Home and Community Care Digest

Home and Community Care Digest September 2005 : 0-0

Risk factors for potentially harmful informal caregiver behaviour


Unpaid caregivers and their care recipients were questioned about harmful behaviours directed towards the care recipient such as screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food. Higher levels of functional dependence, being a spouse of the caregiver, and poor caregiver health status were found to increase the likelihood of harmful caregiver behaviour towards care recipients. Possible applications include the identification and mediation of the risk of harmful caregiver behaviour.

Background: Unpaid caregivers caring for ill family members are at risk of compromised physical and mental health, and even higher risk of mortality. Some caregivers subject their care recipients to mental and physical abuse such as yelling, swearing, threats of abandonment or nursing home placement, and physical force. Most studies in the past have focused on abuse cases that have required the intervention of a service agency. This study is unique because it examines whether health status of the unpaid caregivers and care recipients might be risk factors for harmful behaviours towards the care recipients.

Methods: Participants were recruited from Georgia, Pennsylvania, and Texas in the United States. Eligible participants were caregivers who cared for a family member living in the same community. Care recipients had to living in the community and be older than 60 years of age. The caregiver had to be the primary person responsible for the care of the elderly individual and have provided unpaid assistance with an activity of daily living, such as eating and dressing, and/or an instrumental activity of daily living, such as shopping or banking. Caregivers and care recipients were interviewed in separate rooms at the same time in the respondent's home. The interviewers assessed the health status (e.g., cognitive and selfrated health) of both participants. The caregiver's physical symptoms, depression symptoms, and amount of help they provided were measured. The care recipient's need for care was also assessed. Caregivers and care recipients were questioned about potentially harmful behaviour by the caregiver including: 1) screaming; 2) threatening with nursing home placement / abandonment / physical force; 3) verbal abuse; 4) withholding food; 5) hitting; and 6) shaking. Each participant was asked how frequently these behaviours occurred.

Findings: Spousal caregivers were eight times more likely to engage in potentially harmful behaviour than non-spousal caregivers. Greater functional dependence of the care recipient led to a small increase in the likelihood of harmful behaviour. Increased levels of caregiver cognitive impairment, physical symptoms, and depression increased the likelihood of harmful behaviour towards their care recipient. There were 265 pairs of participants in the study. The care recipients in the study were approximately 77 years old on average and nearly 60% were women. The caregivers' average age was 63 years old and 77% were women. The majority of caregivers and care recipients were Caucasian. Half of the caregivers in the study were spouses, a third were adult children, and the remaining caregivers were other family members or friends.

Conclusions: This study identifies several risk factors that increase the likelihood of potentially harmful caregiver behaviour. The risk factors can be used to identify caregivers at increased risk of potentially harmful behaviour towards their care recipients. These individuals should receive extra support and resources to ensure that the care recipient can continue to stay in the community without an increased risk of abuse. Elderly people cared for by depressed older spouses appear to be at particular risk for abusive behaviour and might represent an appropriate target for intervention efforts. Home care agencies can arrange for the caregiver to attend support groups, provide family counselling, behaviour modification programs, or provide more formal care to decrease the burden of care giving and the potential for abuse towards care recipients. Possible applications of such findings include the identification and mediation of the risk of harmful caregiver behaviour.

Reference: Beach, SR, Schulz, R, Williamson, GM, Miller, LS, Weiner, MF, Lance, CE. "Risk Factors for Potentially Harmful Informal Caregiver Behavior." Journal of the American Geriatric Society, 2005, 53: 255-261.


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