The determinants of family carers' abusive behaviour to people with dementia: results of the CARD study

J Affect Disord. 2010 Feb;121(1-2):136-42. doi: 10.1016/j.jad.2009.05.001. Epub 2009 May 17.


Background: Although dementia and elder abuse prevention are political priorities, there are no evidence-based interventions to reduce abuse by family carers. We have limited understanding of why some family carers, but not others in similar circumstances, behave abusively. We aimed to test our hypothesis, that more anxious dementia carers report more abusive behaviours, and dysfunctional coping strategies and carer burden mediate this relationship.

Method: We interviewed 220 family/friend dementia carers from Essex and London Community Mental Health Teams. We used the revised Modified Conflict Tactics Scale to measure abuse.

Results: More anxious and depressed carers reported more abuse; this relationship was mediated by using dysfunctional coping strategies and higher burden. Abuse was predicted by: spending more hours caring, experiencing more abusive behaviour from care recipients and higher burden.

Limitations: This was a cross-sectional study so we cannot confirm directions of causality. While many carers were willing to report abusive actions, some may not have been and our numbers may be an underestimate.

Conclusion: Anxious and depressed carers are particularly likely to report abusive behaviour when asked. Testing interventions directed at reducing carer anxiety, depression or changing unhelpful coping strategies, and/or reducing care recipient aggression where possible, is a logical and urgent next step.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptation, Psychological
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Caregivers / psychology*
  • Caregivers / statistics & numerical data
  • Cost of Illness*
  • Cross-Sectional Studies
  • Dementia / diagnosis*
  • Dementia / epidemiology
  • Dementia / psychology*
  • Elder Abuse / diagnosis*
  • Elder Abuse / psychology*
  • Elder Abuse / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Personality Inventory / statistics & numerical data
  • Psychometrics
  • Risk Factors
  • United Kingdom