Pamela B. Teaster

Relocation is an option for older adults who leave their home to improve their emotional well-being, physical health, and safety. Moves can enhance agency or foster a loss of empowerment. We explored older adults’ transition experiences from a community setting to a retirement community and created messaging to help with experiences of older adults and their self-identified family or friend caregivers. We conducted 30 telephone interviews and analyzed relocation experiences, which informed I Did It My Way Theatre. The theatrical presentation was performed for over 100 older adult residents and caregivers. Our goal was to ease the transition experiences by disseminating findings to those involved in similar relocation situations. Attendees completed a post-performance questionnaire asking how the play helped them understand relocation and held table discussions concerning production themes. Follow-up interviews with 11 participants revealed that the play delivered hard messages in an impactful way.

Background/Objectives: Interdisciplinary research teams that include critical disability studies (CDS) scholars and Healthcare and Medical Researchers have the potential to investigate complex lived experiences and explore new opportunities to best serve disabled communities. However, individuals in these fields typically approach disability research in different ways. Throughout this manuscript, we refer to a hypothetical interdisciplinary research team as an example of how to integrate the questions, challenges, and possibilities into practice when joining CDS and Healthcare and Medical Research. Discussion: First, we raise three large and complex questions that researchers must address (and discuss) when conducting disability research: (a) what is (a) disability, (b) what does it mean to live with a disability, and (c) who is included in research samples/as research participants for disability research? Then, we discuss the colliding and harmful relationship history between CDS and Healthcare and Medical Research fields, and the continued oppositional training of professionals in both fields. Finally, we offer insights into how collaborative efforts and methods of interdisciplinary research teams can optimize success when tackling complex research questions to serve disabled communities. Conclusions: We suggest approaches for projects at the intersection of CDS and Healthcare and Medical Research: holistic, person-centered research, treating individuals in the disability community as experts, and collaborating with the community while conducting research. This manuscript serves as a starting point for researcher teams looking to conduct ethical, rigorous, and trustworthy research at the intersection of health, medicine, and disability.

Physician Orders for Life-Sustaining Treatment (POLST) arose in 1991 to improve end-of life-care for patients with advanced, chronic, and progressive illnesses whose death is imminent within a year. POLST attempted to address problems inherent in advance directives (e.g., poor completion rates, confusing form language, dismal communication with a surrogate). POLST exists in all U.S. states, although each is unique and uptake is inconsistent, particularly in rural areas. The purpose of this study was to investigate current practices and barriers around POLST in a rural area using an online survey and interviews with practitioners. A total of 101 people responded to the survey, and 20 participated in interviews. Findings included the need for consistent funding, clarification of goals, and greater and varied opportunities for staff training. Also important was establishing strong support for POLST within healthcare entities, physician and community support, identification of champions, and research evaluating processes and patient outcomes.

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.

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.