Running Head: GERIATRICS POPULATION AT-RISK

Geriatrics Population At-Risk

Christopher Allen
Wayne State University

GERIATRICS POPULATION AT-RISK

Introduction
Warren Woods Health and Rehabilitation Center is a for-profit nursing home, they are
partnered with Senior Sava Care. The facility has 178 beds and currently has 155-165 beds filled.
Most of the beds in the facility are filled with the elderly population. The staff consists of many
nurses including Registered Nurses, Certified Nursing Assistants, and Licensed Practical Nurses,
and Special Care Nurses. At the top there is an Administrator and a Director of Nursing then a
rehabilitation team, social services, and activities teams. There are other departments like dietary
and housekeeping. More than half of the seniors that are residents have Alzheimers, Dementia,
or suffer from some sort of behavioral problems. Some families visit the residents very often and
some do not visit at all. There are also some residents that are still their own person and some
that have guardians that are usually family members or some guardianship organization or
attorney for example George Hietmanis. The geriatric population is the most at risk population
located in this facility.
Population At-Risk
Older adults are usually seen in todays world almost like children. The reason for this
comparison is because the needs of the elderly are similar to that of children. Many older adults
need supervision throughout the day just like toddlers as well as diaper changes, feedings,
medications, some even need guardianship. Elders are also at risk for falls, physical or mental
impairments may make it problematic for them to care for themselves and many mental
problems. Elder adults also lack transportation: older adults might not own a vehicle, may lack

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access to a car, or may choose not to drive. Almost everything available at Warren Woods Health
and Rehabilitation Center or any nursing home is what the Geriatric population is at risk for
including malnutrition, wondering, medical risks, falls, emotional stress, and cognitive
impairment. These risk factors are why nursing homes have 24 hour care, psychological services,
social services, nurses, dietary, an activities team, and a transportation team.
Over eating or under eating or just plain nutrition is a big risk factor for a lot of the
elderly not just the demented ones. According to Shatenstein Weight changes after age 50 are
generally associated with deterioration in health, increased mortality risk after age 70 and
mobility problems. Unintentional weight loss has been linked to greater age, poorer health, and
smoking, and in men, widowhood.(p. 146, 2001). Dieticians are there to support, manage, and
help the elder adults with their intake and nutrition. Yes the problem is between all ages but
because more health problems occur when you are older it is a more serious problem.
Malnutrition in elderly patients in institutions has become an issue of clinical concern, yet it
remains largely unrecognized in acute care hospitals.
In the acute care setting it has been linked with a wide range of increased complications
(Azad, Amos, Toppan 1999). The dietary goal moving to an institution like a nursing home is
usually to get the elder adult to the correct diet which often comes with a lot of unintended
weight loss. Unlike medical records dietary records are not usually kept from hospital to hospital
or to the nursing homes. Studies have shown that nutritional status declines during
hospitalization (Young, Kidston, Banks, Mudge, & Isenring 2013). According to a cohort study
on Malnutrition of older
Malnutrition is associated with increased morbidity and mortality. Acute and chronic
diseases, such as trauma, infection, or inflammation that may alter metabolism, appetite,

GERIATRICS POPULATION AT-RISK

or absorption or assimilation of nutrients, may result in or exacerbate malnutrition.

Malnutrition is thus a cause and a consequence of illness. Older people with malnutrition
are at higher risk for disease-related complications and likely to show impaired muscle
function, decreased bone mass, immune dysfunction, anemia, decreased cognitive
function, and poor wound healing. Poor food intake secondary to medications and drugnutrient interactions also affect nutritional status. Hospitalized patients are at particularly
high risk of malnutrition. Due to increased morbidity, malnourished patients have a
prolonged and more intense treatment, increased length of hospital stay, and increased
hospital costs. (Baumeister, Fischer, Doring, Koeing, Zierer, John 2011).
As much of a problem as malnutrition is with elder adults it leads into other factor the put older
adults at risk like heart disease.
A big risk for elders that many might see in the news is elderly abuse. They have since
been battling that in and out of the nursing homes. According to Erica Wood The need for
guardians and other surrogate decision-makers will grow as the population ages, and as the
prevalence of Alzheimer's Disease and the number of individuals with mental disabilities
increases (Wood, 2012). Guardianship is one way that helps protect the elders from abuse
mentally, emotionally, and financially.
Guardianship can be placed with family members but most of the time when no family member
wants to step up and take responsibility or Adult protective Services has to get involved
guardianship is place on an outside company or lawyer that is run with case managers. While
guardianship proceedings at times may be hotly opposed, provoking the sound and fury of the
press, many hearings take only moments, are practically unnoticed, and "with the stroke of a
judge's pen...strip an old man or woman of basic rights" (Bayles and McCartney, 1987).

GERIATRICS POPULATION AT-RISK

Stripping them of their basic rights is a little much to say but some elders really need it
especially when suffering from mental disease or when the make extremely bad choice that can
harm themselves or others.
Abuse and neglect of an elderly person is one of the biggest scares family members or
guardians worry about when the elderly is in the care of someone. When presented in the media
physical abuse is usually a headliner but it actually can be really hard for someone to determine
if not experienced firsthand. The New England Journal of Medicine states that Dramatic cases
of physical abuse rarely present a diagnostic challenge. The diagnosis of abuse should be
considered whenever an older adult presents with multiple injuries in various stages of evolution
or when injuries are unexplained or the explanations provided are implausible (Lachs &
Pillemer, 1995). The elders may be cognitively impaired when dealing with this physical abuse
and might not be able to defend themselves or combat the abuse in any way, they also may be
living with their abuser.
In a lot of cases abuse in neglect happens to independent elders that have primary care
givers. Maintaining patients' independence is a primary goal of modern geriatrics.
Unfortunately, independence may not be possible in the all too common situation in which the
abuser is also the patient's primary care giver. (Lachs & Pillemer, 1995). Another form of abuse
with the geriatrics population is financial abuse.
Financial abuse with the elder population usually happen within the family usually
involving stolen money, cherished belongings, credit card fraud, etc. The National Elder
Mistreatment Study identified financial abuse by a family member as the most common form of
abuse among older community-dwelling people in the USA (Acierno et al., 2010). A lot of these
elders suffer from Dementia or Alzheimers and that puts them in a position to be easily

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manipulated by family members or care takers. Just as a member in society Im sure your run
into a couple of situations that turn out to be a scam or you notice the untrustworthiness of the
situation, well if you do not have the mental capacity to avoid such scams Scams are commonly
targeted at vulnerable people. Others were very aware of the vulnerability of some people to such
scams who found it hard to terminate contact (Manthrope, Samsi, Rapaport 2012). Elders
suffering from a cognitive impairment are subject to these scams and are specifically targeted
because of it.
One of the biggest risk for elders that is cause usually by depression and poor health. The
risk of falling among elderly community-dwelling people is a common problem, and one which
can have very serious consequences in terms of both injuries and trauma, leading to reduced
quality of life and increased medical care costs (Chang et al., 2010). Falling is something that is
taken very serious when dealing with elders health is already taking a toll and falling can lead
too serious injury and in some serious cases may cause death. Medical conditions concerning
visual disorders, hypertension, diabetes, cardiovascular diseases, and arthritis are factors when
elders fall.
The presence of depressive symptoms combined with medical conditions of
cardiovascular disease, diabetes, arthritis, the use of multiple medications or ancillary walking
devices is found to produce a four- to nine-fold increase in the risk of falling. (Kao, Wang, YunChang et. Al, 2012). When dealing with other health problems like diabetes some toes or fingers
may be lost or even some limbs which may offset the balance of anyone suffering so there is a
greater risk of falling. As you get older bones get weaker and you become more fragile which is
why falling is such a big deal with elders.

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Referring to a statement earlier the sometime elders are just like children, everything
becomes a hazard. You have to watch everything that they do because it can become a hazard
especially with falls being a big risk. Elders suffer from any sicknesses which is common for
many to believe but many minority elders are at risk for missed diagnoses, greater disabilities,
and higher death rates unless health care providers acknowledge that disparities in healthcare do
exist and adjust their way of providing care. In the next 30 years, the current elderly population
of 35 million is predicted to increase to 72 million (Byrd, 2007). When not getting the care you
need because you have missed a diagnosis and the elders are stuck suffering in silent. Poor health
is one of the causes for the high risk of falls. The risk of falling among elderly communitydwelling people is a common problem, and one which can have very serious consequences in
terms of both injuries and trauma, leading to reduced quality of life and increased medical care
costs (Chang et al., 2010). Falling seems to come off as a slow death sentence. According to a
study on fall risks;
Based on a multivariate logistic regression and stratification analysis, depression was
found to interact with various medical conditions on fall risk. In comparison with the
non-depressive reference group, a six-fold fall risk was discernible among
depressed elders with polypharmacy, while a five-fold risk was found among
depressive elders using ancillary devices, along with a four-fold risk among
depressive elders with diabetes or cardiovascular disease. Finally, arthritis was found to
produce a nine-fold risk of falls among such populations. Conclusions: These findings
suggest that greater emphasis should be placed on the integration of depression screening
as an element of fall risk assessment in elderly people. (Kao, Wang, Yun-Chang, Tzeng,
2012).

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Falling is one of the biggest risk dealing with the geriatric population which is why hospitals,
nursing homes, and home care and occupational therapy are so adamant about falls. Most elders
can still walk but medical professional in long term care recommend that elders have wheel
chairs or walkers anyway. Some also will not be discharged to live on their own until they are not
at risk for falls anymore.
Most of the at-risk conditions are directly related to elders mental health. A large
majority of elders suffer from many cognitive diseases like Alzheimers and Dementia. The
disease currently affects about 52 million Americans, including 5 million people aged 65 years
and older, a figure expected to increase to 138 million by 2050. (Lancet, 2014). When in
diagnosed the do have medicines to treat these diseases but there is no cure. Many elders suffer
from this disease worldwide, around 36 million people were living with Alzheimer's disease and
other forms of dementia in 2010 (Lancet, 2014). The risk of hurting yourself with dementia is
even greater when living alone. They are at risk of social isolation and inadequate social and
medical supervision (Miranda-Castillo et al, 2010). Demented individuals live in a different
reality and depending on their experiences and environment it can be very dangerous if not
supervised.
Elders do not just suffer from Alzheimers and Dementia, the also can suffer from
anxiety, depression, heart disease, and any other health risk. Alongside Alzheimers and
Dementia Anxiety and depression is very prominent as well. When suffering from any one of
these or all of them elders take medication, one of the big risk factor when taking these
medications especially when elders live alone are over medicating and misuse of medications.
Whether it is taking too much of one drug mixing drugs or substance abuse all together even

GERIATRICS POPULATION AT-RISK

with alcohol. Compared to younger adults, older individuals have an increased sensitivity to
alcohol and a heightened response to over-the-counter and prescription medications (Blow,
Oslin, Barry. 2002). Misuse of alcohol and abuse with it is a big public health concern and can be
really dangerous when mixed with certain medication.
Psychotropic medication is inappropriately used many times with elders. This problem
includes the misuse of substances such as sedatives, hypnotics, and narcotic and non-narcotic
analgesics as well as over-the counter medications including diet aids and decongestants (Blow,
Oslin, Barry. 2002). When in nursing homes or in hospitals there is usually a nurse that passes
out these medication and doctor thoroughly examine them so nothing is over used, but when
elders live alone or have care givers that give them too much or too little it can be a very
dangerous thing. Many medications used by the elderly have the potential for inducing tolerance,
withdrawal syndromes, and harmful medical consequences such as cognitive changes, renal
disease, and liver disease (Blow, 1998).

Ethical Dilemmas
When working in a long term healthcare facility whether a physician, nurse, or social
worker there can be many ethical dilemmas that arise throughout the practice. Some of the major
ethical dilemmas everyone involved with a long term healthcare facility should be familiar with
include informed consent, confidentiality, determining the decision-making capacity of the
patient/resident, do not resuscitate orders, allocating resources, and interventions. Every
profession has a code of ethics to follow and hopefully follow them at their best capacity. When

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dealing with other peoples live everyone might not agree on everything which is when those
ethical dilemmas arise.
In a nursing home nurses actually have the most contact with the resident usually because
the spend 24 hours every day with them when social work is usually a 9am-5pm shift in most
nursing homes. When dealing with elders as stated earlier they are very frail and some decisions
need to be made on the spot and it all falls on the nurses According to an article titled Everyday
Ethical Problems in Dementia Care: a teleological model:
From the nurses perspective, being forced to decide on behalf of another person to
provide a good life for this person can cause moral stresses. Moral stress occurs when
one knows what the right thing to do is but is hindered from doing so by external factors.
Moral stress is discussed in various contexts in the literature. For example, in a study by
Elmberger et al., the focus is on moral responsibility in the context of experiences of
being a mother with cancer. The results showed that wishing to be a good mother was one
factor causing moral stress (Ingrid, 2006).
Clinicians have a big role to play when dealing with the geriatric population, even the little
things could mean life and death.
When in a nursing home as stated earlier man elder adults either have a durable power of
attorney or a guardian which can be a family member, a guardianship company, it could even be
both a family member and guardianship company if decision is made by the courts, or a lawyer.
One of the biggest ethical dilemmas dealt with amongst clinicians and social workers is when the
elders decision-making capacity is no longer. The need for guardians and other surrogate
decision-makers will increase as the population ages, and as the occurrence of Alzheimer's

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disease and the number of individuals with mental disabilities increases (Wood, 2012). Some
elderly people are frustrated by the fact that they cannot make decisions of their own and spend
their money like they want to anymore when they have a guardian. When a durable power of
attorney is in place the individual can still make decisions until deemed by clinicians and social
worker otherwise which in the most case is situational.
Determining the patients decision-making capacity can be difficult on some especially if
the family does not agree that the elder can be their own guardian or vice versa. Another major
ethical dilemma is the Do Not Resuscitate Orders or the DNR. A lot of family members may not
agrees but the one deemed guardian has the power to put those orders in place.
When a DNR order is implemented, other interventions could be allowed that might
prolong the dying process (Baumrucker 2001; Chessa 2004; Meyers 2010). DNR orders
have been described as a negative or passive order set (Koch 2008, p. 14). DNR is not
a plan of care (Pike 1991), it is crisis responsea decision offered when death is in the
offing and the patient is unable to participate in EOL conversations and decision-making
(Stecher 2008). Negative emotional reactions to DNR orders among patients, families,
and clinicians in the clinical setting have been described (Schlairet, 2013).
Residents are either know as Full code or do not resuscitate, a lot of the drama that falls with
those orders is between the guardian and family members but sometimes can be about the
decision-making capacity of the elder.
Conclusion
Elders are at risk for falls, physical or mental impairments may make it problematic for
them to care for themselves and many mental problems. Elder adults also lack transportation:

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older adults might not own a vehicle, may lack access to a car, or may choose not to drive.
Almost everything available at Warren Woods Health and Rehabilitation Center or any nursing
home is what the Geriatric population is at risk for including malnutrition, wondering, medical
risks, falls, emotional stress, and cognitive impairment. These risk factors are why nursing homes
have 24 hour care, psychological services, social services, nurses, dietary, an activities team, and
a transportation team. Ethical dilemmas surround everyone involved with a long term healthcare
facility and everyone should be familiar with them, they include informed consent,
confidentiality, determining the decision-making capacity of the patient/resident, do not
resuscitate orders, allocating resources, and interventions.

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13

References

Acierno, R. (2010). Prevalence and correlates of emotional, physical, sexual, and financial abuse and
potential neglect in the United States: the National Elder Mistreatment Study. American
Journal of Public Health, 100, 292-297.10.2105/AJPH.2009.16308920019303
Azad, N., Murphy, J., Amos, S. S., & Toppan, J. (1999). Nutrition survey in an elderly population
following admission to a tertiary care hospital. Canadian Medical Association.Journal, 161(5),
511-5. Retrieved from http://search.proquest.com.proxy.lib.wayne.edu/docview/204977873?
accountid=14925
Baumeister, S. E., Fischer, B., Dring, A., Koenig, W., Zierer, A., John, J., . . . Meisinger, C. (2011). The
geriatric nutritional risk index predicts increased healthcare costs and hospitalization in a
cohort of community-dwelling older adults: Results from the MONICA/KORA augsburg cohort
study, 1994-2005. Nutrition, 27(5), 534-42. doi:http://dx.doi.org/10.1016/j.nut.2010.06.005
Bayles, F., and McCartney, S. 1987. Guardians of the Elderly: An Ailing System. Special Report. New
York: Associated Press. September 20. p. 1.
Blow, F. 1998. Substance Abuse Among Older Adults. Rockville, Md.: U.S. Department of Health and
Human Services, Public Health Service, Substance Abuse and Mental Health Services
Administration, Center for Substance Abuse Treatment. Treatment Improvement Protocol (Tip)
Series No. 26.
Blow, F. C., Oslin, D. W., & Barry, K. L. (2002). Misuse and abuse of alcohol, illicit drugs, and
psychoactive medication among older people.

Generations, 26(1), 50-54. Retrieved

from http://search.proquest.com.proxy.lib.wayne.edu/docview/212205784?
accountid=14925
Byrd, L.,PhD.C.F.N.P., Fletcher, A.,PhD.C.F.N.P., & Menifield, C., PhD. (2007). Disparities in health care:
Minority elders at risk.ABNF Journal, 18(2), 51-5. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/218876681?accountid=14925

GERIATRICS POPULATION AT-RISK

14

Ingrid gren Bolmsj, Edberg, A., & Sandman, L. (2006). Everyday ethical problems in dementia care:
A teleological model.Nursing

Ethics, 13(4), 340-59.

doi:http://dx.doi.org/10.1191/0969733006ne890oa
H. J. Chang (2010). Epidemiological survey of salls and associated risk factors in old females in an
aging community. Taiwan Geriatrics & Gerontology, 5, 50-61.
Lachs, Mark S,M.D., M.P.H., & Pillemer, K., PhD. (1995). Abuse and neglect of elderly persons. The
New England Journal of Medicine, 332(7), 437-443. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/223981234?accountid=14925
Lancet, T. (2014). Towards a better life with alzheimer's disease.

The Lancet, 383(9923), 1100.

doi:http://dx.doi.org/10.1016/S0140-6736(14)60548-1
Manthorpe, J., Samsi, K., & Rapaport, J. (2012). Responding to the financial abuse of people with
dementia: A qualitative study of safeguarding experiences in england. International
Psychogeriatrics, 24(9), 1454-64. doi:http://dx.doi.org/10.1017/S1041610212000348
Schlairet, M. C., & Cohen, R. W. (2013). Allow-natural-death (AND) orders: Legal, ethical, and
practical considerations.

HEC Forum, 25(2), 161-71.

doi:http://dx.doi.org/10.1007/s10730-012-9181-1
Shatenstein, B., Kergoat, M., & Nadon, S. (2001). Weight change, nutritional risk and its determinants
among cognitively intact and demented elderly canadians. Canadian Journal of Public
Health, 92(2), 143-9. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/232005066?accountid=14925
Wood, E. F. (2012). The paradox of adult guardianship: A solution to-and a source for- elder
abuse. Generations, 36(3), 79-82. Retrieved from
http://search.proquest.com.proxy.lib.wayne.edu/docview/1316580414?accountid=14925

GERIATRICS POPULATION AT-RISK

15

Young, A. M., Kidston, S., Banks, M. D., Mudge, A. M., & Isenring, E. A. (2013). Malnutrition screening
tools: Comparison against two validated nutrition assessment methods in older medical
inpatients. Nutrition, 29(1), 101-6. doi:http://dx.doi.org/10.1016/j.nut.2012.04.007