Elderly people cared for by spouse are at greater risk for abuse

Effect pronounced when caregivers experience own health problems or care for especially needy spouses

When elderly people need assistance with the activities of daily life, one might assume that the best people to care for them would be the ones who know them best–their spouses. But, as a team of researchers at the University of Pittsburgh report in this month’s issue of the Journal of the American Geriatrics Society, being married to one’s caregiver could be a prescription for abuse, especially if the caregiver is also suffering from his or her own physical or mental problems.

Scott Beach, director of survey research in Pitt’s University Center for Social and Urban Research (UCSUR); Richard Schulz, professor of psychiatry and director of UCSUR; and colleagues at the University of Georgia and the University of Texas Southwestern Medical Center found that caregivers who are married to those they care for–particularly those caregivers who are more cognitively impaired, in poorer health, more depressed, or taking care of someone who needs more help–are more likely to be abusive.

Such situations should send a “red flag” to family members and doctors, Beach and his colleagues warn in their paper, titled “Risk Factors for Potentially Harmful Informal Caregiver Behavior.” In such cases, they say, the couple should be screened and, if troublesome signs are found, possibly targeted for intervention.

Prior research, some conducted at Pitt, has shown that being a caregiver causes negative health effects. “Caregiving is stressful, and it breaks down the people that are providing the care–they wear down,” said Beach. “This study shows that that’s not good for the person they’re taking care of.”

Beach and colleagues studied 265 pairs of caregivers and care recipients. Caregivers were primarily responsible for an impaired family member 60 years or older who needed help with at least one “activity of daily living,” such as bathing or dressing, or at least two “instrumental activities of daily living,” such as paying bills or talking on the phone.

The researchers found that the risk of abuse increased when caregivers were married to the care recipients, especially when the caregivers were at risk for clinical depression, were cognitively impaired, had reported physical symptoms in the previous week, or were taking care of more needy recipients. In those situations, care recipients were more likely to report that their caregivers screamed and yelled at them, used a harsh tone of voice, insulted them, called them names, or swore at them.

However, when caregivers were nonspousal family members, such as adult children, they did not show the same treatment toward the care recipient, even if the pair lived together. Beach speculated that the reason for the especially harsh spousal treatment was “marital relationships–some of this could have been going on before caregiving began. “There’s more opportunity for spouses to be abusive,” he added. “If an adult daughter is living with her mother or father, the adult daughter is more than likely working, so she’s not there eight hours a day.” He also pointed out that adult children are less likely to have cognitive deficits, physical problems, or depression than elderly caregivers.

The findings from this study could provide useful tools to doctors, who can help identify caregivers at risk for providing poor-quality care. They may particularly target depressed, older spousal caregivers for screening and intervention efforts. “Clinicians should focus not only on treating the depression, but also on providing these caregivers with alternatives that might ease the burden of caregiving, such as support group referral or arranging for other family members, friends, or formal service providers to perform respite care,” wrote the researchers.

While other studies on caregiving have typically interviewed only one person in the relationship, the Pitt researchers spoke with both caregivers and care recipients, minimizing potential bias.