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	Elderly Cancer Survivors Vulnerability Ernest H. Rosenbaum, MD, William Goodson, IV, BA

People generally become more vulnerable as they age. In 2004, the Adult Protective Service agencies across the USA had over 600,000 reports of elders requiring protection. This is a potential problem for many cancer survivors, who become frail as a consequence of their advancing illness. Unfortunately, some elderly live in squalid conditions without electricity or utilities. Often their homes are contaminated with animal feces and roaches. There are many types of vulnerability in the elderly population: 1. Physical abuse 2. Caregiver neglect 3. Financial exploitation 4. Self-neglect, which afflicts many older people unable to meet basic functional and living needs. Personal neglect, in part, could be due to mental deterioration or Alzheimer's and often the inability to maintain the home or otherwise live independently. Unsafe environments have many causes, such as living in poor housing, inadequate nursing home facilities, or if the principal caregiver is not physically or emotionally capable of providing appropriate care. Sometimes elder abuse and mistreatment can also be the cause. There are certain situations where direct intervention by health industry professionals is mandated by law. For example, the health industry has the obligation to test the elderly for medical conditions, such as hypothyroidism, diabetes, and vitamin B12 deficiency. They must also check living conditions in which these people exist, although nurses or medical social workers may be assigned the task. They often have the obligation to help provide health care to those neglecting themselves or deferring or declining treatment. In some cases hospitalization is necessary and may be covered if needed. The clues as to whether or not an elderly patient is at risk are not obvious. It takes a very knowledgeable physician to observe these clues. Once the condition is discovered, it requires a special skill set to provide necessary supportive care and treatments, as indicated. The problem is growing, as the elderly population of the United States is aging dramatically. The problems are often neuropsychiatric with dementia, depression or even psychosis. Self-neglect is both a consequence and a symptom of these conditions. There have been two national studies showing that between 39 -50% of adults over 60 showed signs of self-neglect.2,3 As awareness of this condition increases, it is hoped that the needs of these patients can be better managed. In the past, many erroneously considered the symptoms of self-neglect a lifestyle choice. However, the symptoms should be treated as a problem associated with aging. This requires the help of family, friends and caregivers who deal with the vulnerable adults. Unfortunately, many of these resources are not locally available and, if so, are often not helpful. There is little evidence-based data on how best to approach the problem of self-neglect of the elderly population. The research, clinical, nursing, social work, legal and public health communities are needed to implemented new strategies to identify and treat patients who are neglectful. It is important to know when the elderly are in jeopardy, and research is a vital component in helping solve this problem and finding better ways of treating our frail, elderly, impaired growing adult population. This problem has enormous financial implications. It was estimated that in 2004, the cost of caring for the entire elderly community in the USA was under $500 million. Self-neglect in the elderly must be checked and corrected. As the Baby Boomer's population ages, there is an imminent risk of many elders living and dying in unsafe situations. The sex life of elderly adults is another facet of their lives that is vulnerable to neglect. There is emerging evidence that older adults continue to have sex despite an age-related increase in the sexual dysfunction of both genders. It is important to note that the elderly are still at risk for contracting sexually transmitted infections.4 There are also specific legal statutes addressing the sex lives of the elderly in care homes that must be studied. Despite this risk, many physicians omit discussions with seniors about their sex life and many family members shy away from what can be an uncomfortable topic.5 References 2 Choi NG, Kim J, Asseff J.Self-neglect and neglect of vulnerable older adults: reexamination of etiology., J Gerontol Soc Work. 2009 Feb-Mar;52(2):171-87. 3 Marijke A. Bremmera, Dorly J.H. Deega, Aartjan T.F. Beekmana, Brenda W.J.H. Penninxa, Paul Lipsc and Witte J.G. Hoogendijk, Major Depression in Late Life Is Associated with Both Hypo- and Hypercortisolemia, Biological Psychiatry, Volume 62, Issue 5, 1 September 2007, Pages 479-486 4 Mary Ann E. Zagaria, PharmD, MS, RPh, CGP, Sexual Activity and STDs Among Seniors, US Pharm. 2008;33(8):28-30 5 Bridget M. Kuehn Time for the Talk Again. Seniors need information on sexual health from the Medical News and Perspectives, JAMA, Sept. 17, 2008; 300(11):1285-86.

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