Vulnerable Adult Research Articles

Unequal smiles: consequences of untreated dental caries in citizens living in vulnerable circumstances in the Netherlands: an exploratory pilot study.

The often poor oral health status of socioeconomically vulnerable adults is widely recognised. Nevertheless, research on it is scarce. To address this gap, this exploratory pilot study aimed to report on the prevalence of untreated caries and its clinical odontogenic consequences, as well as the associated Oral Health Related Quality of Life (OHRQoL) in a marginalised adult Dutch population. The Dutch department of Médecins du Monde (Doctors of the World) included socioeconomically vulnerable (low socioeconomic position [SEP]) adults in the Netherlands through community organisations. The validated Deprivation in Primary Care Questionnaire (DiPCare-Q) was translated in Dutch and used to characterise the SEP of the population. To document untreated caries and severe odontogenic consequences, the DMFT (Decayed, Missing, Filled Permanent Teeth) and PUFA (Pulpal, Fistula, Ulceration, Abscess) index were used. The validated Dutch Oral Health Impact Profile questionnaire (OHIP-14) was used to document the impact of these issues on OHRQoL. Data analysis was conducted in SPSS® (Statistical Package for the Social Sciences) statistics (Kruskal-Wallis, Mann-Whitney-U-test) and STATA software. Data from 59 adult participants were analysed. The prevalence of untreated caries (DT ≥ 1) was 65.5%, 57.9% of which experienced severe odontogenic consequences (DT+PUFA). The prevalence of severe odontogenic consequences (PUFA ≥ 1) was 45.5%. The mean OHIP-14 score of 17.7 ± 13.4 (25th-75th percentile: 6-26) illustrated that untreated caries may have impact on OHRQoL. Individuals who experienced any severe odontogenic consequences from untreated caries reported significantly higher OHIP-14 scores (mean ± s.d.: 21.8 ± 14.8 vs.11.1 ± 7.2). The untreated caries and severe odontogenic consequences seen in a large number of the socioeconomically vulnerable adult participants seemed to have an impact on OHRQoL. These findings emphasise the urgency of including these adults in the professional oral health system for treatment and prevention, and may emphasise the necessity of improving the socioeconomic circumstances of this population. Further exploration of the exact barriers and facilitators to oral healthcare access for socioeconomically vulnerable adults is necessary.

DECISION-MAKING CAPACITY ASSESSMENTS FOR VULNERABLE ADULTS: LESSONS FOR SOCIAL WORK COMPETENCY

Abstract Social work approaches to the assessment of decision-making capacity (DMC) assessment have largely been informed by literature from 25 years ago. Evidence-based practices include the ACED short version and the IDA-CA 3.0. When considering this specific practice by social workers there is the UK policy supporting competent practice through legislation, the Mental Capacity Act (2017) of England and Wales. Nine practitioners practicing through guidance presented by this policy were interviewed to learn what may support practices in the United States. Findings point to the importance of foundational values and efforts to optimize the vulnerable adult’s performance. Practical methods used in the assessment are gleaned, along with the training that has informed their work. Training advice included didactic, case review, and role-playing of increasingly complex cases. Experience working with diverse populations of vulnerable adults was also highlighted. This research strives to inform steps that enhance capacity within health and social care settings to adequately assess DMC. Understanding decision-making ability aids in preventing both paternalism and the insufficiency of support and/or protection.

The Portuguese Protection of the Adult

The Portuguese Law nº. 49/2018, of 14 August, creates the legal adult protection regime, regarding vulnerable adults. This matter has suffered recent changes in the Portuguese legal and judiciary field. A vulnerable adult is someone who is unable to - due to health, disability or behaviour reasons - fully, personally and consciously exercise his/her rights or, in the same terms, fulfil his/her duties.

Elderly Abuse in Rural and Urban Areas of Guntur District - A Comparative Study

Beautiful old people are works of art!". There is still time for us to help the 'art' that is our beautiful elders” said by Eleanor Roosevelt. Elder abuse is a term referring to any knowing, intentional, or negligent act by a care-given or any other person that causes harm or a serious risk of harm to a vulnerable adult. Therefore, we can say that mistreatment by the care given to the elderly is a normal thing or phenomenon as the family structure is changed from a joint to a nuclear family. There is no space for elderly people in the family. They are considered a burden and useless, which results, in ignorance of the elderly. According to the 2011 Census, there are 104 million elderly persons (aged 60 years or above) in India. The proportion of the elderly was 8.6% in 2011 and is rising. Also, the average Indian can expect to live at least 18 years beyond the age of 60, which means the dependency ratio is also rising. In this connection since the elderly abuse is a burning topic there is a great need in studying and knowing the problems of elderly, types of elderly abuse and features of elderly abuse etc. An attempt is made in this paper to Examining the socioeconomic and demographic profiles of respondents of the age of abuse and analysis of responses of elderly people on different types of abuse faced in the study area.

Vulnerability, Ecclesial Abuse, and Vulnerable Adults

The term vulnerable adult has been used for decades within health or legal scientific reports describing potential subjects of abuse. More recently, it appears in relation to ecclesial abuse, as well as in psychologic and legal discussions in relation to the definition of these adults, and the reparation that they are owed. Admitting that the recognition of adult victims of abuse in the Catholic church is a breakthrough toward acknowledging the damage committed, the author states that the use of vulnerable adults to describe these victims is ambiguous. By redefining the ethical-anthropological category of vulnerability as an inherent human characteristic with a dual conception –anthropological and situational–she claims all people can be in either of these moments of experienced vulnerability, thus the inappropriateness of the term used to describe victims of ecclesial abuse.

A review of leg ulcerations coverage in the United Kingdom print media: A growing problem for the vulnerable adult

It is estimated that venous leg ulcers affect 1–1.5% of the industrialised world's population. These can be painful, malodorous and debilitating to the person affected. In this paper we explore, through an analysis of the print media, how journalists translate medical knowledge into lay language and how they represent new directions in treatment. We also show how the term ‘leg ulcer’ is used as part of the description of vulnerable people at the edge of society, some whom are to be seen as needing our compassion, others as (morally) problematic. Finally, we show how stories around ‘leg ulcers’ are also used in relation to narratives around austerity in the UK and to show gaps in health and social care. We conclude that journalists, wound care researchers and health professionals should work together to inform the public and persons affected that leg ulceration can be successfully treated.

The Use of Telehealth for Psychological Counselling of Vulnerable Adult Patients With Rheumatic Diseases or Diabetes: Explorative Study Inspired by Participatory Design.

BackgroundVideo consultation is increasingly used in different health care settings to reach patients. However, little is known about telehealth in psychological counselling for vulnerable patients with somatic and chronic conditions such as rheumatoid arthritis and diabetes.ObjectiveThis study aimed to develop and pilot test a telepsychology module for inclusion in the app My Hospital (Mit Sygehus) to provide remote psychological counselling to vulnerable adults with either rheumatic diseases or diabetes.MethodsWith inspiration from participatory design, the content of the telepsychology module was developed through user involvement and evaluated by individual interviews with patients and psychologists as well as questionnaires.ResultsWe developed a module with our patient partners that targeted patients with rheumatic diseases and diabetes in relation to the psychological challenges of living with chronic diseases. The module included information, tools, exercises, and videoconferencing. In total, 16 patients and 3 psychologists participated in the pilot test. Psychological counselling was described by 4 themes: “The good relation despite physical distance,” “The comfort of being at home,” “The pros of saving time on transport and energy,” and “A therapeutic alliance at a distance.”ConclusionsPsychological counselling in relation to somatic care can be provided by videoconferencing supported by web-based or mobile delivery of tailored information, tools, and exercises without compromising on the quality of care. To ensure a good alliance between the patient and psychologist, a first face-to-face meeting is important. The home location provided patients with a safe environment and increased accessibility and reduced travel time to the hospital.

Schema Modes, Trauma, and Disordered Eating.

Maladaptive schema modes may mediate between trauma and disordered eating, however there is little relevant evidence. This study aimed to predict disordered eating from modes, trauma, and age and gender. Also, to re-examine the factor structure of the Schema Mode Inventory for Eating Disorders, using an online cross-sectional survey of 612 volunteer participants aged 18 to 65, recruited from online eating disorder support groups, including people with and without diagnosed eating disorders. Measures were sociodemographic variables, the Schema Mode Inventory for Eating Disorders (Short Form; SMI-ED-SF), the Eating Disorder Examination Questionnaire (EDE-Q), and the Trauma History Questionnaire (THQ). Confirmatory factor analysis produced 16 factors similar to the 16 modes. Differences were that Vulnerable Child, Happy Child, and Healthy Adult appeared as a one factor, that all ED items appeared as one factor, and that Bully & Attack and Self-Aggrandizer modes appeared combined. In stepwise linear regression, EDE-Q scores was predicted by Total maladaptive mode score (37.3% of variance), Total adaptive mode score (1.5%) variance, Vulnerable Child (2.8%), Detached Self-Soother (1.5%). Other modes accounted for 1% or less of variance. Schema modes predicted EDE-Q, but the stable existence of discrete persona-like modes was less clear. Further research should refine the structure of SMI-ED-SF and relate modes to interpersonal traumas.

Pregnancy in underweight women: implications, management and outcomes

Key Content Despite attention on obesity in pregnancy, within the UK and globally, many women enter pregnancy underweight. There remains a paucity of evidence‐based guidance on the optimal care of these women. Maternal underweight is associated with low birthweight and preterm birth, both spontaneous and iatrogenic, but appropriate gestational weight gain may mitigate low body mass index (BMI). Although being underweight may be protective against several antenatal and intrapartum complications, low BMI can be related to underlying organic disease and/or eating disorders, or there may be modifiable lifestyle factors that should be addressed in pregnancy. BMI at booking should assist as a screening tool. Body image, genetic, socioeconomic and cultural factors may affect BMI, making underweight women a heterogeneous group requiring individualised assessment. Learning Objectives To understand the associations of low BMI in pregnancy and its impact on maternal and fetal outcomes. To understand the antenatal care of underweight women, including nutritional advice and when additional fetal surveillance is required. To understand the heterogeneity of underlying causes of low BMI in pregnancy and the importance of gestational weight gain. Ethical Issues Beware making assumptions about different ethnicities that will interfere with offering the most appropriate care. Low BMI that is not managed as a risk issue during pregnancy is an avoidable cause of low birthweight and preterm birth. Women presenting with low BMI may have features in their history, such as certain mental health disorders, that mean they should be referred for safeguarding as a vulnerable adult. The unborn child and other children may also need assessment.

Financial abuse of older people by third parties in banking institutions: a qualitative exploration

AbstractFinancial abuse is a significant form of elder maltreatment and is frequently ranked in the top two most common forms of abuse perpetration. Despite this, it is under-identified, under-reported and under-prosecuted. Financial institutions, such as banks, are important environments for identifying and responding to the financial abuse of older people. Traditionally, banks have not always been part of inter-sectorial responses to financial abuse, yet are important stakeholders. The aim of this study is to explore perceptions and experiences of financial abuse in five national banks. Data were collected from 20 bank managers and five members of the National Safeguarding Committee in the Republic of Ireland. Using thematic analysis, four themes were identified: defining a vulnerable adult; cases of financial abuse of vulnerable adults; case responses to financial abuse of vulnerable adults; and contextual issues. The data demonstrate the multiplicity of manifestations and the complexity of case investigation and management. Findings point to the need to enhance banks’ responses, through additional education and training, and promote integrated inter-sectorial collaboration. In addition, a change in societal beliefs is needed regarding financial entitlement, responding to ageism, public awareness of the consequences of financial decisions and types of financial abuse, as well as ensuring such crimes are addressed within the legal system.

Safeguarding Vulnerable Autonomy? Situational Vulnerability, the Inherent Jurisdiction, and Insights from Feminist Philosophy.

The High Court continues to exercise its inherent jurisdiction to make declarations about interventions into the lives of situationally vulnerable adults with mental capacity. In the light of the protective responses of health care providers and the courts to decision-making situations involving capacitous vulnerable adults, this article has two aims. The first is diagnostic. The second is normative. The first aim is to identify the harms to a capacitous vulnerable adult’s autonomy that arise based on the characterisation of situational vulnerability and autonomy as fundamentally opposed concepts or the failure to adequately acknowledge the conceptual relationship between them at common law. The second (normative) aim is to develop an account of self-authorised, intersubjective autonomy based on insights from analytic feminist philosophy. This approach not only attempts to capture the autonomy of capacitous vulnerable adults and account for the necessary harms to their autonomy that arise from standard common law responses to their situational vulnerability, it is also predicated on the distinctions between mental capacity, informed consent, and autonomy, meaning that it is better placed to fulfil the primary aim of the inherent jurisdiction—to facilitate the autonomy of vulnerable adults with capacity.

From Need to Policy: Community Supported Development and Implementation of the South Carolina Vulnerable Adult Guardian Ad Litem (SC VAGAL) Program.

Adult guardian ad litem programs are a necessary public service to protect adults from abuse and neglect. This article describes the development and implementation of an adult guardian ad litem program. We discuss the program's impetus, pilot testing, evaluation, and implementation of the program. Our experience highlights the vital role of diverse inter-sectoral stakeholders. Furthermore, the development process highlights the need for flexibility in program development, tension negotiation among stakeholders, and engagement of aging stakeholders in nontraditional arenas.

Applying time series modeling to assess the dynamics and forecast monthly reports of abuse, neglect and/or exploitation involving a vulnerable adult

BackgroundApplication of time series modeling to predict reports related to maltreatment of vulnerable adults can be helpful for efficient early planning and resource allocation to handle a high volume of investigations. The goal of this study is to apply: (1) autoregressive integrated moving average (ARIMA) time series modeling to fit and forecast monthly maltreatment reports accepted for assessment reported to adult protective services (APS), and (2) interrupted time series analysis to test whether the implementation of intake hubs have a significant impact in the number of maltreatment reports after the implementation period.MethodsA time series analysis on monthly APS intake reports was conducted using administrative data from SC Child and Adult Protective Services between January 2014 and June 2018. Monthly APS data were subjected to ARIMA modeling adjusting for the time period when intake hubs were implemented. The coefficient of determination, normalized SBC, AIC, MSE, and Ljung-Box Q-test were used to evaluate the goodness-of-fit of constructed models. The most parsimonious model was selected to predict the monthly APS intakes from July to December 2018. Poisson regression was fit to examine the association of the implementation of the hubs and the number of intake reports received to APS, adjusting for confounders.ResultsOver 24,000 APS intakes accepted for investigation were identified over a period of four calendar years with an increase in the monthly average of APS intakes between 2014 and 2017. An increase in the number of monthly APS intakes was found after the intake hubs were implemented in 2015 (Phase-1) and 2017 (Phase-2). Of all the models tested, an ARIMA (12), 1, 1 model was found to work best after evaluating all fit measures for both models. For Phase-1, the optimum model predicted an average of 488 APS intake reports between July and December 2018, representing a 9% increase from January–June 2018 (median = 445). For Phase-2, the percent increase was 32%.ConclusionsThe implementation of the intake hubs has a significant impact in the number of reports received after the implementation period. ARIMA time series is a valuable tool to predict future reports of maltreatment of vulnerable adults, which could be used to allow appropriate planning and resource allocation to handle a high volume of monthly intake reports.

Closer Than You Think: The Vulnerable Older Adult

“Please! Please! Don’t make me go back there! The frail, white-haired old woman clutches your arm as the attendant attempts to transfer her to the wheelchair so she can be returned to where she lives. She continues to resist the transfer, grabbing at the side rails of the stretcher, crying, and saying, “They’ll hurt me again!” TableResources related to care of older and vulnerable adults Resource Web site The Long-Term Care Ombudsman Program, Adult Protective Services, and State Survey and Certification Agency www.theconsumervoice.org/get_help Eldercare Locator www.eldercare.acl.gov National Consumer Voice for Quality Long-Term Care www.theconsumervoice.org National Long-Term Care Ombudsman Resource Center www.ltcombudsman.org National Center on Elder Abuse https://ncea.acl.gov/ National Sexual Violence Resource Center www.nsvrc.org National Adult Protective Services Association www.napsa-now.org Open table in a new tab Joan Somes, Member, Greater Twin Cities Chapter, is Critical Care Educator, Regions Hospital EMS, St. Paul, MN.

Testimonial Injustice and Vulnerability: A Qualitative Analysis of Participation in the Court of Protection

This article explores participation in Court of Protection (COP) proceedings by people considered vulnerable. The article is based on original data obtained from observing COP proceedings and reviewing COP case files. It is argued that the observed absence of the subject of proceedings is a form of testimonial injustice, that is, a failure to value a person in their capacity as a giver of knowledge. The issue of competence to give evidence is considered but it is argued that it is not the formal evidential rules that prohibit a vulnerable adult from giving evidence. Instead, it is the result of a persistent assumption that they are inherently vulnerable and therefore lack credibility as a knowledge giver. This assumption results in the voices of vulnerable adults being routinely absent from legal proceedings. It is argued that having a voice in the courtroom is essential and has a number of intrinsic and instrumental benefits. The article concludes with a discussion about the implications of the research, including the current trend towards the increased use of special measures, and recommends a presumption in favour of the subject of COP proceedings giving evidence.

Vulnerable Adults in the Privately Rented Sector in England: A Snapshot of Current Practice Issues

In the UK, in common with many developed countries, there is a crisis in the provision of adequate, affordable and quality housing. This paper discusses how an unprecedented rise in the privately rented housing sector has impacted on housing security for vulnerable adults and the challenges for social work emerging from this situation (The core definition of ‘vulnerable adult’ from the 1997 Consultation ‘Who Decides?’ issued by the Lord Chancellor’s Department, is a person: ‘Who is or may be in need of community care services by reason of disability, age or illness; and is or may be unable to take care of unable to protect him or herself against significant harm or exploitation’. This definition of an adult covers all people over 18 years of age.). We report on a scoping review of the relevant literature and a subsequent online survey of practitioner’s views on the challenges and possible solutions to this issue. Together these provide a snapshot of practice issues and concerns which can be used to promote further debate and help shape recommendations.

Honour based abuse: the response by professionals to vulnerable adult investigations

PurposeThe purpose of this paper is to examine responses by police and Adult Social Care to honour based abuse (HBA) victims who have a diagnosed or perceived vulnerability, such as a physical disability or mental health issue. The aim is to improve professional practice in ensuring vulnerable victims are safeguarded.Design/methodology/approachFindings are drawn from 100 HBA investigations (2012-2014) derived from classified police electronic records and interviews with 15, predominantly specialist, public protection police officers in one UK force.FindingsHBA against vulnerable adults is an obscure crime area. In cases of diagnosed vulnerability (3 per cent), police officers wrongly attributed “freewill” and choice to vulnerable adults who legally lacked the capacity to consent to marriage. Conversely, in 9 per cent of cases where victims were depressed and/or self-harming, perpetrators exaggerated the poor mental health of victims in order to discredit them to law enforcement. Professionals illogically latched onto perpetrator explanations and in turn undermined and problematised the victims.Research limitations/implicationsThere is limited access to data on vulnerable adult abuse, making this an under researched area of crime.Practical implicationsFailing to undertake risk assessments, or record whether the victim is legally vulnerable should lead to a review of police practice. An evaluation of joint working arrangements is necessary concerning which agency (police or Adult Social Care) should take primacy.Social implicationsVulnerable adult victims were retained in risk predicaments alongside perpetrating family members.Originality/valuePolice officers suggesting vulnerable adults can “consent” to marriage is a new concept, along with issues of goal displacement which illustrates avoidance behaviours by professionals and under protection by the state.

Home pressures: failures of care and pressure ulcer problems in the community – the findings of serious case reviews

Purpose Local serious case reviews (SCRs) (now Safeguarding Adults Reviews (SARs)) may be held in England when a vulnerable adult dies or is harmed or at risk of being so, and local agencies may not have responded to the abuse or neglect. The purpose of this paper is to present findings from a documentary analysis of these reviews to ascertain what recommendations are made about pressure ulcer prevention and treatment at home, setting these in the context of safeguarding, and assessing what lessons may be learned by considering them as a group. This analysis is presented at a time of increased interest of the risks of pressure ulcers among frail and very ill populations; and debates about the interface of neglect and safeguarding systems. Design/methodology/approach Identification of SCRs from England where the person who died or who was harmed had been suffering from pressure ulcers or their synonyms in their home; termed home acquired pressure ulcers. Narrative and textual analysis of documents summarising the reports was undertaken to explore the reviews’ observations and recommendations. The main circumstances, recommendations and common themes were identified. Findings The authors located 18 relevant SCRs, one of which was a case summary and two SARs covering pressure ulcers that had been acquired or worsened when the individual was living at home. Most of these inquired into the individual’s circumstances, their acceptance of care and support, the actions of others in their family or professionals, and the events leading up to the death or harm. Failures to have followed guidance were noted among professionals, and problems within wider health and care systems were identified. Recommendations include calls for greater training on pressure ulcers for home care workers, but also greater risk communication and better adherence to clinical guidelines. A small number focus on neglect by family members, others on self-neglect, including some vulnerable adults’ lack of capacity to care for themselves or to access help. In some SCRs the presence of a pressure ulcer is only mentioned circumstantially. Research limitations/implications The value of this documentary analysis is that it draws on case examples and scrutiny at local level. Future research could consider the related findings of SARs as they emerge, similar documents from the rest of the UK, and international perspectives Practical implications This analysis highlights the multitude of complex social and health situations that gives rise to pressure ulcers among people living at home. Several SCRs observe problems in the wider communications with and between health and care providers. Nonetheless poor care quality and negligence are reported in some SCRs. Cases of self-neglect give rise to challenging practice situations. While practices and policies about poor quality care and safeguarding in the form of prevention of wilful neglect are emerging, they often relate to hospital and care home settings. Preventing and treating pressure ulcers may be part of safeguarding in its broadest sense but raises the question of whether training, expertise and support on this subject or wider self-neglect and neglect by others are sufficiently robust for home care workers and community-based professionals. Originality/value The value of having a set of SCRs is that they lend themselves to analysis and comparison. This analysis is the first to focus on home acquired pressure ulcers and to address wider considerations related to safeguarding policy and practice. Pressure ulcers feature in several SCRs either as contextual information about the vulnerable adults’ health-status or as indications of poor care. The potential value of examining home acquired pressure ulcers as a key line of enquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what is optimal care and treatment. In the new Care Act 2014 context, they may still feature in safeguarding inquiries as symptoms of failings in systems or of personal culpability for poor care. Learning from them may be of interest to other parts of the UK.

The role of the appropriate adult in supporting vulnerable adults in custody: Comparing the perspectives of service users and service providers

Accessible Summary When a vulnerable adult is in police custody, they should have someone with them to help them understand what is happening. This person is called an appropriate adult (AA). Previous research has shown that the role of the AA is not always well understood. This study compares the views of both professionals and vulnerable adults. Adults with learning disabilities and mental health problems said looking after them and helping them communicate were the most important things an AA should do. Like other studies have shown, not all adults who should be provided with an AA in custody have had one. This may be because no agency has a statutory duty to provide one. This study recommends that AA services should try and engage more effectively with vulnerable adults. AbstractBackgroundPolice custody sergeants have a duty to secure an AA to safeguard the rights and welfare of vulnerable people detained or questioned by the police. This study focuses on the role of the AA in supporting vulnerable adults and seeks to examine what stakeholders would expect from an effective AA service.MethodsThis was a qualitative study of four AA services in England. Interviews were undertaken with 25 professionals, and two focus groups were held with service‐user groups (13 participants).ResultsThere is disparity between the expectations of professionals, and service users, on what comprises an effective service. Professionals tend to prioritise the availability and response time of AAs, while service users prioritise their personal attributes and demeanour.ConclusionsProfessionals involved in commissioning and management of AA services should monitor whether the rights of vulnerable adults in custody are protected and better engage vulnerable adults beyond service delivery.

Cardiac surgery as a stressor and the response of the vulnerable older adult

In an aging population, recovery and restoration of function are critical to maintaining independence. Over the past 50years, there have been dramatic improvements made in cardiac surgery processes and outcomes that allow for procedures to be performed on an increasingly older population with the goal of improving function. Although improved function is possible, major surgical procedures are associated with substantial stress, which can severely impact outcomes. Past literature has identified that frail patients, who are vulnerable to the stress of surgery, are more likely to have postoperative major adverse cardiac and cerebrovascular events (OR 4.9, 95% confidence interval 1.6, 14.6). The objective of this manuscript is to examine preoperative frailty in biological, psychological, and social domains using cardiac surgery to induce stress. We systematically searched PubMed for keywords including “cardiac surgery, frailty, and aged” in addition to the biological, psychological, and social keywords. In the biological domain, we examine the association of physiological and physical vulnerabilities, as well as, the impact of comorbidities and inflammation on negative surgical outcomes. In the psychological domain, the impact of cognitive impairment, depression, and anxiety as vulnerabilities were examined. In the social domain, social structure, coping, disparities, and addiction as vulnerabilities are described. Importantly, there is substantial overlap in the domains of vulnerability. While frailty research has largely focused on discrete physical vulnerability criteria, a broader definition of frailty demonstrates that vulnerabilities in biological, psychological, and social domains can limit recovery after the stress of cardiac surgery. Identification of vulnerability in these domains can allow better understanding of the risks of cardiac surgery and tailoring of interventions to improve outcomes.