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An Examination of the Vulnerability Hypothesis
Abstract
Follow-up information from three groups of older persons (community residents, clinic clients, the institutionalized) confirms and extends data presented by Yolmans and Yarrow [1] indicating that increasing interdependence among different areas of functioning increases with age, possibly resulting in increased vulnerability in time of loss. Some implications of these findings were indicated.
... Also, age differences can impact how people cope with trauma. Getting older may increase vulnerability (Fillenbaum, 1977Fillenbaum, –1978), affect adaptive and coping capacities (Elwell & Maltbie-Crannel, 1981) or increase resistance to subsequent stress and adaptability to the trauma (Eysenck, 1983;Norris & Murrell, 1988;Phifer & Norris, 1989). The relationship of age to flood-related PTSD is unclear, although one study suggested that older flood victims reported more severe PTSD symptoms than younger victims (Liu et al., 2006). ...
... Also, age differences can impact how people cope with trauma. Getting older may increase vulnerability (Fillenbaum, 1977Fillenbaum, –1978), affect adaptive and coping capacities (Elwell & Maltbie-Crannel, 1981) or increase resistance to subsequent stress and adaptability to the trauma (Eysenck, 1983;Norris & Murrell, 1988;Phifer & Norris, 1989). The relationship of age to flood-related PTSD is unclear, although one study suggested that older flood victims reported more severe PTSD symptoms than younger victims (Liu et al., 2006). ...
Background:
In literature, the effect of age on posttraumatic stress disorder (PTSD) is inconclusive; the effect on flood-related PTSD is particularly unclear. Little is known on distorted cognitions among flood victims, although cognition distortions and PTSD have been linked among victims of other traumas.
Aims:
To investigate: (1) whether flood-related PTSD, psychiatric co-morbidity and cognitive distortions would differ according to age and (2) distinctive patterns of association between the preceding variables for different age groups.
Methods:
One hundred and fifty-four flood victims of different ages completed standardized questionnaires measuring PTSD, psychiatric co-morbidity and cognitive distortions.
Results:
Adolescents and young adults reported significantly fewer PTSD, psychiatric co-morbidity and distorted cognition symptoms than people who were older. Preoccupation with danger and hopelessness were associated with both outcomes for adolescents, people in their thirties and middle-aged/older people. For young adults, helplessness was associated with PTSD; hopelessness and preoccupation with danger with psychiatric co-morbidity.
Conclusions:
Adolescents and young adults buffered against flood-related psychological distress better than older people. Distorted cognitions related to distress outcomes differently depending on age.
... Kilijanek and Drabek, 1979 ) and perceived themselves as being at greater risk of extended disasterrelated traumatic stress (Melick and Logue, 1986). The theoretical underpinning for the above view lies in the age-related differential vulnerability hypothesis which suggests that when people become older, they become more vulnerable (Fillenbaum, 1977Fillenbaum, –1978). Through aging, adaptive capacities, coping resources (Elwell and Maltbie-Crannel, 1981) and external resources reduce, while exposure to traumatic events or illnesses increases. ...
... Kilijanek and Drabek, 1979 ) and perceived themselves as being at greater risk of extended disasterrelated traumatic stress (Melick and Logue, 1986). The theoretical underpinning for the above view lies in the age-related differential vulnerability hypothesis which suggests that when people become older, they become more vulnerable (Fillenbaum, 1977Fillenbaum, –1978). Through aging, adaptive capacities, coping resources (Elwell and Maltbie-Crannel, 1981) and external resources reduce, while exposure to traumatic events or illnesses increases. ...
Debate persists about whether people of different ages react similarly to traumatic events, and whether elderly people are more vulnerable to such events, or better able to cope with them. The first aim of this paper was to shed light on this debate by comparing the post-traumatic responses of young, middle-aged and elderly community residents who had been exposed to technological disasters. The second aim was to differentiate between these three age groups in terms of coping strategies.
One hundred and forty-eight community residents, who were exposed to two technological disasters, participated in the study. They were assessed using the Impact of Event Scale (IES), the General Health Questionnaire (GHQ-28) and the Ways of Coping Checklists (WOC).
The results showed that in terms of IES, GHQ and WOC scores, no significant differences were found across the three age groups. However, main effects were found according to type of disaster and intensity of exposure to disaster. One significant interaction effect was that residents exposed to the aircraft crash used significantly more confrontive coping than those exposed to the train collision, in all three age groups. Correlation coefficients results showed that for all three age groups, on the whole, the more they experienced intrusive thoughts and avoidance behaviour, the more they experienced general health problems.
Following exposure to technological disasters, young, middle-aged and elderly community residents could display similar post-traumatic responses and employ similar coping strategies, which contradicts the vulnerability hypothesis and the inoculation hypothesis.
... The combination of these factors would have created a great deal of distress particularly for those who were older [51]. According to the age-related differential vulnerability hypothesis [55,56], vulnerability, difficulty in adaptability and coping would have emerged for these people. In turn, the ability to buffer against the impact of the trauma on their concept of self and secure psychological well-being would have been affected. ...
It has been documented that trauma centrality is associated with posttraumatic stress disorder (PTSD) and psychiatric co-morbidity among Syrian refugees. Whether age would influence the levels of the above constructs and the association between trauma centrality and distress outcomes is unclear. This study compared age differences in 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees. One thousand one hundred and ninety-seven refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28. Age groups were divided into young, middle-aged adults and adults of 45 or above. No significant group differences were found in the proportion of refugees meeting the diagnostic criteria for PTSD. Controlling for demographic variables, all subscales of trauma centrality and psychiatric co-morbidity were significantly different between groups. Young adults reported significantly less trauma centrality and psychiatric co-morbidity than the other groups. Multiple-indicator multiple-cause modelling showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity. Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model. To conclude, age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults' sense of self and other psychological problems than those who were older. The way in which young and middle-aged adults responded to distress varied depending on environment and personal characteristics.
... Since 1976, however, the notion started to be used in a broader sense: in the context of professional relationships, for example between patients and nurses (McGilloway 1976). Over the years, the context of use has gradually expanded, including the following: human development and aging (Fillenbaum 1976), violence and crime (Cutler 1979;Shainess 1979), disasters (Snarr, Brown, and Leonard 1979), commerce (Anonymous 1980), developing countries (Steady 1982), social conditions such as homelessness (Sebastian 1985), economic stress (Aldwin and Revenson 1986), and poverty (Zaidi 1988). The notion of vulnerability was also used to categorize states (Lewis 1990). ...
Alongside globalization, the sense of vulnerability among people and populations has increased. We feel vulnerable to disease as new infections spread rapidly across the globe, while disasters and climate change make health increasingly precarious. Moreover, clinical trials of new drugs often exploit vulnerable populations in developing countries that otherwise have no access to healthcare and new genetic technologies make people with disabilities vulnerable to discrimination. Therefore the concept of 'vulnerability' has contributed new ideas to the debates about the ethical dimensions of medicine and healthcare. This book explains and elaborates the new concept of vulnerability in today's bioethics. Firstly, Henk ten Have argues that vulnerability cannot be fully understood within the framework of individual autonomy that dominates mainstream bioethics today: it is often not the individual person who is vulnerable, rather that his or her vulnerability is created through the social and economic conditions in which he or she lives. Contending that the language of vulnerability offers perspectives beyond the traditional autonomy model, this book offers a new approach which will enable bioethics to evolve into a global enterprise. This groundbreaking book critically analyses the concept of vulnerability as a global phenomenon. It will appeal to scholars and students of ethics, bioethics, globalization, healthcare, medical science, medical research, culture, law, and politics.
... Since 1976, however, the notion started to be used in a broader sense: in the context of professional relationships, for example between patients and nurses (McGilloway 1976). Over the years, the context of use has gradually expanded, including the following: human development and aging (Fillenbaum 1976), violence and crime (Cutler 1979;Shainess 1979), disasters (Snarr, Brown, and Leonard 1979), commerce (Anonymous 1980), developing countries (Steady 1982), social conditions such as homelessness (Sebastian 1985), economic stress (Aldwin and Revenson 1986), and poverty (Zaidi 1988). The notion of vulnerability was also used to categorize states (Lewis 1990). ...
Vulnerability has become a popular though controversial topic in bioethics, notably since 2000. As a result, a common body of knowledge has emerged (1) distinguishing between different types of vulnerability, (2) criticizing the categorization of populations as vulnerable, and (3) questioning the practical implications. It is argued that two perspectives on vulnerability, i.e., the philosophical and political, pose challenges to contemporary bioethics discourse: they re-examine the significance of human agency, the primacy of the individual person, and the negativity of vulnerability. As a phenomenon of globalization, vulnerability can only be properly addressed in a global bioethics that takes the social dimension of human existence seriously.
The Clinical Dementia Rating (CDR) scale is broadly accepted by clinicians as a staging measure for Alzheimer’s disease (AD). Extensive assessment of its validity is, however, lacking. We examined the concurrent and predictive validity of both summary CDR scores (global CDR, Sum of Boxes [sum of scores on the individual components]) and scores on two (Memory and Orientation) of the CDR’s six components (the other four components are judgement and problem-solving, community affairs, home and hobbies, personal care) using cross-sectional, longitudinal and survival information on 434 community-resident probable AD patients. Cross-sectionally the Orientation box score correlated substantially with an independent neuropsychology measure of orientation, but the Memory box score correlated more poorly with an independent measure of memory than with any other neuropsychology measure. The relationship of the global CDR score and the Sum of Boxes score to scores on neuropsychology measures was comparable to that of the Orientation and Memory box scores. Longitudinally, Memory box score a year later was predicted equally well by the other box scores (personal care excepted). The individual components were comparable to both summary CDR scores in predicting time to death. The CDR has content and criterion validity. However, since intentionally all components measure aspects of cognitive functioning, they are closely related. Nevertheless, sufficient distinctions remain that assessment in each area is still warranted.
This study investigated the extent of posttraumatic stress disorder (PTSD) and psychiatric comorbidity among the 2010 flood victims in Pakistan and its relationship with disaster exposure characteristics, cognitive distortions, and emotional suppression. One hundred and thirty-one (F = 89, M = 42) flood victims were assessed using the Posttraumatic Diagnostic Scale, the General Health Questionnaire-28, the Cognitive Distortion Scales, and the Courtauld Emotional Control Scale. The results showed that all victims met the diagnostic criteria for PTSD and scored above the cut-off for psychiatric caseness. Partial least squares modelling showed that disaster exposure characteristics were significantly correlated with PTSD and psychiatric comorbidity. Disaster exposure characteristics were also significantly associated with cognitive distortions which in turn were also significantly associated with PTSD and psychiatric comorbidity. Cognitive distortions were also correlated with emotional suppression which, however, was not associated with PTSD or psychiatric comorbidity. To conclude, the flood victims reported PTSD and psychiatric comorbid symptoms which were related to their subjective exposure to the flood. Such exposure led to the development of dysfunctional thinking patterns which in turn influenced distress symptoms.
Admission data from 159 residents of four Saskatchewan nursing homes were analysed in order to identify predictors of level of care. Multiple regression analyses showed that a high level of care was assigned to those who were unable to perform various activities of daily living, those who had behavioral problems, and those who had recently experienced a stressful life event; with these variables and a nursing home variable explaining 47.2% of the variance. Appropriately, the most important predictor is activities of daily living. The other major predictor is behavioral problems which, the results suggest, are caused by either an organic psychotic disorder or a high level of stress. It is recommended that, following admission, new residents with behavioral problems caused by stress should be the recipients of programs designed to help them cope with this stress and mitigate their behavioral problems. Then, they should be reassessed and, where appropriate, reassigned to a lower level of care.
To use a joint modeling approach to examine the association between longitudinal changes in depressive symptoms and mortality. Research on the relationship of depression to mortality has yielded mixed results. Limitations of previous studies include mostly one-time assessment of depression, short follow-ups, and failure to model appropriately changes in depression.
Data were obtained from the Florida Retirement Study, a prospective cohort study of community-dwelling oldest old individuals. At baseline, 879 people (mean age = 80.6 years, 65.8% women) had a comprehensive psychosocial assessment, including the Center of Epidemiological Studies-Depression Scale (CES-D). They were then assessed annually up to 11 years. Longitudinal changes of CES-D, modeled by a joint modeling approach of repeated measures and survival data, were used to predict mortality at follow-up (15 years after baseline), at the same time adjusting for five classes of covariates.
The total mortality rate was 69.9%. CES-D at baseline was not predictive of mortality at 15-year follow-up after adjusting for baseline covariates. The joint modeling revealed that an annual increase of 1 point in CES-D scores over the years was associated with a 57% higher risk of mortality (HR = 1.57, p < .001) at follow-up. Compared with those whose CES-D scores were stable over time, subjects with increasing CED-D scores over time had a 70% increase in mortality risk, p < .001, and their median survival time was 4 years shorter.
Although baseline CES-D was not predictive of mortality, the increase in depressive symptoms over time was associated with higher mortality. It is important to assess longitudinal changes in depression.
The purpose of this qualitative study was to determine the process of spousal influence as it relates to health-promotion behaviors and the concept desire to change spousal health behaviors. Fifty-nine elderly couples in long-term marriages were recruited through three senior centers; participants were asked to respond to five open-ended questions. The majority of couples said that they made health decisions jointly; wives tended to be the primary deciders in the even that a health decision had to be made. Most people, but particularly wives, desired to change something about their spouses' health behavior; a variety of strategies were used in the attempt to change spousal behavior. Aging or illness in the self or spouse were identified as precipitants of increased desire to change the spouses' health behavior over time.
Explaining survival variation in prostate cancer requires the identification of new predictive factors, of which physical function is attractive hypothetically. To understand physical dysfunction in prostate cancer better, we examined medical claims. Our aims were to describe the consumption of inpatient resources, examine the association of physical therapy with institutionalization after hospital discharge and determine the association of disease stage with frequency of hospitalization, inpatient physical therapy and discharge to a skilled nursing facility.
We used 1994 Medicare claims for patients in South Florida who had prostate cancer. To examine the association of disease stage with use of health services, we inferred disease stage from stage specific treatment. Multiple linear regression was used to examine the interaction of inferred disease stage with health services while adjusting for age.
A total of 22,279 residents of South Florida a mean of 78.3 years old with prostate cancer billed Medicare in 1994. Of these patients 2,507 were admitted to a hospital 4,606 times, resulting in total charges of $70 million. Many claims indicated physical dysfunction, including 1,896 charges for physical therapy, which was associated with more institutionalization after hospital discharge. Disease stage and patient age were individually associated with the frequency of hospitalization, inpatient physical therapy and discharge to a skilled nursing facility.
Inpatients with prostate cancer have substantial stage dependent physical dysfunction. If the hypothesized interaction of physical dysfunction with mortality is confirmed in prospective studies and outpatient settings, theoretically the door will have been opened to new interventions for prolonging survival in patients with prostate cancer.
Quality of life research in prostate cancer involves the use of many questionnaires and specific items that may be partly redundant. We examine dimensions of quality of life in prostate cancer in the hope of somewhat simplifying communication of basic information.
We analyzed cross-sectional survey data on quality of life in patients with prostate cancer belonging to a Southern California HMO. Quality of life was assessed with the University of California, Los Angeles prostate cancer index. Scree plot and parallel analysis were used to identify factors for extraction and orthogonal (varimax) rotation to examine scale loadings.
Four extracted factors explained a cumulative variance of 86%. The 8 physical and emotional scales loaded on 1 general factor explained 41% of the cumulative variance. Urinary function and bother, sexual function and bother, and bowel function and bother scales loaded on factors explained 16, 15 and 14% of the cumulative variance, respectively.
The observation of only 1 general quality of life factor diverges from consistent previous observations of distinct physical and emotional factors in other types of patients, and the tight interaction of emotional and physical scales supports the vulnerability hypothesis, "with age the increasing interactions across dimensions of health leave a patient vulnerable in all when any is affected." The tight interaction of physical and emotional scales in these but not other patients opens the door theoretically to better evaluation of and targeting of health services for patients with prostate cancer.
The comparative measurement performance of self-reported health status instruments for African American and Hispanic elderly has rarely been studied, despite evidence of their poor health status. This study examined psychometric performance and health status differences by age, ethnicity, and gender among 10,569 ethnically diverse patients who completed the Short-Form General Health Survey in the Medical Outcomes Study (MOS). Hispanics and African Americans tended to have slightly lower measurement performance than other ethnic groups. Compared with whites, health status scores for African American and Hispanic women were slightly but significantly lower. The small differences in health status by ethnicity may be due to the MOS sampling strategy, which excluded low-socioeconomic status minorities with poor education and no regular medical care. The psychometric performance of MOS health status measures should be examined in studies of ethnically diverse, community-dwelling, elderly populations who have poor access to care, poor education, and/or low socioeconomic status.
This study aimed to investigate the extent to which spinal cord injury posttraumatic stress (SCI PTSD) responses and the use of the external or internal health locus of control might vary according to age. Sixty-two patients with SCI were recruited for the study and divided into young (n = 23), middle-aged (n = 25) and elderly (n = 14) groups. They were assessed using the Posttraumatic Stress Disorder Checklist (PCL), the General Health Questionnaire-28 (GHQ-28), and the Multidimensional Health Locus of Control (MHLC). The results showed no significant differences between the three age groups in terms of PTSD symptoms. The elderly patients were significantly more socially dysfunctional than the other patients. The young patients believed in chance locus of control (CHLC) significantly more than the middle-aged and elderly patients. Correlation results revealed no significant relationship between PTSD symptoms and type of locus of control for the middle-aged patients. Otherwise, for both the young and elderly patients, internal health locus of control (IHLC) was negatively correlated with the avoidance symptom. For the elderly patients, powerful other locus of control (POLC) was positively correlated with the avoidance symptom. Both young and middle-aged patients revealed significant positive correlations between POLC, CHLC, and general health problems. For the elderly patients, POLC was positively correlated with social dysfunction and depression. SCI-PTSD responses did not differ according to age; however, the use of health locus of control differed depending on whether patients were younger or older.
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