Older People's Mental Health, Sydney Local Health District, Sydney, New South Wales, Australia.
Specialty of Psychiatry, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Dement Geriatr Cogn Disord. 2022;51(1):1-17. doi: 10.1159/000521878. Epub 2022 Mar 18.
Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a progressive neurological condition which may amplify behavioural disturbances such as aggression. This systematic review aims to evaluate the factors associated with homicide committed by people with dementia in order to inform clinical practice.
MEDLINE, PsychINFO, Embase, and PubMed databases were searched in accordance with PRISMA guidelines for empirical studies examining the characteristics and circumstances of people with dementia who committed homicides. Data on factors associated with the homicide were extracted and the quality of each study rated using standardized criteria. A total of 499 papers were screened and thirteen studies met the inclusion criteria. Study design included case reports (seven studies), case series (four studies), and two retrospective cohort studies, indicative of low levels of evidence. Sample sizes were 1-70. Study findings were predominantly descriptive. Quality ratings ranged from 50 to 100%. Factors associated with disinhibition such as dysexecutive syndrome, alcohol use, and delirium may predispose to severe impulsive aggression. Psychosis and personality pathology appeared to influence targeted assaults resulting in homicide by people with dementia. Victim vulnerability was also a key element.
The current evidence examining risk factors for homicide committed by people with dementia is limited. However, there are common characteristics reported in these descriptive studies including psychiatric factors and cognitive states causing disinhibition. Recommendations for clinical practice include early assessment of older people with dementia and changed behaviours to allow management of comorbidities and reversible risk factors, alongside education, and advice to carers (who may be targets of aggression). Specialized geriatric forensic psychiatry services and care settings should be developed.
老年罪犯实施的杀人案件较为罕见，但后果严重。此类案件可能是个人、社会和环境等多种因素综合作用的结果。痴呆是一种进行性的神经疾病，可能会加剧攻击等行为障碍。本系统综述旨在评估与痴呆患者杀人行为相关的因素，以期为临床实践提供参考。
根据 PRISMA 指南，检索了 MEDLINE、PsychINFO、Embase 和 PubMed 数据库，以查找检查实施杀人行为的痴呆患者特征和情况的实证研究。提取与杀人案相关的因素数据，并使用标准化标准对每项研究的质量进行评级。共筛选出 499 篇论文，其中 13 项研究符合纳入标准。研究设计包括病例报告（7 项研究）、病例系列（4 项研究）和 2 项回顾性队列研究，表明证据水平较低。样本量为 1-70。研究结果主要为描述性。质量评分范围为 50-100%。与去抑制相关的因素，如执行功能障碍、酒精使用和谵妄，可能导致严重的冲动性攻击。精神病和人格病理似乎影响了导致痴呆患者杀人的有针对性的攻击。受害者的脆弱性也是一个关键因素。
目前，关于痴呆患者杀人风险因素的证据有限。然而，这些描述性研究报告了一些常见特征，包括导致去抑制的精神因素和认知状态。为临床实践提出的建议包括对痴呆老年人进行早期评估以及改变行为，以管理共病和可逆转的风险因素，同时向护理人员（可能成为攻击目标）提供教育和建议。应开发专门的老年法医精神病学服务和护理环境。
