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 (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)).
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.