J Neurol Neurosurg Psychiatry 81:592-596 doi:10.1136/jnnp.2009.190934
  • Research paper

Abusive behaviour experienced by family carers from people with dementia: the CARD (caring for relatives with dementia) study

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  1. G Livingston
  1. Department of Mental Health Sciences, UCL, Charles Bell House, London, UK
  1. Correspondence to Dr Claudia Cooper, Department of Mental Health Sciences, UCL, 67–73 Riding House Street, 2nd Floor, Charles Bell House, London W1W 7EJ, UK
  1. Contributors CC, GL and MB conceived and designed the study; CC analysed the data; all authors (CC, GL, MB and AS) were involved in interpretation of data; CC drafted the article and all authors (CC, GL, MB and AS) revised it critically for important intellectual content and gave final approval of the version to be published. CC will act as guarantor.

  • Received 4 August 2009
  • Revised 27 September 2009
  • Accepted 28 September 2009
  • Published Online First 1 December 2009


Background 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.

Methods 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.

Results 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 (β=0.66 (95% CI 0.55 to 0.77)), less abuse from the care recipient (β=−0.39 (−0.65 to −0.13)) and fewer dysfunctional coping strategies (β=−0.98 (−1.50 to–0.46)).

Conclusion 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.


  • Funding This research was funded by a research training fellowship awarded to CC by the Medical Research Council. The author's work was carried out independently of the funders.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the London MREC.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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