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

Understanding Risk Factors for Abuse

Effective responses are needed to address the causes of elder abuse, regardless of the setting and circumstance. To find effective methods of treatment and prevention, health and mental health practitioners need to understand which factors put older people at risk. Decreasing risk factors and, conversely, increasing protective factors to make older people less vulnerable are important steps in addressing the hidden problem of elder abuse.

Recognizing the context of the relationships in which elder abuse occurs also is important. Elder abuse experts have found that the characteristics within the caregiver are better predictors of elder abuse than are victim characteristics. Emphasis must be put on changing the dynamics of the relationship to ensure behaviors of the perpetrator are addressed. To guard against "blaming the victim," it is important to hold abusers accountable and to address situational factors conducive to abuse.

Aging-associated vulnerabilities, such as decreased physical or mental faculties or reduced social contacts, may increase the risk of elder abuse, neglect, or self-neglect. As with other forms of violence, one of the most common factors putting older people at risk is the victim's or perpetrator's abuse of alcohol or other substances. The National Committee for the Prevention of Elder Abuse identifies substance abuse as the most frequently cited risk factor associated with elder abuse and neglect. Substance use may impact the problem in several ways:

• An older person who abuses substances may self-neglect, endangering her/his health and well-being.
• An older person may have physical or cognitive impairments resulting from substance abuse that make him or her dependent on others and vulnerable to exploitation.
• Family members who abuse substances may try to gain access to an older relative's home or other resources.
• Substances may be used to control the victim through over- or undermedication.
• Caregivers may try to cope with the demands of providing care by using drugs or alcohol.
• If the caregiver is a spouse, substance abuse can increase the likelihood of intimate partner violence. Problem drinking in men increases the chance of partner abuse eightfold. ref

A major problem in addressing an older person's substance abuse is that the signs of alcohol abuse mirror symptoms of other diseases and chronic conditions associated with aging. Alcohol use also may mask signs of trauma (e.g., confusion may be caused by victimization, dementia, or substance abuse). Family members and many health and mental health care professionals often have difficulty identifying substance abuse among older adults, which hinders assistance.

Not all seniors who use alcohol are at risk for elder abuse. Likewise, substance abuse does not always play a part in elder abuse situations. Elder abuse is a complex problem involving a range of factors.