Abuse of older people with dementia: a review

Abstract

A review undertaken for Ireland’s National Dementia \nStrategy (Cahill \net al. \n2012) provides evidence on the \nprevalence of dementia and on the provision of dementia \ncare in Ireland. Findings indicate that there are 41,740 \npeople with dementia in Ireland, most of whom are over \n65 years of age. A significant proportion of these older \npeople, 23,058, live in the community where care is \nprovided, in the main, by family caregivers, primarily \nwomen, within an embryonic and disjointed community \nsupport services infrastructure (Cahill \net al. \n2012). Family \ncaregivers of older people with dementia may be \nunaware of actions that are abusive (Beech \net al \n. 2005). \nMoreover, such actions may have consequences for the \nolder person. For example, in a study entitled Caring for \nRelatives with Dementia (CARD) (Cooper \net al. \n2009), \nover half of caregivers self-reported perpetrating physical \nor psychological abuse of their care-recipient and one \nthird met the criteria of significant abuse. \nElder abuse has received considerable attention in public \ndiscourses, policy reports and research as the issue has \nincreasingly been discussed and studied and attempts \nhave been made to address it. At the same time, new \nperspectives have transcended the traditional, medical \nperspective of dementia, allowing new understandings \nfrom other disciplines to emerge, which draw attention to \nthe economic and social implications of the condition \n(Cahill \net al. \n2012). In this context, a link between \ndementia and a higher risk of elder abuse has been \nestablished (Hansberry \net al. \n2005; Cooney \net al. \n2006). It \nis widely accepted that the effects of dementia can \nrender older people more susceptible to exploitation by \nothers and can severely impair their ability to seek help, \nadvocate for themselves or remove themselves from potentially abusive situations (Bonnie and Wallace, 2003). \nMoreover, the higher risk of elder abuse for this \npopulation cohort may be related to a number of \ninteracting and reinforcing factors, including the greater \nlikelihood of cognitive impairment, depression, \nbehavioural difficulties, social isolation and dependency \n(Coyne \net al. \n1993; VandeWeerd and Paveza, 2005; \nHansberry \net al \n. 2005; Selwood and Cooper, 2009). \nSeveral authors attest to the unique challenges, demands, \nstresses and burdens associated with caregiving in \ndementia (Coyne \net al \n. 1993; Lachs and Pillemer, 2004; \nSchulz and Martire, 2004; Hansberry \net al \n. 2005; Bertrand \net al \n. 2006; Drossel \net al. \n2011). These factors, in \ncombination, may place an older person with dementia \nat increased risk of abuse. \nSimilar to global estimates (WHO, 2012), it is projected \nthat the prevalence of dementia in Ireland will increase \ndramaticallwcoming decades with the most marked \nincrease expected among those aged 85 years and over \n(Cahill \net al. \n2012). With the continuing rise in the \nnumber of older people with dementia and the \nrecognition of their particular vulnerability to abuse and \nneglect, it is important to examine the issue of abuse of \nthis subgroup of the older population. Moreover, in the \nrecent Irish National Positive Ageing Strategy (DoH, \n2013), the national goals emphasise protecting the health \nof older people throughout the life-course, enabling older \npeople to live in confidence, security and dignity in their \nown homes and using evidence-based research to \nrespond to population ageing issues in Ireland. Within \nthese foci, ascertaining the extent of elder abuse in \npeople with dementia, the risk factors for its occurrence \nand the particular challenges that the presence of \ndementia presents when dealing with suspected cases of \nelder abuse are necessary steps in the development of \nbest practice approaches to detecting, preventing and \nmanaging abuse of older people with dementia and for \ninforming future research.

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