Vulnerable groups: characteristics, needs, and social support

Vulnerable Groups: Nutrition, Insurance, And the Elderly

One of the most vulnerable groups in the United States and throughout the world today is the elderly population. There are many reasons why this is the case, but the most serious ones are that many of these individuals do not get the proper nutrition that they need to remain strong, and that they do not get the medication and testing that they need to ensure that they continue to feel well. There are reasons for this lack of nutrition and lack of medication that will be addressed within the following pages so that the reader clearly understands how this happens and why it is so very significant. Another issue for the reader to clearly understand is the issue of vulnerability and what that really means for elderly people.

The elderly population is vulnerable because elderly people are not as strong on average, both mentally and physically, than their younger counterparts and due to this they are not able to accomplish as many things for themselves. As a generalization, the elderly population has less money, less food, more physical and mental difficulties, and a higher chance of being harmed or taken advantage of. There are many elderly people that do not have any of these difficulties, but these people are the exception and not the rule. America appears to many people to be a land of plenty, but that is not always the case. Nutrition issues will be discussed first, and then the topic will turn to Medicare and other insurance issues, as these are also very important.

For some, there is little to eat, and this is not always true just of the homeless and other underprivileged groups. Older adults in America today often have poor nutrition, and there are several causes for this. The purpose of this paper is to discuss these issues and causes in the context of showing the vulnerability of the elderly population, so that a better understanding of the plight of these older Americans is obtained. It is important to understand the various risk factors that these individuals face, the causes of their lack of nutrition, and what can be done about this problem.

Low income and poor living conditions are but two of the difficulties that many of these older Americans face when it comes to proper nutrition (Sahyoun, 2002). Other factors include a lack of ability to prepare proper food, living alone, a lack of support from family and friends, and a lack of food that is deemed acceptable (Sahyoun, 2002). Some medications can also interact and cause a loss of appetite, which can lead to malnutrition (Sahyoun, 2002). In addition to these problems, senses such as taste and smell can be somewhat less sharp in older age, which causes older Americans to have less interest in the foods that they consume (Sahyoun, 2002). A further concern is oral health, as many older Americans have problems with their teeth and mouths that cause them pain, making it more difficult to eat many of the foods that they previously enjoyed, even if they are hungry (Sahyoun, 2002).

There are many problems that come about from this, and some of the problems that older Americans often have also contribute to their lack of good nutrition. For example, those that have diabetes, heart disease, and other common ailments of older Americans are often less interested in eating well (Sahyoun, 2002). When these things become combined with a lack of social support or a lack of taste and smell, malnutrition can quickly result (Sahyoun, 2002). For this reason, it is important to study these individuals in order to determine what can be done to avoid malnutrition in those that may be at risk and correct it in those that have already started down that path.

As has been mentioned, there are many risk factors for malnutrition in the older American population (Collinsworth & Boyle, 1989). An inappropriate amount of food intake is one of the largest problems that these individuals face (Collinsworth & Boyle, 1989). When older Americans do not have any kind of normal routine during which they eat at certain times each day, malnutrition can result simply because these individuals are not taking in enough food (Collinsworth & Boyle, 1989). Some of these individuals have difficulties preparing their own food, so they eat very little (Collinsworth & Boyle, 1989). Others cannot afford to eat much, and sometimes will not eat for an entire day, because they must have money for their medications or to pay a bill for electricity or some other necessity (Collinsworth & Boyle, 1989). When these people live alone and/or do not have any kind of social support from friends and family they often suffer from depression, and depressed people sometimes eat very little (Collinsworth & Boyle, 1989).

When these people are evaluated, they must be studied not only for malnutrition, but to determine what kinds of risk factors for developing malnutrition they may have in their lives (Collinsworth & Boyle, 1989). If they are having trouble paying for their prescriptions, if they live alone, if they have no family, and other issues that could be problematic must be considered and evaluated (Collinsworth & Boyle, 1989). There are ways to help many of these individuals to live better lives and eat better meals, but this can only be accomplished if the problem is actually known (Collinsworth & Boyle, 1989).

Another risk factor that should be assessed is the kind of food that these individuals are eating and how much (Bartholomew, Parcel, Kok, & Gottlieb, 2001). Asking what these older Americans have eaten in the past 24 hours and what they usually eat is important, but some people may be unwilling to talk about this because they are ashamed of having little food and little money (Bartholomew, Parcel, Kok, & Gottlieb, 2001). If these individuals have friends and family nearby it is helpful, because someone else can be asked about the older person's food intake (Bartholomew, Parcel, Kok, & Gottlieb, 2001). However, where there is no family to help out, finding out this information can be very difficult, and for some patients, it may not be possible to find out what and how much they actually eat on a daily basis (Bartholomew, Parcel, Kok, & Gottlieb, 2001). For those older Americans who are willing to discuss this, or have family and friends that are willing to discuss it, what is eaten and how much is eaten can be compared with dietary guidelines to determine whether that person is receiving proper nutrition or whether malnutrition may be a problem (Bartholomew, Parcel, Kok, & Gottlieb, 2001).

Another important risk factor, and one that is often overlooked by many, is the cultural, ethnic, or religious beliefs of an individual (Miller, Morley, Rubenstein, & Pietruszka, 1991). Some of these older Americans have very different and complex beliefs about food consumption, and if this is the case, their risk for malnutrition may be much higher than the average population (Miller, Morley, Rubenstein, & Pietruszka, 1991). One cause of this can be nutritional imbalances caused by refusing a certain food group, but another cause can be the fact that these individuals are often very selective about what they eat and they cannot always find food that they will accept (Miller, Morley, Rubenstein, & Pietruszka, 1991). When this happens, they will go without eating rather than eat something that they are forbidden, for whatever reason, to consume (Miller, Morley, Rubenstein, & Pietruszka, 1991).

Having a low income and spending too much money for other things can also contribute to poor nutritional status, and seems to be one of the largest reasons why some older Americans are malnourished (Miller, Morley, Rubenstein, & Pietruszka, 1991). Many of these people rely on government-funded programs that provide economic assistance, and this should indicate the fact that there are many older people in this country today that are struggling (Miller, Morley, Rubenstein, & Pietruszka, 1991). For the majority of these people, social security does not provide enough money for them to pay all of their bills, purchase their prescriptions, and still be able to buy enough food (Miller, Morley, Rubenstein, & Pietruszka, 1991). It is a concern that is becoming more obvious as the baby boomers age and require assistance.

When many of these older Americans are isolated from others, their plight becomes even more severe (Marshall, Warren, Hand, Xie, & Stumbo, 2002). While many people are quite happy living alone even into old age, there are also many who find that they feel alone and depressed (Marshall, Warren, Hand, Xie, & Stumbo, 2002). For these people, eating is also a social occasion, and without someone to share their meal times with, they may see little point in eating (Marshall, Warren, Hand, Xie, & Stumbo, 2002). These individuals will quickly become malnourished if they do not have the support that they need from others (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Meals-on-Wheels, senior citizens centers, and other programs can provide some comfort and companionship to these people, as well as seeing that they receive good food that will keep them as healthy as possible in their later years (Marshall, Warren, Hand, Xie, & Stumbo, 2002).

Assessing the ability of these individuals to perform basic tasks in their daily lives can also have much significance (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Many older Americans are able to feed and clothe themselves without apparent problems, but others are not as fortunate (Marshall, Warren, Hand, Xie, & Stumbo, 2002). If they are unable to do these things correctly without help, their nutritional status will often suffer (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Patients who are older should be assessed for their ability to do these simple tasks, and also for their ability to perform slightly more complex tasks such as fixing their own meals, cleaning their house, and balancing their checkbook (Marshall, Warren, Hand, Xie, & Stumbo, 2002). Sometimes cognitive impairment will lead to a lack of nutrition, and when this is the case, it often shows up in forgetfulness and an inability to perform even simple tasks that require some thought (Marshall, Warren, Hand, Xie, & Stumbo, 2002).

Older Americans can be protected from much of this pain and suffering that they sometimes face in later years, but intervention is necessary. Those that evaluate older Americans must pay attention to whether these individuals are losing weight without any apparent effort, whether they seem depressed, whether they have a support system of friends and family, and many other factors. They should pay attention to the medications that these individuals take, especially those that can cause a loss of appetite, and to the oral health of these patients, as this has been seen to be a cause of malnutrition when teeth are decayed and painful or when dentures do not fit properly. As the baby boomers age, there will be a rapid increase in older Americans, and this will place a burden on society in some respects.

However, many of these people will continue in good health in their later years. The average life expectancy for both men and women in this country continues to rise, and this is encouraging news, but it also means that there will be more older Americans, and those that live with chronic ailments and other problems will need care and support from family, friends, and the medical community. Something as simple as a visit from someone in the neighborhood around lunchtime can have an effect on an older America that is having difficulties with loneliness and depression, and there are other simple ways to help these people as well. For those that need more complex answers to their problems, the medical community must be aware of the problems that these individuals face and the idea that malnutrition among older Americans is a serious problem that must be addressed.

In the medical community, however, many doctors and others are not ordering the tests and medications that their elderly patients need because the insurance that their patients have does not cover what they actually should have done or offered to them. Now that nutritional status and information has been discussed, information regarding Medicare and its drug coverage must be discussed so that the reader can see how vulnerable elderly people are where their insurance and medical care is concerned.

Prescription drug coverage is one of the major concerns when discussing Medicare reform. Seniors that have Medicare do not have any coverage for prescription drugs, and because of this they have to pay a large amount of money out of pocket. It is good that Medicare pays for doctor visits and other issues that the elderly people must deal with, but most people who are in the grips of old age are on medication, and when this medication is something that they cannot afford, they often either do without it or do without some basic necessity of life in order to afford the medication.

The prescription drug plan that Medicare is proposing is good, but it is not enough. It still requires premiums that are too high, and it requires a $275 deductible per year, with Medicare then paying 50% of the cost of the drugs up to $4,500 per year. After that, Medicare would pay the rest. However, the $275 deductible and the 50% co-pay are still too much for many seniors to afford (Miller, 2003).

Some congressmen want to know why seniors are being treated so badly. One member of Congress figured out that Congress people are paid approximately 20% of their medical costs, and their insurance company pays 80%. For seniors, this new prescription to plan would mean that Medicare will be paying approximately 20% of the seniors' medication bill, and the seniors will be left to pay 80%. This particular congressman wants to know why Congress is treated so much better than the elderly individuals in this country, and calls the Medicare prescription drug reform program nothing but a fraud (Zweifel, 2003).

Another thing that the Medicare plan will do is stop the government from negotiating with drug companies to attempt to get low rates for seniors. This has been done in the past, and the Department of Veterans Affairs has successfully negotiated in the past to get a 40% reduction in medication costs for senior veterans. Medicare, however, will not be able to do the same, and this will end up costing seniors more (Zweifel, 2003).

It is clear, however, that something must be done about the Medicare system. At the current rate, Medicare will begin running out of money in 2016, and it will go completely bankrupt by the year 2030 (Kaveny & Keenan, 1995). This is why Medicare reform must begin now. However, many believe that the Medicare reform that is being proposed to take effect in 2006 is not what is really needed. The argument has been made by many of those in the Senate and in Congress that the prescription drug plan that so many seniors need is just a desert that is being dangled in the face of government to get them to swallow a very bitter package of other Medicare reform ideas that will not actually help seniors at all (Lakely, 2003).

The prescription drug benefit, while many believe it is not helpful to those that need it most, will actually help some seniors. There are approximately 15 million elderly individuals in this country that live at or near the government poverty line. Those individuals will pay no premiums, and they will pay between one and five dollars per prescription. This appears to be the only group of seniors that will actually be helped by the drug coverage plan, but in the past, Medicare has had no prescription drug coverage at all, and therefore the plan does have some benefits for some individuals. The concern for many is that it does not have enough benefits for enough individuals in the long run (Wilson, Garrett, and Angle, 2003).

There was clearly much concern in the House and Senate when they voted on the Medicare reform bill, as it passed with a 55 to 44 margin in the Senate and was hotly debated on for quite some time before the House chose to pass it. The problem with much of the Medicare reform is that surveys conducted showed that 75% of the people asked thought that the law should be passed, however 62% admitted that they really knew little to nothing about the details of the plan (United, 2003).