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Intersection of substance abuse and addiction with elder abuse and neglect

March 17, 2020

By Guest Writer Diana Spore, PhD, MGS

This is the fifth in a series of blogs from Dr. Spore about the importance of the Adult Advocacy Centers’ work.

Two elderly hands sort pills into a pill organizerThe Adult Advocacy Centers’ Model emphasizes a multi-disciplinary team approach, forging alliances with other agencies and providers that serve individuals who have been victimized. The Adult Advocacy Centers aim to provide a one-stop destination for the process of investigation, prosecution and treatment of adults with disabilities who have been victims of crime. This process is designed to be taken without long delays, while also preserving safety. Complex issues may come to the forefront as the process is implemented. For example, “How do we balance the dichotomy of rights versus safety? Does it have to be a dichotomy?” The Adult Advocacy Centers acknowledge the rights of seniors with disabilities who are competent, who have not been found to be incompetent in the legal system.

One common characteristic of those who are perpetrators of elder abuse and neglect is current substance abuse. Also, seniors are at risk of being victimized if they misuse, overuse or abuse addictive medications. Drug addiction among seniors is becoming more prevalent, resulting in costly hospitalizations and emergency room visits, physical disability and mortality. There are serious ramifications associated with substance abuse and addiction for elders, beyond increasing their risk of financial exploitation.

While Adult Protective Services’ staff investigate and track cases of alleged abuse, they are not required to note if victimization is associated with abuse of opioids or any other addictive substances. Therefore, we do not know the actual scope of the problem at state or national levels. We only truly know that the substance abuse intersection with elder abuse is affecting a larger number of elderly individuals, particularly since our nation is aging and facing an opioid epidemic. This connection has financial implications at multiple levels.

Risks of Abuse, Neglect, and Exploitation

Seniors who have disabilities are at risk of being victimized by relatives who are addicts, particularly when dwelling in the same home. The risks are especially high when disabilities are linked with dementia, marked cognitive impairment or mental illness.

Elder abuse experts, researchers, practitioners and policy makers have been focusing more on the risks of financial exploitation. These vulnerable older adults with disabilities are at risk of being manipulated to change their wills and designate a power-of-attorney, to sign over major assets (most notably, their homes) to family members who are addicted, to lose all life savings or to have personal property pawned by addicts to purchase drugs. Because they have income from their pensions or Social Security benefits, seniors with disabilities are easy targets for emotional abuse (e.g., not being allowed to have friends visit or to have telephone services, being socially isolated) as well as for financial exploitation. When they refuse to give their abuser money or access to assets, seniors may be abused physically and neglected. Adult children who are addicted may use seniors’ homes as sites for manufacturing and selling drugs. They may also use pain drugs that have been prescribed to seniors, adversely affecting a senior’s quality of life.

Additionally, overuse of and addiction to powerful painkillers can make it difficult for seniors to make sound decisions and care for themselves well. This can put these seniors at high risk of falling for scams, and they may move toward serious and life-threatening self-neglect. Seniors with disabilities are susceptible to undue influence and isolation, and they may fear being placed in a nursing home and losing what may be minimal independence or sense of control.

Vision of the Adult Advocacy Centers

The Adult Advocacy Centers prioritize the need for collaborative relationships between agencies and providers that serve seniors with disabilities facing abuse, neglect and exploitation by family members who are addicted. The AACs Model promotes training and education for mandated reporters who are in a position to recognize “red flags.” Those seniors who have been victimized are unlikely to report their abuse due to lack of awareness, cognitive impairment, fear, guilt and isolation. Education efforts can increase the community’s awareness of these issues. As our nation ages and the opioid epidemic rages on, the intersection between elder abuse and substance abuse will come to light to a greater extent. Our system then will be driven to serve more individuals who have been exploited and abused. All stakeholders will become more cognizant of the potential ramifications through education, training, and advocacy efforts by the Adult Advocacy Centers.

Diana Spore is an advocate for individuals facing mental health challenges and those who are living with dementia, a writer/editor, and a mental health consumer in recovery. Spore received her Master’s degree in Gerontological Studies from Miami University (Ohio), and earned a PhD in Human Development and Family Studies, with a concentration in aging, from Penn State. She completed postdoctoral training at Brown University. Spore’s areas of expertise include mental health and aging, mental health recovery and trauma-informed care, medication optimization, long-term care, caregiving, and psychotropic drug use and inappropriate drug use among older adults. She is a former Board member of the Mental Health and Recovery Board of Ashland County (Ohio; MHRB). She was Editor-of-Chief of TAPESTRY OF OUR LIVES, an anthology of works created by individuals in recovery, a project that was done under the auspices of the MHRB. Spore served as Project Lead for a “Writing for Recovery” initiative, MHRB, and engaged in all aspects of the project, which has resulted in sustained spin-off efforts. Currently, she is a consultant at the MHRB, and serves as a facilitator of a “writing for recovery” writing group, which is under the auspices of Catholic Charities’ Pathways Peer Support Program, Ashland. Diana Spore has expertise in creative writing, writing for recovery, journaling for caregivers, legacy writing, and advocacy writing.