Objective Assess family caregivers’ primary appraisal of stressors related to COVID-19 stay-at-home orders, secondary appraisal of resources and support availability, and use of coping strategies as predictors of perceived role overload during the stay-at-home phase of the pandemic. Method Telephone interviews with 53 family caregivers of persons with dementia from rural Virginia two weeks after enactment of the governor’s stay-at-home order using structured and open-ended questions. Results Caregivers who were more concerned about the COVID-19 pandemic were at greater odds of experiencing high role overload than those who recognized positive aspects of the pandemic, as were those who received insufficient support from family and friends. Discussion Use of the transactional model of stress responses yielded important insights about families coping with dementia. Caregivers’ perceptions of the pandemic’s impact varied, with differential effects on their well-being.

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Older adults are negatively affected by the national opioid crisis, including being victims of abuse by family members and trusted others who struggle with opioid addiction. This study explored ways in which opioid misuse underlies substantiated Adult Protective Services cases of elder abuse in rural Central Appalachia, a region that has been particularly hard hit by the opioid crisis. Using an intersectionality theoretical lens, we analyzed 25 opioid-related elder abuse cases from de-identified data records for substantiated abuse cases of persons aged 60 and older in 13 counties comprising Kentucky's Eastern Mountain Service Region. Descriptive data and case notes were extracted from the records. We conducted a content analysis of the case notes, using open and focused coding strategies, to identify common themes. Twenty-one of the older victims of opioid-related abuse were women. Men and women were equally likely to be perpetrators. Two major themes emerged from the analysis: Patterns of Substantiation and Facets of Dependency. Cases frequently involved community dwelling older women as victims of abuse and nonspousal family members as perpetrators. In all cases, exploitation was the primary form of abuse substantiated. Findings suggest that opioid-related elder abuse cases are complex, with family loyalties and interdependences influencing how the cases played out. Practitioners are encouraged to take into consideration cultural norms and close relationships with extended family in the development of education and treatment program for addressing abuse within the context of opioid addiction. Public Health Significance StatementThis study suggests that older adults who are prescribed opioids may be particularly vulnerable to exploitation and neglect by family members with histories of substance abuse and who are often being supported by their aging parents. Efforts to address the opioid epidemic must consider how prevention and intervention practices, which often focuses on individual users could also benefit and protect vulnerable older adults.

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Most family caregivers provide appropriate care and a supportive environment for their older relatives with dementia (PwD), yet the stress and strain associated with caregiving can trigger potentially harmful responses. Although much has been written about dealing with memory problems, researchers know less about how caregivers cope with difficult behaviors such as hallucinations, violent outbursts, or refusing food, medicine, or bathing. Interviews with 30 relatives providing care to community-dwelling PwD in rural Virginia revealed that caregivers typically used four behavior management strategies: reasoning with PwD; redirecting PwD’s attention; forceful actions, such as shouting at PwD; and withdrawing from interactions. Forceful management strategies and withdrawing from interactions were usually employed after reasoning and redirection failed to elicit desired behavior. Understanding whether caregivers’ expectations of PwD’s capacities are realistic, and why and when caregivers use various behavior management strategies, can help service providers develop appropriate educational interventions for frustrated caregivers.