Elder Abuse and the Opioid Epidemic: Evidence From APS Cases in Central Appalachia

• Published in: Journal of rural mental health 2022-01, Vol.46 (1), p.50-62
• Main Authors: Roberto, Karen A., McCann, Brandy Renee, Teaster, Pamela B., Hoyt, Emily
• Format: Article
• Language: English
• Subjects: Elder Abuse; Epidemics; Family Members; Female; Human; Male; Older Adulthood; Opiates; Perpetrators; Rural Environments; Rural Health
• ISSN: 1935-942X; 2163-8969
• DOI: 10.1037/rmh0000181

Older adults are negatively affected by the national opioid crisis, including being victims of abuse by family members and trusted others who struggle with opioid addiction. This study explored ways in which opioid misuse underlies substantiated Adult Protective Services cases of elder abuse in rural Central Appalachia, a region that has been particularly hard hit by the opioid crisis. Using an intersectionality theoretical lens, we analyzed 25 opioid-related elder abuse cases from de-identified data records for substantiated abuse cases of persons aged 60 and older in 13 counties comprising Kentucky's Eastern Mountain Service Region. Descriptive data and case notes were extracted from the records. We conducted a content analysis of the case notes, using open and focused coding strategies, to identify common themes. Twenty-one of the older victims of opioid-related abuse were women. Men and women were equally likely to be perpetrators. Two major themes emerged from the analysis: Patterns of Substantiation and Facets of Dependency. Cases frequently involved community dwelling older women as victims of abuse and nonspousal family members as perpetrators. In all cases, exploitation was the primary form of abuse substantiated. Findings suggest that opioid-related elder abuse cases are complex, with family loyalties and interdependences influencing how the cases played out. Practitioners are encouraged to take into consideration cultural norms and close relationships with extended family in the development of education and treatment program for addressing abuse within the context of opioid addiction. Public Health Significance Statement This study suggests that older adults who are prescribed opioids may be particularly vulnerable to exploitation and neglect by family members with histories of substance abuse and who are often being supported by their aging parents. Efforts to address the opioid epidemic must consider how prevention and intervention practices, which often focuses on individual users could also benefit and protect vulnerable older adults.