NURS 4212 Week 6 Vulnerable Population Analysis Example

Vulnerable Population Analysis: Older Adults Living Alone in Portsmouth's Most Socially Vulnerable Tracts, and Extreme Heat

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College of Nursing, Walden University

NURS 4212: Population Health Nursing

Instructor Name

Month Day, Year

Vulnerable Population Analysis: Older Adults Living Alone in Portsmouth's Most Socially Vulnerable Tracts, and Extreme Heat

Vulnerability is often used as a label for a group. This analysis treats it as something that can be evidenced. The population is adults aged 65 and older who live alone in the six census tracts in and around Portsmouth, Ohio, that rank in the top fifth of Ohio tracts on the Social Vulnerability Index. The hazard is extreme summer heat. Vulnerability to heat is examined, using the framework of Wilhelmi and Hayden (2010), as three components: exposure to heat, sensitivity to its effects, and the capacity to adapt.

Defining the Population

The Social Vulnerability Index, a federal tool maintained by the Agency for Toxic Substances and Disease Registry (ATSDR), ranks census tracts on social factors such as poverty, lack of vehicle access, disability and crowded housing that affect a community's ability to prepare for and recover from hazards (Flanagan et al., 2011). In the 2022 index, ranked within Ohio, tracts 31, 32, 34, 35, 36 and 37 in Scioto County all fall at or above the 82nd percentile; tract 34 ranks at the 92nd (Agency for Toxic Substances and Disease Registry [ATSDR], 2024).

Across these six tracts, American Community Survey estimates count 2,343 residents aged 65 and older, of whom about 906, or 39%, live alone (U.S. Census Bureau, 2025). The share varies widely: about half of older residents in tracts 32 and 36 live alone, compared with about one in five in tracts 35 and 37. Tract-level margins of error for these counts are large, often more than half the estimate, so the figures describe the order of magnitude rather than exact numbers.

Table 1

Social Vulnerability, Living Alone and Selected Conditions in Six Scioto County Tracts

Note. SVI percentiles, vehicle access and housing from the 2022 Social Vulnerability Index (ATSDR, 2024); living alone from ACS 2020-2024 table B09020 (U.S. Census Bureau, 2025); COPD and coronary heart disease are PLACES 2023 model-based estimates for all adults, not only older adults (Centers for Disease Control and Prevention [CDC], 2025). For comparison, Ohio adults report COPD at 7.9% and coronary heart disease at 5.0%.

Exposure

Exposure describes how much heat reaches a person. Portsmouth sits in the Ohio River valley, where summer heat is often combined with high humidity. Within the city, exposure depends heavily on housing. In tracts 36 and 37, a quarter to a third of homes are in buildings with ten or more units, where upper floors can hold heat, and Semenza et al. (1996) found that living on the top floor of a building raised the risk of heat-related death during the 1995 Chicago heat wave. Older single-family homes in the other tracts may lack insulation or central cooling. No tract-level measure of indoor heat exists for the city, so this component is inferred from housing type rather than measured.

Sensitivity

Sensitivity describes how strongly a body is affected by the heat it receives. Aging reduces the body's ability to sweat and to increase blood flow to the skin, and chronic conditions such as cardiovascular disease, diabetes and obesity further impair heat loss (Kenny et al., 2010). Common medications add to the problem: diuretics, some antihypertensives and drugs with anticholinergic effects can reduce heat tolerance or increase fluid loss. The table shows that the adult populations of these tracts carry roughly twice Ohio's prevalence of COPD and coronary heart disease. Those figures cover all adults, so the burden among the older residents is likely higher still.

Adaptive Capacity

Adaptive capacity describes the resources a person has to reduce heat's effects: a working air conditioner, the money to run it, a way to reach a cooler place, and someone who notices when something is wrong. In Chicago, working air conditioning and access to transportation each reduced the risk of heat-related death by about 70%, while living alone more than doubled it and not leaving home each day raised it further (Semenza et al., 1996). In these tracts, between 9% and 36% of households have no vehicle, and more than half of residents live below 150% of the poverty line in every one of the six tracts (ATSDR, 2024), which makes both buying and running an air conditioner harder. Air conditioning access itself is not measured at the tract level, which is a gap this analysis cannot close.

Outcome Measure and Assets

The outcome measure for any later intervention would be heat-related emergency department visits among adults 65 and older. CDC's Heat and Health Tracker reports heat-related illness visits drawn from syndromic surveillance (CDC, n.d.), and the county or state health department would need to provide local counts, since small numbers are unlikely to be published for a single county.

The community already has assets to build on. The Portsmouth Public Library and other air-conditioned public buildings can serve as cooling sites during declared heat events. The regional Area Agency on Aging serves Scioto County and already has contact with many older residents through meal and in-home services. Ohio's summer crisis assistance through the Home Energy Assistance Program helps eligible older and medically vulnerable households with cooling costs and equipment. Churches and neighborhood groups in the high-vulnerability tracts are a further resource for informal check-ins.

Conclusion

All three components point to elevated risk, but the evidence suggests social isolation matters most. Exposure and sensitivity raise the chance that an older person becomes ill in the heat; isolation decides whether anyone notices in time. In the Chicago case-control study, living alone and not leaving home were among the strongest predictors of death, while social contacts were protective (Semenza et al., 1996). In Portsmouth's most vulnerable tracts, an estimated 900 older adults live alone, many without a car. Any plan to reduce heat deaths here should start with finding and checking on them.

References

Agency for Toxic Substances and Disease Registry. (2024). CDC/ATSDR Social Vulnerability Index 2022 database, Ohio [Data set]. Centers for Disease Control and Prevention. https://www.atsdr.cdc.gov/place-health/php/svi/

Centers for Disease Control and Prevention. (n.d.). Heat and health tracker. https://ephtracking.cdc.gov/Applications/HeatTracker/

Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, census tract data, 2025 release [Data set]. https://data.cdc.gov/d/cwsq-ngmh

Flanagan, B. E., Gregory, E. W., Hallisey, E. J., Heitgerd, J. L., & Lewis, B. (2011). A social vulnerability index for disaster management. Journal of Homeland Security and Emergency Management, 8(1), Article 3. https://doi.org/10.2202/1547-7355.1792

Kenny, G. P., Yardley, J., Brown, C., Sigal, R. J., & Jay, O. (2010). Heat stress in older individuals and patients with common chronic diseases. Canadian Medical Association Journal, 182(10), 1053-1060. https://doi.org/10.1503/cmaj.081050

Semenza, J. C., Rubin, C. H., Falter, K. H., Selanikio, J. D., Flanders, W. D., Howe, H. L., & Wilhelm, J. L. (1996). Heat-related deaths during the July 1995 heat wave in Chicago. New England Journal of Medicine, 335(2), 84-90. https://doi.org/10.1056/NEJM199607113350203

U.S. Census Bureau. (2025). American Community Survey 5-year estimates, 2020-2024 [Data set]. https://data.census.gov/

Wilhelmi, O. V., & Hayden, M. H. (2010). Connecting people and place: A new framework for reducing urban vulnerability to extreme heat. Environmental Research Letters, 5(1), Article 014021. https://doi.org/10.1088/1748-9326/5/1/014021