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

Health and Mental Health Services

Health and mental health professionals play important roles in identifying abuse. They can evaluate the plausibility of the explanation victims or abusers give for injuries, screen for other problems, and treat injuries or health problems resulting from abuse.

Assessments of abusers also are necessary to determine if they pose a danger to others and need treatment. For more assessment information, see Module 4.

It is important to assess receptivity to intervention before developing a plan. One study suggests receptivity to intervention can be assessed along a continuum of three stages -- from reluctance to recognition to acceptance.ref

Stage 1 -- Reluctance

• Victim has not acknowledged abuse.
• Victim has tremendous denial, self-blame, and ambivalence.
• Victim is extremely isolated.

Stage 2 -- Recognition

• Victim recognizes seriousness and complexity of abuse.
• Victim has decreased denial and self-blame, but is still ambivalent.
• Victim recognizes need for help from outside individual.

Stage 3 -- Acceptance

• Victim seeks a change in the situation and a reshaping of self-identity.
• Victim has diminished self-blame.
• Victim wants to develop a support system.

Crucial to successful intervention is assessing how receptive the older adult victim is to accepting help. Establishing rapport with the older adult and knowing how much information to give at the time are key. Mental health professionals or family physicians can provide counseling for older adult victims to help them overcome feelings of denial, isolation, guilt, and self-blame. They can provide information or referral to emergency assistance, housing alternatives, financial services, or Adult Protective Services. Suspected victims also may need information concerning access to the police, courts, the criminal justice system, and advocacy services. ref

Private therapists, health maintenance organizations, or mental health clinics may provide individual, couple, family, or group counseling. In abuse cases, counseling typically focuses on:

• Educating victims about resources and options
• Breaking through denial and shame
• Safety planning (planning what to do if abuse occurs)
• Building support networks
• Addressing codependency for substance abuse problems
• Addressing traumatic or posttraumatic stress

In some cases, counseling may involve psychiatric treatment and medical assessment or institutionalization. Abusers who may depend on their victims for money or housing can benefit from vocational counseling or job placement programs. Educational groups teach abusers alternatives to violence.