Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Victim Barriers

• Cognitive Challenges -- Older adults may seem confused, which can disguise the signs of abuse. The confusion can be the result of abuse or cognitive decline due to aging, medication side effects, or chronic disease.
• Fear -- Victims of abuse often are reluctant to report the abuse for fear of retaliation, punishment, abandonment, or institutionalization by the abuser. This fear may cause the victim to minimize or negate the effects of the abuse.
• Stigma -- Elder mistreatment, much like other forms of family violence, often results in feelings of shame, guilt, and denial. Some feel at fault, making it less likely for them to divulge the abuse to a health provider or mental health professional. When substance abuse is a factor in the abuse, strong denial of both problems creates challenges.
• Cultural Factors -- Cultural beliefs, attitudes, values, and traditions can strongly influence how elder abuse is perceived and manifested and how an individual or family responds to it. Culture determines how families make decisions, how problems are defined, and how and when they seek help.ref Thus, what one family might define as abuse, another might see as a traditional family role. This complicates the problem of identifying abuse and assessing appropriate intervention.
• Dependence -- Despite the abuse, the victim may depend on the abuser for physical care, food, and financial assistance. Particularly when a family member perpetrates the abuse, the older adult often displays loyalty to the abuser, jeopardizing his or her health and well-being.ref In situations in which the abuser depends on the older adult (e.g., an adult child with mental health or substance abuse problems) neither the victim nor the abuser is likely to report the abuse.
• Substance Abuse and Codependence -- The substance abuser is likely to mistrust or resist any offer of assistance or outside services. A codependent family member may rationalize or minimize the problems caused by substance abuse or resulting violence, or even take responsibility for it.
• Autonomy and Self-Determination -- In elder abuse cases, a conflict often exists between protecting a client's health and safety and preserving the client's right to autonomy and self-determination. Adults have the right to make decisions about their lives without unwanted interference.ref This can be a delicate issue with older adults with cognitive decline or those with potential indicators of abuse.
• Isolation -- Physical and social isolation are a common problem for older adults. This isolation may increase with escalating violence, making it difficult to identify the abuse.