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"At Risk":
Determining Vulnerability

Charmaine Spencer
Gerontology Research Centre, SFU

The terms "seniors at risk" and "vulnerable groups" seem to have become the buzz words of the late 1980s and early 1990s. For governments trying to address fiscal problems and agencies facing limited funding, the labels have been a way of developing priorities based on the idea of helping those "most at risk" or likely to benefit most from the programs. But what do the terms really mean? How do we determine who is "at risk", who is "vulnerable", and who is not?

Determining Risk

Simply speaking, risk is the chance (probability) of some kind of harm or loss occurring. Referring to "high risk seniors", "children at risk" or "vulnerable populations" is meaningless unless we precisely identify the type or risk or vulnerability in question, whether that is being at risk of poverty, abuse, suicide, alcoholism or self neglect.

The concept of "risk" was borrowed from science, where the focus was on discovering factors (riskindicators) that seemed to be linked to specific diseases. Three elements make up a person's level of risk: a) risk factors b) resources and c) life experiences.

Risk factors help identify people who are more likely than the general population to experience a particular negative outcome. For example, some of the commonly cited risk factors for financial abuse of older adults are 1) social isolation, 2) cognitive impairment, and 3) grown children who are dependent on the senior or who have alcohol or drug problems. Risk factors are not causes of the harm. For example, a grown offspring's drug or alcohol abuse does not cause the senior's abuse or neglect, but it may establish a pathway to the risk.

On the other side of the coin, other factors (resources) can protect the person from the harm or counteract the effects of the harm. Examples of resources include the person's inner strength, social support from family, friends or neighbours, the availability of housing options, or sufficient income. A person's life experiences can also influence whether the risk is more or less likely to happen.

The way that friends, family, community or even government deal with seniors can increase or decrease the likelihood of risks such as abuse or neglect. For example, a society that does not discourage ageism, stereotypes seniors in the media as "dotty old fools", or downplays their contribution to society may makes it easier for family members and perpetrators to denigrate or belittle seniors, leaving seniors open to psychological abuse.

Some factors (reinforcing factors) can intensify or prolong the risk once it has occurred. Reinforcing factors may include the way that peers or authorities respond when they learn a senior has been abused or neglected. Do they turn their back, do they treat it as a private family matter, or do they offer constructive advice/ feedback? Reinforcing factors also include the presence or absence of viable and affordable legal options for the person who has been victimized.

Risk exists in a social context. Risk increases or decreases depending on the environment and supports that are available to a person. As with other types of probabilities, risk can increase or decrease depending on changes in circumstances. Risks can interact, and some types of social problems have a synergistic (intensifying) effect. For example, a senior who has severe health care problems may be twice as likely, and a senior whose family has long standing conflicts may be three times as likely, to be abused or neglected as the average senior. However, when the two risk factors are combined, the person may be eight times as likely to be abused or neglected as the average senior.

In some instances there can be a spiral of risk, where one problem leads to another, which leads to another. For example, facing a daily barrage of belittling from a family member can quickly deplete the remaining physical and emotional reserves the senior has, making it hard to fight family pressure to sign over title to his or her house. The significant personal asset for most seniors is their home and losing it can easily mean poverty. Poverty, in turn, can force a senior to live in unsafe neighbourhoods, leaving them at risk of further victimization, this time by strangers. Or poverty can result in rapid physical deterioration for a senior, leading to forced placement in an institution.

Risk Indicators and Beyond

Much of the discussion about risk, particularly in the area of family violence, focusses on risk indicators. The strength of knowing about risk factors is that it enables us to tailor programs to meets those people's needs. Knowledge about risk factors helps service agencies and policy makers target a prevention or intervention program to the people who have those characteristics.

The drawback is that an abused or neglected person may not meet that profile. For example, consider the commonly cited profile of the victim of elder abuse: female, aged 75, with physical or mental impairment. If the abused person is a male in his 60s, his predicament may be discounted, he may not be believed, or resources may not be made available to him. If the abused person is a relatively healthy, cognitively intact woman in her 80s, she may also be overlooked.

Risk factors are often treated as a checklist, so that if a person has three out of five of the risk indicators, people tend to assume the individual has the problem. The drawback to this approach is that often the risk indicators are based on averages, they are very general descriptions (e.g. being female is a risk indicator for abuse), and sometimes they are based on erroneous information.

Also, certain risk factors emerge as stronger predictors than others. On the other hand, numerous presumably weak risk factors may combine to leave the senior at increased risk of a particular negative outcome.

Identifying risk indicators (e.g. social isolation, alcohol abuse) is only a starting point to understanding a social problem such as abuse or neglect. It is even more important to know why it is a risk factor. How, when and why does a factor such as social isolation put the senior at risk? Identification of specific risk factors should help explain the onset of the risk, how it progresses, and its specific effects.

There are also other limits to focussing on risk factors - they focus on deficiencies in the person's life, they label the person, and once the label is there, others are given the authority to intervene in the person's life.

For seniors, the effects of being labelled "at risk" are compounded by the fact that they often do not have a say in the planning of services designed to support them and reduce risk. Personal choices get left by the wayside or are replaced by a particular treatment or assistance that someone else has identified as appropriate.

For some, assistance becomes a form of social control. As a result, the senior may feel that he or she is balancing the risk of abuse or neglect against the risk of losing control over his or her own life by asking for help.

An alternate, and arguably preferable, way to addressing risk is to focus on the stable assets and areas of the senior's life that can be strengthened, to build on the resources that can prevent the risk, and to reduce the impact of factors that presently reinforce the risk.

Last but not least, if our goal is to optimize a senior's ability to function in society, as opposed to simply reducing the risk in absolute terms, then reducing risk means drawing on the types of assistance that the senior endorses, feels comfortable with, and is willing to participate in.