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

Barriers to Identifying Elder Abuse

It can be challenging to identify elder abuse because of the complexity and dynamics of the relationships that often are involved. The following are some of the many barriers that exist on the part of the health care provider and victim:

Provider Barriers

• Lack of Knowledge and Training About Signs of Elder Abuse and How To Report It -- Due to the hidden nature of elder mistreatment, many medical providers lack up-to-date training on the available screening tools and protocols for diagnosis, intervention, treatment, and reporting.
• Disbelief and Discomfort -- Health practitioners may have long-standing relationships with the victim and perpetrator. When this is the case, disbelief may overshadow the warning signs, or the discomfort in confronting the patient may be overwhelming.
• Reluctance To Report Abuse -- Health providers may be reluctant to report abuse due to fear of the unknown, feelings of helplessness to protect the patient, or belief that reporting against a patient's wishes may destroy the doctor-patient relationship or increase the violence.
• Ageism -- Some may believe the functional or cognitive decline due to aging is inevitable, or simply have an unfavorable attitude toward older adults.ref
• Signs of Abuse Mimic Signs of Aging or Chronic Disease -- Dehydration, confusion, or impaired mobility can be symptoms of a chronic medical condition or signs of aging. However, these same signs can indicate physical or emotional abuse or neglect. Without proper screening for elder abuse, alcohol and medication misuse, or depression, it is impossible to determine the root cause of these symptoms.

Collecting information from an older adult may require patience, tact, belief, discretion, and the ability to create trust. ref This is a challenge for health and mental health professionals who often have large caseloads, limited time, and inadequate resources.

Screening Tips provide suggestions to help professionals discuss difficult issues with older adults.