Opioid-Involved Elder Abuse in the United States: Perspectives from Adult Protective Services

The purpose of this descriptive study was to understand the nature, extent, and challenges confronted by APS programs in the United States in providing services to older clients affected by opioids. The study design involved a two-step process: Phase I involved telephone interviews with state-level Adult Protective Services administrators from 11 states considered to be “hot-bed states” for the opioid epidemic. Findings from the administrator interviews informed questions for Phase II telephone interviews with individual and small groups of local APS workers from the same states. Key findings that emerged from the interviews indicated that when opioids were involved in cases of elder abuse, allegations most often concerned self-neglect, followed by caretaker neglect and facility drug diversion. Perpetrators of opioid-involved abuse were mostly family members followed by facility staff; and cases involving opioids were perceived as harder to substantiate due to the difficulty of proving if and how medication was missing and the denial of the older victim if the perpetrator was a family member. The inability of older adults to manage medications prescribed to them was the most common explanation of how they became victims of opioid abuse. Improvements to intervention for cases involving opioids include giving APS the ability to perform background checks, more frequent use of electronic medical boxes for appropriate and timely dispensing of medications, holding perpetrators accountable to timeframes, and policies to facilitate greater access and trust of APS. In addition, working with community partners was a critical component to maximally helping older adults involved with opioid misuse. APS field staff stressed that available resources were inadequate for the complexities involved in working cases involving opioids and older adults, highlighting needs for greater financial assistance, enhanced and targeted training, specialists in addiction, and resources for homeless people.