principle 1 states that a personalised form of relation needs to be established with the vulnerable individual by the social and care professionals. Any decision making process regarding provision of support services should involve the vulnerable individuals and need to require informed consent. The vulnerable individual should be informed how the support and care services would benefit in the healthy living.

According to principle 2, prevention forms a prior requirement as a concern before any harm can occur. This means that the individuals who are at risk of vulnerability are informed beforehand to understand the concept of abuse and recognise the indications of abuse (Boland, Burnage. and Chowhan 2013). Principle 3 suggests proportionality, which means that the social and health professionals would lend proportionate support so as to meet the requirements of the vulnerable individuals. The professionals would reach only to that extent as required by the individual. Principle 4 states about providing protection to safeguard the elderly people at risk of vulnerability.

This protection would aim to those individuals who are at greater risk. According to principle 5, the health and social professionals would work in partnership with the vulnerable individual and communities to bring about better and efficient support services. Working in partnership would focus on maintaining the sensitive information of vulnerable individual confidential and thereby help to build confidence within the vulnerable individual that they would get adequate support and care from care professionals to improve lifestyle (Stevens 2013). The principle 6 states about accountability and transparency in rendering support and care to safeguard adults from risks of vulnerability.  

Ideology of safeguarding

Considering Tereza’s condition which involves both self-neglect and neglect by her daughter, the community neighbours, families and adult service providers need to take active roles in protecting the vulnerable people. The local social and health organisations should coordinate to reduce isolation for vulnerable people living alone. Continuous contact and communication need to be made between the service providers and the vulnerable people. The health care professionals should involve in providing physical support to perform day to day activities for vulnerable old people.

It is a collaborative role of the service providers to identify the signs of self-neglect and neglect and assess the vulnerable individuals would ensure that the concerning issues in improving her state of wellbeing is achieved. I would engage with social organisations involved in safeguarding adults. I would work collaboratively with the social organisations to arrange for physical support to Tereza. Tereza needed regular physical support to perform cleaning activities in order to make her flat appear clean and hygienic and thereby helping her to restore personal hygiene (Betts, Marks-Maran and Morris-Thompson 2014).

Tereza was not aware of the concept of safeguarding adults and its necessity. It is necessary for adult service providers to contact the families and friends of vulnerable people and involve them in making the vulnerable people understand about the self-care approach and provision of support services in order to develop a healthy aging process. The communities need to be alert and report to the adult service provider organisations in cases of any vulnerable incidences. Having an enquiry with Tereza, I have learnt that she has mental capacity to make decisions, however, due to physical immobility, diabetes and old age, she was not being able to provide herself with the basic care to meet the basic needs. Considering Tereza’s condition, Tereza cared least for her personal wellbeing.

Safeguarding laws and principles

It is necessary for the old age service providers to promote a welfare check on a community basis. If the vulnerable people do not wish to take supportive care services from the service providers, they should be respected for such decisions. No public laws or legislations demand discriminating against vulnerable people if they choose to reside in poor hygienic conditions. The six safeguarding principles underpinned by The Care Act 2014 needs to be followed in case of Tereza to safeguard her and enable her to take decisions of her own regarding how and what kind of care and support services she would wish to require from care professionals.

Tereza was estranged by her daughter and resided all alone in her flat filled with dirt and garbage. Living lonely can result in emotional detachment causing depression and anxiety (Charles and Luong 2013). Therefore safeguarding adults would also require provision of emotional support to vulnerable elderly people. Evidences of the assessment of the physical conditions need to be maintained and consulted with the safeguarding adult senior. Tereza and other vulnerable individuals should be empowered so as to enable them to take active part in community and social participation.

The principles of the respective Acts need to be followed by the social and health professionals. Involvement of multidisciplinary teams would be statutory to meet every requirement of the vulnerable elderly people. A group of professionals should provide for emotional support in order to prevent any depression and anxiety from occurring. Focussing on emotional support of lonely elderly people is equally important to promote mental wellness of these vulnerable people. Individual decisions of vulnerable individuals should be recorded and collated; these should be discussed with the members of safeguarding adults board and evaluated.

The professionals should work in groups and reach out to family members to advocate them about appropriate supportive roles to the elderly to promote healthy aging and healthy lifestyle. The safeguarding principles should be followed while involving the elderly individuals in self-decision making. They should be listened patiently by the care providers, thereby respecting their dignity. The risk factors for vulnerability like poverty, family connection, need to be assessed through proper reliable assessment methods.

The care providers need to be cautious while communicating with the vulnerable elderly people, taking consideration that they have mental capacity to understand. Calm and patient communication should be made with the vulnerable people taking care to respect them so that they feel comfortable and safe within support services and are therefore empowered to take active participation in their decisions for wellbeing (Braye, Orr and Preston-Shoot 2015). It should be taken into consideration that elderly vulnerable people like Tereza who possess mental capacity, can refuse to comply with the support services they have previously agreed upon.

The care professionals need to handle such situations with care. Safeguarding adults to protect them abuse is essential to promote wellbeing and healthy living. A multi-agency framework needs to be established to promote safeguarding vulnerable adults. Efficiency in safeguarding adults could be reached through clarification of the intermediate interface between quality of care and support service provision and safeguarding principles (Huxhold, Miche and Schüz 2013).

A general awareness needs to be spread among the local communities, focussing on their active participation in identifying, responding and reporting incidents of abuse and neglect to the local organisations involved in safeguarding adults. Older people require dependence on others to care for themselves and meet the basic necessities in life (Dodds 2014). Safeguarding should be focussed on maintaining the privacy of information of these individuals and services offered to them should maintain respect and dignity while these vulnerable people take decisions.

References

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