Assessing Safe and Independent Living in Vulnerable Older Adults: Perspectives of Professionals Who Conduct Home Assessments

The Journal of the American Board of Family Medicine

Mark E. Kunik²  Aanand D. Naik²  Jeethy Nair²  John Coverdale¹  Kristin R. Cassidy² 

[1] Menninger Department of Psychiatry and Behavioral Medicine (MEK, JC), Baylor College of Medicine;Houston Health Services Research and Development Center of Excellence (ADN, MEK, KRC, JN)

关键词: Vulnerable Populations;    Independent Living;    Aging;    Behavioral Sciences;    Decision Making;    Geriatrics;    Qualitative Research;   

DOI  :  10.3122/jabfm.2010.05.090065

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Objectives: The objectives of this study were to describe social services and health professionals’ perceptions of vulnerability among older adults living in the community and to elicit how these professionals screen vulnerability in community and in-home settings.

Methods: Focus group sessions were conducted and analyzed using standardized methods of qualitative analysis. Participants included social services and health professionals (n = 45) who routinely encounter vulnerable older adults.

Results: Four themes characterized vulnerability: the inability to perform activities of daily living, lack of social support, sociodemographic factors, and neuropsychiatric conditions. When screening older adults, participants reported evaluating basic cognitive abilities, decision-making processes, and the capacity to adequately plan and safely perform everyday tasks. Participants stated that screening is best performed by an interdisciplinary team in the home setting and preferably on more than one occasion.

Conclusions: Social services and health professionals in this study described routinely screening for vulnerability in community-living older adults using a multidomain approach. These professionals endorse the use of assessments that screen an older adult's cognitive and functional capacities for safe and independent living. Further research is needed that integrates routine screening for vulnerability by community social services professionals with the assessments and interventions conducted by primary care physicians.

• Vulnerable Populations
• Independent Living
• Aging
• Behavioral Sciences
• Decision Making
• Geriatrics
• Qualitative Research

Older adults represent a large and growing proportion of the typical primary care provider's practice.¹ Older adults report that living safely and independently in their own home is a principal health goal.² Disability, aging, and illness can adversely affect the ability of an older adult to live independently by increasing one's vulnerability to health and safety risks within the home.³ Vulnerability is the failure to engage in acts of self care that adequately regulate safe and independent living, or to take actions to prevent conditions or situations that adversely affect personal health and safety.^3–6 Vulnerable older adults may display poor personal care and nutrition, have difficulty managing basic medications and personal finances, or live in unsafe environments regardless of physical appearance or behavior.^3,7 Furthermore, vulnerable older adults are at risk for neglect, exploitation, and numerous safety hazards, as well as functional impairment, medical morbidity, and death.^8–11 Thus, a common denominator among vulnerable, community-living older adults may be the diminished ability to perform personal care tasks and protect themselves.

Primary care interventions that target vulnerable community-living and homebound older adults have demonstrated effectiveness at reducing mortality and placement in long-term care.^12,13 The issue of assessing vulnerability, therefore, is of particular importance to primary care physicians. However, the clues to recognizing vulnerability are often not readily apparent during routine primary care visits.^3,14 Assessments done in outpatient settings may lead to erroneous assumptions about an older adult's vulnerability.¹⁵ Furthermore, hospital staff and outpatient clinicians rarely have the opportunity to observe patients’ home environments to ascertain their ability to live safely and independently.¹⁶ One goal of assessing vulnerability is to identify and implement interventions that prevent further impairments and harms to allow older adults to continue to live at home. Assessments that are conducted in patients’ homes are more effective at tailoring interventions to reduce vulnerability.¹³

Financial and geographic barriers are important impediments to home-based primary care services in most settings. In one study, more than half of primary care providers reported that they conducted home visits; however, only 8% perform more than 2 visits per month.¹⁷ Physicians who report that they perform routine home visits tend to be older and live in rural areas.¹⁷ Family medicine residency programs provide specific training for geriatric assessment, including home-based primary care, but with variable emphasis on assessing vulnerability.^1,18

Primary care physicians continue to endorse the importance of home-based assessments of vulnerability as part of their scope of practice.¹⁹ To address this gap, primary care physicians sometimes rely on the services of other clinical and social services professionals.¹⁷ Primary care physicians cannot rely on a standardized assessment battery for vulnerability because of the heterogeneity of assessment tools across clinical and social services disciplines.^3,20 In addition, their recommendations for interventions are limited by a lack of consensus across disciplines of what constitutes vulnerability for safe and independent living among older adults.^3,21

【 授权许可】

Unknown   

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