The elderly, because of reasons of pride or because of mental impairment may not always state their problem or problems directly. Tolerance and patience may be required in teasing out the issues. Often a great deal of trust must be present before a frail elder will confide in a professional who may be caring for them.

Working with this group of older individuals simply takes more time to form a strong relationship to be effective. That relationship must also include a sincere and caring attitude. The older individual in return for that care may worry and want to give “gifts” of some sort to staff and caretakers. It is their way at an attempt of feeling less dependent and an attempt to have greater control over their situation.

It is important to remember that older adults are survivors, people who have lived through major world wars, social upheavals, and personal hardships. The researcher, Ebersole said it best, “These folks have survival capacity and there is little we understand at present of the elements of this endurance. Is it love of life, courage, determination, stubbornness? Perhaps a bit of each.”

Adult Protective Services
Adult protective services is a subspecialty of aging that deals with the frail elder. These services have evolved over several decades to the immense growth in the numbers of older people who need assistance with their activities of daily living. Adult protective service workers deal with people who tend to have complicated problems and many urgent needs, all of which usually present themselves at the same time. To deal with what seems like chaos, workers need guidelines.

A theory of intervention with the frail, vulnerable elderly has already been advanced by the Human Services and Development Institute. The theory is as follow:

• When interests compete, the elderly client is the only person you are charged with serving.
• When interests compete, the adult elderly client is in charge of decision making until he or she delegates responsibility, voluntarily, to another or until the court grants responsibility to another.
• Freedom is more important than safety i.e.: the individual can choose to live in harm or even self-destructively, provided he or she is capable of choosing, does not harm others, and commits no crimes.
• In the ideal case, protection of the elder adult seeks to achieve simultaneously and in order of importance the following: freedom-safety, least disruption of lifestyle and least restrictive care alternatives.

What then is the future for a frail and vulnerable aging population? Recent statistics indicate a continued increase of a frail elderly population that are being maintained by an advanced medical technology while experiencing, with time, an increase in functional deficits. Multiple alternatives to institutional placement are available throughout our nation’s communities. These alternatives are also cost effective when offered in the context of comprehensive, coordinated health care that includes respite care and home health care.

Here are several of the alternatives to institutional care:

• Geriatric crisis outreach
• Neighborhood support networks
• Community nursing centers
• Telephone peer networks
• Adopt a Grandparent program
• Adult residential day care.

Final Thought
It has been said that the progress of civilization can be judged by the total fraction of human beings who achieve longevity while maintaining a life of meaning and purpose. This thought becomes our goal as professionals as well as society’s goals.

Quotable Quote: “All great achievements require time.”