Family Ties and Opioid Lies: Pathways to Elder Abuse in Rural Appalachia.

Background and objectives: The opioid crisis has run rampant throughout America, with communities in rural Appalachia especially hard hit. While the direct effects of opioid use disorder on individuals, families, and communities are well documented, an unforeseen consequence of this crisis is the abuse of older adults by family members or paid caregivers with opioid addiction. The purpose of this study was to characterize cases of opioid-involved elder abuse compared to cases where opioids were not involved.

Research design and methods: Guided by lifecourse and ecological perspectives, we analyzed quantitative case data and narrative notes for 220 substantiated incidences of abuse of persons aged 60+ that occurred between 2015 and 2017 in eastern Kentucky. Multinomial logistic regression analysis with robust standard errors was used to compare cases on key variables including the older adults' age, gender, income, activities of daily livings/instrumental activities of daily livings, and cognitive capacity. Composite narratives developed from thematic analysis of the case notes were used to contextualize opioid-involved elder abuse cases.

Results: We found 25 opioid-involved cases of elder abuse and 15 cases in which the perpetrator used alcohol/other drugs. Compared to cases not involving substance abuse, women were more frequently victims of perpetrators who use opioids and alcohol/other drugs. Victims of opioid-involved abuse were more likely to experience material exploitation (stealing medication) than when perpetrators misused alcohol/other drugs or used no substances. A primary pathway to elder abuse was older adults taking in a family member due to various life circumstances. A second pathway to opioid-involved abuse was when older adults relied on the perpetrator for support and assistance.

Discussion and implications: Opioid misuse by perpetrators heightened susceptibility to elder abuse. Older adults are often protective of their struggling families and may not recognize their own vulnerabilities. Interventions sensitive to cultural norms and close family relationships are needed to combat opioid-involved elder abuse.