Is abusive behaviour a consequence of carer distress?
Lead Research Organisation:
University College London
Department Name: Mental Health Sciences
Abstract
In previous research, a quarter of caregivers of older people were willing to report actions that would be defined as abusive, although they may be unaware their behaviours could be seen in this light. This number is doubled in cases involving dementia. Preliminary studies suggest these caregivers are the most anxious and depressed. My pilot study found family caregivers of people with dementia were more burdened if caring for people with more behavioural problems. Greater burden was associated with unhelpful coping strategies, anxiety and depression.
My study aims to determine whether anxious or depressed family caregivers of those with dementia are more likely to report abusive behaviour towards care recipients, and how caregiver burden, coping strategies and care recipient neuropsychiatric symptoms influence this. Secondly I will determine whether more care recipients experiencing abusive behaviours are institutionalised a year later. Interviews with 220 such caregivers of people referred to psychiatric services will include quantitative measures of these factors. We have consulted carers locally and nationally during the study development, particularly because of the distressing nature of the topic. Knowing more about risks associated with potentially abusive caregiver behaviour will enable development of early preventative interventions to help caregivers and care recipients.
My study aims to determine whether anxious or depressed family caregivers of those with dementia are more likely to report abusive behaviour towards care recipients, and how caregiver burden, coping strategies and care recipient neuropsychiatric symptoms influence this. Secondly I will determine whether more care recipients experiencing abusive behaviours are institutionalised a year later. Interviews with 220 such caregivers of people referred to psychiatric services will include quantitative measures of these factors. We have consulted carers locally and nationally during the study development, particularly because of the distressing nature of the topic. Knowing more about risks associated with potentially abusive caregiver behaviour will enable development of early preventative interventions to help caregivers and care recipients.
Technical Summary
Background: In previous research, a quarter of caregivers of elders have been willing to report actions that would be defined as abusive, although they may not be aware their behaviours could be seen in this light. This number is doubled in dementia. We do not know what leads some caregivers to behave abusively towards people with dementia while others manage with the difficulties, but preliminary studies suggest these caregivers may be the most anxious and depressed. My pilot study found that i) caregivers for people with more neuropsychiatric symptoms experience higher levels of caregiver burden, and ii) those with greater burden, who also use dysfunctional coping strategies are the most likely to be anxious and depressed. My main study hypothesis is that anxious or depressed caregivers are more likely to act towards their CR in ways considered abusive. As this study tackles a topic which is difficult and potentially distressing, we have consulted carers locally and nationally during its development.
Objectives:
1. To test my hypothesis that psychologically distressed caregivers of people with dementia are more likely to report significant physical and psychological abusive behaviours towards the person they care for than carers who are not distressed, and the effect of potential mediators and confounders, including caregiver burden, coping strategies and CR neuropsychiatric symptoms.
2. To determine prospectively whether abusive behaviours reported by caregivers are associated with institutionalisation of the CR within a year, taking into account possible demographic and morbidity based confounders.
Methods: I shall recruit 220 consecutive primary family caregivers of people referred to four Community Mental Health Teams and living in the community at the time of dementia diagnosis. Caregiver interview will include the modified Conflict Tactics Scale, to measure caregiver reports of abuse towards CRs; the Hospital Anxiety and Depression Scale, Zarit Burden scale, the COPE as a measure of coping strategies and caregiver reports of CR impairments in activities of daily living, cognition and neuropsychiatric symptoms. I shall also record demographic factors; caregiver psychiatric history; caregiving duration and hours of care per week; and CR service receipt. I shall record whether the CR is institutionalised in the subsequent year.
Opportunities: Knowing more about the associated risks of caregiver behaviour which may be abusive will enable development of early preventative interventions to help caregivers and care receivers. It will advance my training and research links and enhance the research portfolio of the proposed department.
Objectives:
1. To test my hypothesis that psychologically distressed caregivers of people with dementia are more likely to report significant physical and psychological abusive behaviours towards the person they care for than carers who are not distressed, and the effect of potential mediators and confounders, including caregiver burden, coping strategies and CR neuropsychiatric symptoms.
2. To determine prospectively whether abusive behaviours reported by caregivers are associated with institutionalisation of the CR within a year, taking into account possible demographic and morbidity based confounders.
Methods: I shall recruit 220 consecutive primary family caregivers of people referred to four Community Mental Health Teams and living in the community at the time of dementia diagnosis. Caregiver interview will include the modified Conflict Tactics Scale, to measure caregiver reports of abuse towards CRs; the Hospital Anxiety and Depression Scale, Zarit Burden scale, the COPE as a measure of coping strategies and caregiver reports of CR impairments in activities of daily living, cognition and neuropsychiatric symptoms. I shall also record demographic factors; caregiver psychiatric history; caregiving duration and hours of care per week; and CR service receipt. I shall record whether the CR is institutionalised in the subsequent year.
Opportunities: Knowing more about the associated risks of caregiver behaviour which may be abusive will enable development of early preventative interventions to help caregivers and care receivers. It will advance my training and research links and enhance the research portfolio of the proposed department.
