The effect of carers' healthcare practices on the categorization of elderly patients as vulnerable

Purpose: The purpose of this paper is to show that the categorization of elderly patients as vulnerable is affected by health-care service interactions with caregivers, which may increase, reduce or even negate entirely elderly patients' vulnerable status. Design/methodology/approach: The paper reports the results of a qualitative study based on in-depth interviews conducted with a large and varied sample of health-care personnel in charge of elderly patients in two hospital geriatric departments in France. Findings: Findings show that the limits of the service-dominant logic approach when the service (care) relationship concerns vulnerable individuals who are, completely or partially, unable to take part in the co-creation of the service and the roles played by caregivers as resource integrators (intermediaries, facilitatorapomediaries and transformativeapomediaries) and that this affects the categorization of elderly patients as vulnerable. Research limitations/implications: The results enrich knowledge about the service relationship with vulnerable people by showing that the categorization of elderly patients as vulnerable is not immutable but stems from the dynamics among actors that may variously "reify it" (contribute to its internalization), "reduce it" (enable access to aspects of normal life), or "neutralize it" (help free this cohort from their categorization as vulnerable). Practical implications: The findings provide insights for care providers by stressing the need to raise awareness among hospital staff regarding their active role in affecting the categorization of elderly patients as vulnerable through their care practices. In the context of public health policies, the findings show that the regulatory injunction to empower patients to preserve their well-being tends to produce the opposite effect on the frailest patients, who are unable to participate in their care pathway. Originality/value: The research shows that categorization as vulnerable, in the health-care services context, is affected by the care interactions between caregivers and elderly patients. The support provided to hospital staff in this context helps to maintain patients' well-being and dignity.