Healthcare systems globally struggle to care for vulnerable older persons. Challenges such as transitions between healthcare settings, language barriers, and difficulties with advance care planning are what vulnerable older adults face in receiving optimal care. Based on the recent literature, the discussion focuses on various dimensions associated with caring for vulnerable older adults. The discussion will address physician care, transitional care from hospital to home, barriers to advanced care planning, and vulnerability in elderly care.
Enhancing Physician Care of Vulnerable Older Adults
Addressing the diverse needs of vulnerable older persons requires improving physician care. Danto-Nocton and Malone (2021) emphasize the importance of effective communication, thorough assessments, and customized care plans for older persons. This involves identifying and treating cognitive impairments, functional limits, and social determinants of health, which greatly affect their well-being. Geriatricians and social workers must work together to treat vulnerable older persons’ complex needs (Lee et al., 2022). Team-based techniques assist and manage this demographic’s unique requirements. Continuous education and training programs are crucial for clinicians to stay current on geriatric care and best practices (Danto-Nocton & Malone, 2021). Physicians must learn and use new geriatrics skills to provide high-quality treatment. Recognizing language and access challenges to healthcare for vulnerable older individuals are essential to creating solutions (Phung et al., 2021). Improving physician care for vulnerable older persons requires a patient-centered approach.
Patients, families, and caregivers should be actively included in decision-making processes (Danto-Nocton & Malone, 2021). Physicians can promote patient autonomy and pleasure by incorporating older persons in discussions about their care preferences and goals to personalize treatment regimens to their needs. Improved communication, comprehensive assessments, interdisciplinary collaboration, continuing education, and patient-centered care are needed to improve physician care for vulnerable older persons. Physicians can improve health outcomes and quality of life for older persons by addressing their needs and vulnerabilities in a supportive and collaborative healthcare framework.
Transitional Care from Hospital to Home for Frail Older Adults
The transition from hospital to home for older persons must be carefully managed to guarantee the best outcomes. A comprehensive review and meta-analysis by Lee et al. (2022) highlighted the necessity of transitional care for this vulnerable population. They concluded that comprehensive discharge planning, medication management, and post-discharge follow-up prevent readmissions and improve outcomes for frail older adults. Generally, such interventions consist of primary care providers, specialists, and home health professionals jointly working to facilitate the transition (Lee et al., 2022). Transitional care should be person-centered and suit the necessities of older persons. Health professionals could improve transitional care by engaging patients in decision-making and individualizing care plans (Lee et al., 2022). Transitional care interventions reduce readmissions, but their impact on mortality and quality of life is uncertain (Lee et al., 2022).
More studies are required to fill knowledge gaps and identify the best transitional care solutions for frail elderly persons. Surprisingly, transitional care is finding its way to better post-hospitalization results and continuity of care for older, more vulnerable adults. Healthcare systems are improved by strengthening transitional care processes and improving the quality of life of frail older persons moving from hospital to home through care coordination, medication management, and patient engagement. Fragile elderly need bridging care to shift safely from the hospital to home. Transitional care programs targeted at preventing readmissions and improving outcomes for this vulnerable population use coordinated discharge planning, inter-provider collaboration, and patient-centered approaches. Problems and uncertainties are still present; however, specific measures can be taken to modify transitional care solutions and help improve healthcare outcomes among fragile old patients.
Barriers to Advance Care Planning
ACP is a process that commands that the ultimate life or serious illness decisions follow the older individuals’ preferences and values. Phung et al. (2021) studied the ACP barriers among elderly English and Spanish speakers with related risks. Their research, moreover, brings out some linguistic problems, ignorance of ACP, and cultural beliefs. These obstacles propel the formation of interventions aimed at eliminating them, for example, providing language-compatible ACP materials, culturally relevant education, and support from healthcare providers. Community-based ACP is underlined as an essential approach by Phung et al. (2021) that involves older adults and their families in crucial conversations regarding future healthcare choices. Including the ACP argument, the technique’s ignorance, little assistance from family and friends, distrust of the healthcare system, and suspicion mark the main barriers to ACP (Phung et al.,2021). However, they become more common among the most vulnerable groups, particularly racial/ethnic minorities and people with limited health literacy. Hence, culturally sensitive interventions are critical in overcoming those barriers and promoting ACP among diverse elderly to protect the dignity and desires of old adults at the end of their lives. By addressing such barriers and offering special assistance, healthcare systems can enable older persons to participate in ACP dialogues, enhancing informed decision-making and end-of-life care quality.
The Concept of Vulnerability in Aged Care
Comprehension of vulnerability in aged care is essential in delivering ethical and compassionate care to older adults. Sanchini et al. (2022) conducted a systematic review with a VBEE-ethics perspective, focusing on arguments of vulnerability in aged care. They identify various causes of vulnerability, for example, physical frailty, cognitive impairment, social isolation, and depending on others for care. The review stresses the need to appreciate frail older adults’ agency and dignity despite their vulnerability. Sanchini et al. (2022) emphasize an ethical consideration of caregiving relationships by transmitting the need to respect older adults’ autonomy and rights, encourage social inclusion, and address structural inequalities in the aged care context. Delving deeper into the concept, the authors identify six dimensions of vulnerability in older adults: physical and psychological, relating to social groups, moral, sociocultural, and existential norms. The dimensions demonstrate the different and interdependent elements contributing to vulnerability in aged care settings (Sanchini et al., 2022). Appropriate care should be developed towards these vulnerabilities, which differentiate each patient. Adopting an ethically informed vantage point in caregiving ensures the provision of caring and effective care to fragile older adults in such a way that their well-being and dignity are also promoted.
Conclusion
Providing care for the most vulnerable older persons needs a complete and dynamic model involving various health service delivery areas. High-quality care is provided by the physicians, which is done through the enhancement of communication, conducting comprehensive assessments, and customizing personalized care to address the multiple needs of the elderly. Interdisciplinary collaboration combined with continuous education is crucial in providing a whole approach to this population segment. Transitional care from hospital to home is important in maximizing post-hospitalization outcomes, involving detailed discharge planning, medication management, and patient engagement. Despite persisting obstacles, research and continual improvement of transitional care approaches offer hope of positive results in caring for frail elderly. Breaking through the obstacles to advance care planning, which include the language barrier and cultural beliefs, requires targeted interventions and community-based efforts to facilitate end-of-life care decision-making for older adults. Recognizing and honoring older people’s agency and dignity is critical in addressing aged care vulnerability, which has multiple dimensions. Consequently, patient-centered, interdisciplinary, and ethically-informed approaches are adopted by healthcare systems to improve the health and well-being of vulnerable older adults, which eventually leads to the enhancement of quality of life and dignified aging.
Reference
Danto‐Nocton, E., & Malone, M. L. (2021). Enhancing physician care of vulnerable older adults. Journal of the American Geriatrics Society, 69(6), 1463-1465.https://doi.org/10.1111/jgs.17164
Lee, J. Y., Yang, Y. S., & Cho, E. (2022). Transitional care from hospital to home for frail older adults: A systematic review and meta-analysis. Geriatric Nursing, 43, 64–76. https://doi.org/10.1016/j.gerinurse.2021.11.003
Phung, L. H., Barnes, D. E., Volow, A. M., Li, B. H., Shirsat, N. R., & Sudore, R. L. (2021). English and Spanish-speaking vulnerable older adults report many barriers to advanced care planning. Journal of the American Geriatrics Society, 69(8), 2110–2121. https://doi.org/10.1111/jgs.17230
Sanchini, V., Sala, R., & Gastmans, C. (2022). The concept of vulnerability in aged care: a systematic review of argument-based ethics literature. BMC Medical Ethics, 23(1). https://doi.org/10.1186/s12910-022-00819-3
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