Department of Mental Health Sciences, UCL, 67-73 Riding House Street, 2nd Floor, Charles Bell House, London W1W 7EJ, UK.
J Neurol Neurosurg Psychiatry. 2010 Jun;81(6):592-6. doi: 10.1136/jnnp.2009.190934. Epub 2009 Dec 1.
The authors report the first study of abusive behaviour by people with dementia towards their family carers. The authors hypothesised that while abusive behaviour would be associated with the carer reporting a less rewarding relationship, this could be mediated by the carer's coping style.
The authors interviewed 220 consecutively referred family dementia carers from five UK Community Mental Health Teams, using the revised Modified Conflict Tactics Scale to measure abuse, and the Relationship Rewards Scale.
82 (37.3%) carers reported abuse from the care recipient 'at least sometimes' over the last 3 months. 80 (36.4%) reported psychologically, and 13 (5.9%) physically abusive behaviour. On average, current carer relationship rewards had decreased from premorbid levels (mean difference -1.5 (95% CI 1.8 to 1.2); p<0.001). The association between higher abuse score and lower current relationship rewards was mediated by dysfunctional coping use. In our final model, current relationship rewards were predicted by reporting a better past relationship (beta=0.66 (95% CI 0.55 to 0.77)), less abuse from the care recipient (beta=-0.39 (-0.65 to -0.13)) and fewer dysfunctional coping strategies (beta=-0.98 (-1.50 to-0.46)).
Over a third of family carers reported significant abuse from the people they cared for. Carers who reported more abuse also reported a greater deterioration in their relationship with the person with dementia. The extent to which carers used dysfunctional coping strategies partially explained this, suggesting that interventions to change the carers' coping styles might alleviate the impact of abusive behaviour.
作者报告了首项针对痴呆症患者对其家庭照顾者实施虐待行为的研究。作者假设，尽管虐待行为与照顾者报告的关系回报较少有关，但这可能会被照顾者的应对方式所调节。
作者对来自五个英国社区心理健康团队的 220 名连续转介的家庭痴呆症照顾者进行了访谈，使用修订后的改良冲突策略量表来衡量虐待行为，并使用关系回报量表。
82 名（37.3%）照顾者报告在过去 3 个月中至少有时受到护理对象的虐待。80 名（36.4%）报告了心理虐待行为，13 名（5.9%）报告了身体虐待行为。平均而言，当前照顾者的关系回报已经从发病前的水平下降（平均差异-1.5（95%置信区间 1.8 至 1.2）；p<0.001）。较高的虐待评分与较低的当前关系回报之间的关联受到功能失调应对方式的调节。在我们的最终模型中，当前关系回报由报告过去关系更好（β=0.66（95%置信区间 0.55 至 0.77））、来自护理对象的虐待较少（β=-0.39（-0.65 至-0.13））和较少的功能失调应对策略（β=-0.98（-1.50 至-0.46））来预测。
超过三分之一的家庭照顾者报告了来自他们所照顾的人的重大虐待行为。报告受到更多虐待的照顾者也报告说，他们与痴呆症患者的关系恶化得更严重。照顾者使用功能失调的应对策略在多大程度上解释了这一点，这表明干预措施改变照顾者的应对方式可能会减轻虐待行为的影响。
