As recent contests indicate, a handful of voters can decide an election.

According to CNN, out of nearly 15 million votes cast on Super Tuesday, Democratic presidential candidates Hillary Clinton and Barack Obama were separated by just 0.4 percent.

Older Americans are routinely the largest voting age group, and, as a whole, can therefore affect election outcomes. On Super Tuesday, this group comprised a hefty 28 percent of the electorate, according to CBS News.

But Jason Karlawish, associate professor of Medicine and Medical Ethics at Penn’s School of Medicine, says a large portion of this bloc is ignored each election season—the disabled and infirmed elderly.

Karlawish, a member of Penn’s Institute on Aging, conducted a study of voting in long-term care facilities. His research has roots in the disputed 2000 presidential election. After the Florida incident, he overhead persistent chatter blaming the “old people of Florida” for “not thinking clearly.”

“I just started to look into the issues of, ‘Do the elderly actually vote? If so, how do they vote?’ Especially the elderly with cognitive disabilities,” he says. “The more I asked those questions, the less I knew I could answer them.”

A group of experts in law, voting rights, voting practices, medicine, psychiatry, and long-term care assisted Karlawish with the study. What they found was that many elderly voters rely on others to exercise their right to vote, leaving them susceptible to fraud.

Karlawish pointed to America’s convoluted voting system as a cause of the problem. “Voting in this country is actually run by everyone and, therefore, kind of run by no one,” he says. “What I mean by that is the federal government largely delegates to the states how they are going to run elections. The states, in turn, oftentimes delegate it to the counties, and the counties may then delegate it to the towns and the cities. So what you have is a very decentralized system with no kind of overarching organization.

“I think the other issue is a deeper one, which is that society has a lot of problems in how we value the elderly, specifically the disabled elderly,” he adds. “I think looking at this voting issue makes us confront how much we respect them and the people they are. So I think that’s why it’s kind of been ignored.”

Federal law requires access to the ballots for people with disabilities but these laws are often under-funded and not enforced. Karlawish says the Office of Inspector General and other federal surveys have shown that a substantial number of polling places still remain inaccessible to the handicapped.

Absentee voting, he says, is not a sufficient alternative because the elderly often need assistance in completing the ballots. “Almost all of the sites said that at least two-thirds of people, if not the majority, needed help doing their absentee ballots,” he says. “And then you have to trust that that person’s going to hand it in.”

In testimony before the U.S. Senate Special Committee on Aging, Karlawish recommended that the U.S. develop a model for mobile polling. Under this format, election officials would visit long-term facilities prior to registration deadlines and ask for registrations. Ballots would be directly distributed to long-term facility populations, who would be assisted with voting, and their ballots returned to the polling place.

“I think this is a non-partisan issue,” Karlawish says. “If you look at what’s happening in America, like other Western nations, you know someone who’s old and you know someone who’s trying to take care of someone who’s old. [There’s] quite a bit of empathy for these issues that resonate with [people].”

States such as Maryland and countries such as Canada or Australia can serve as models on how to better serve elderly voters, Karlawish says. “I don’t think a lot more research is needed to figure out what to do, it’s just a question of looking at what the best practices are and then implementing them and seeing how well they work.”