One of the commonly used concept in health care when it comes to summarizing all of the risk factors of individuals and communities is termed as vulnerability. Vulnerability is an important concept for the reason that it impacts the health status and health outcomes of patients. A group of individuals who are at risk of particular factors or are susceptible to multiple risk factors is commonly known as vulnerable populations or high risk populations. Individuals belonging to the high risk population are in need of maximum amount of care and attention since these groups are considered as individuals who have greater chances of acquiring certain diseases and illnesses (Shivayogi, 2013; Minnesota Department of Health, 2010).
Some of the major contributing factors to the vulnerability of an individual or a population include poverty, malnutrition, lack of education, age, sex, ethnicity, and poor environment (McHugh, et al., 2012; deChesnay & Anderson, 2012). The most commonly acknowledged vulnerable groups include infants and children, elderly, pregnant women, individuals with disabilities (chronic mental illness or Human Immunodeficiency Virus), ethnic minorities, homeless, and the uninsured (Tacoma-Pierce County Health Department, 2013).
The identification of various vulnerable populations is considered as one of the core responsibilities of Doctor of Nursing Practice (DNP)-prepared nurses. Since DNP nurses are considered as prime movers when it comes to preventive healthcare and primary care, they are considered as the main stakeholders in dealing with researches and studies which aim to identify various high risk groups and socioeconomic factors associated with these groups. As the leaders of preventive and primary care, DNP nurses are tasked to develop community-based programs and projects which focus on the reduction of the morbidity and mortality of certain diseases and disorders (Lathrop & Hodnicki, 2014).
At the microsystem level, one high-risk population from my practice area include elderly patients at home. These patients are provided with visits and different health care services while at home. Since health professionals directly attend to patients and relatives at the microsystem level, patients are considered as high risk population due to the fact that majority of medical inaccuracies and mistakes occur in the microsystem level (Stanley, 2010).
An individual can be classified as a homebound elderly patient when the individual experiences certain factors or conditions that are valid and that makes him or her unable to leave home. Inability to leave home can also be affected by the effort and cost that will be expended as compared to receiving treatment at home. However, it does not mean that an individual who is classified as homebound have to be bedridden or unable to make occasional absences due to nonmedical purposes. Generally, elderly can be considered as homebound if they experience conditions which restricts them from leaving their respective homes (Baker, 2016).
Elderly patients who stay at home are considered high risk and vulnerable for the reason that majority of these individuals are affected with complex and interrelated health problems. Aside from health problems, these individuals also suffer from a few social problems which makes them frail. Since these elderly patients are homebound, provision of proper office-based primary health care services are particularly difficult as a consequence of limited access to primary care services and equipment that are only available at health centers and health institutions. Another reason for being classified as a high risk population is the fact that homebound elderly patients usually experience deterioration when admitted to hospitals and other health care facilities. Additionally, studies focused on homebound elderly patients found out that these individuals are at higher risk of suffering from diseases affecting metabolism, cardiovascular and musculoskeletal system, and nerves. Unfortunately, these patients are also more likely to suffer from chronic use of medications, frequent visits to emergency centers, and higher rates of hospitalizations (Stall, 2013).
Using the epidemiologic triangle, it is possible to identify the host, agent or cause, and the environment leading to the occurrence of certain risk factors linked to the health status of homebound elderly patients. According to studies, one of the main reasons that makes elderly patients homebound is the combination of physical and mental disorders. The feeling of isolation experienced by homebound elderly patients because of losing contact with the outside world ( health care system and social world) result to negative impacts when it comes to the health status of the patients. Studies have shown that homebound elderly are at higher risk of getting ill, lonely, and depressed because of being confined in their homes. However, the association of psychological and psychiatric disorders is yet to be analyzed by health professionals. Thus, the combination of the presence of multifaceted diseases and the environment where elderly patients are confined greatly contribute to the health status and health outcomes of individuals (Qiu, et al., 2010).
Another risk factor of homebound elderly patients is their poor nutritional and care condition. These may be affected by the environment where they reside and other factors such as difficulty in accessing and managing necessary medications and healthcare procedures along with financial problems. Since elderly patients do not have the ability to do certain tasks associated with personal care and self-protection, they are also considered as the major population which is considered as vulnerable to neglect, exploitation and even death. These factors may also influence the environment where elderly individuals stay. Due to the fact that elderly individuals are considered as a nuisance more than a help, relatives and other friends tend to neglect and emotionally abuse the elderly. Thus, contributing to higher levels of emotional and physical stress experienced by homebound patients which can eventually result to increase progression of their illness, or worse, their death (Naik, et al., 2010).
When dealing with the health outcomes of the elderly, homebound elder patients are at higher risk of acquiring and experiencing adverse health outcomes. Some of these health outcomes include oral disease, food insecurity which can lead to diabetes, hypertension, and even asthma, medical and psychiatric illnesses (Feeding America, 2015; Qiu, et al., 2010; Griffin, et al., 2012).
Since oral health is considered as vital in the well-being and health status of an individual, it is important to consider it as one of the adverse health outcomes experienced by homebound elderly. One of the major health outcome associated with oral health is its effect in the appetite of the elderly. An indication of poor oral health include loss of tooth, weight loss and obesity. When an individual loses tooth, the efficiency when chewing, intimacy, speech, social interaction, and self-esteem will also be affected. Thus, elderly patients are found to have lower self-esteem, limited social interaction, inhibited intimacy, and unclear speech. Oral health complications can further cause adverse health outcomes when not properly prevented and treated. During advanced stages of poor oral health, ulcerations and abscesses can be formed as a result of the destruction of tooth pulp. Studies have shown that dental procedures are considered as one of the causes of high incidence of myocardial infarctions and ischemic strokes among the elderly population (Griffin, et al., 2012).
Another health outcome is associated with food insecurity among seniors which usually leads to nutrient deficiencies. Since elders affected with food insecurity consume lesser calories and fewer quantities of food, they are considered to have inadequate amounts of iron and protein. These health consequences associated with food insecurity leads to adverse health outcomes like diabetes, hypertension, and even asthma. One of the contributing factor to these health outcomes is the limited food access of elderly (Feeding America, 2015).
Lastly, homebound elderly are also at higher risk of physical and mental health. Some of the medical disorders linked with homebound elderly patients include cardiovascular disease, hypertension, osteoarthritis, stroke, and even angina. Additionally, there have also been reports on weight loss, arthritis affecting the spine, and falls. Aside from physical disorders, homebound elderly patients are also affected with psychiatric disorders specifically dementia and depression. The physical and mental status of the elderly patients are greatly affected due to their limited social interaction and exposure. The feeling of isolation is considered as one of the main causes of stress which can considerably affect the mental and emotional status of patients (Qiu, et al., 2010).
The high risk group of homebound elderly patients can be defined and described using epidemiological terms such as morbidity, mortality, risk, incidence, and prevalence. Morbidity is an epidemiological concept used to determine the number of individuals affected by a particular disease. On the other hand, mortality is the epidemiological term used to describe the number of deaths of an individual over the total number of population. Two other concepts have been greatly used in epidemiology and healthcare: incidence and prevalence. Incidence is considered as the epidemiological concept which is used to identify the probability that an individual will be diagnosed with a particular disease during a given time period while prevalence is the measure used to determine an individual’s likelihood of being affected with the disease. Lastly, risk is the epidemiological term used to determine the chances that an individual will be affected by a particular disease (Centers for Disease Control and Prevention, 2016).
According to latest survey on geriatric, it has been estimated that the prevalence of homebound elderly in the United States is 9.24%. Of these elderly patients, the prevalence of musculoskeletal morbidities has been reported as 42%-60%. These highly prevalent musculoskeletal morbidities is considered as a primary contributor to the increased risk of patients experiencing severe falls and corpus callosum abnormality (Qiu, et al., 2010).
Based on the information and data presented, it is evident that additional studies and researches focusing on geriatric and other prevention strategies to aid in the formulation of appropriate projects and programs.
References
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