A third of family carers report significant abusive behaviour towards people with dementia, and half report some abusive behaviour, according to a study published on bmj.com today.
People with dementia are particularly vulnerable to abuse, which can be psychological, financial, sexual or by neglect.
The UK government is currently consulting about a revision of the policy for safeguarding vulnerable adults, but this review is entirely focused on preventing abuse by paid carers, suggesting that abuse is confined to the formal care system.
However, previous studies have shown that many family carers for people with dementia report acting abusively, and professionals are reluctant to ask about elder abuse.
So, in the first study of its kind, Claudia Cooper and colleagues set out to determine the prevalence of abuse by family carers of people with dementia.
They interviewed 220 family carers of people with dementia who were living at home and who were referred to Community Mental Health Teams in London and Essex. They defined a family carer as providing care for four or more hours/week.
Background data, such as age, sex, ethnicity and qualifications were recorded, together with details of the relationship to the care recipient, living arrangements, and whether the carer worked.
A recognised scoring scale was used to assess levels of psychological and physical abuse towards the care recipient. A score of two or more on one interview question denoted significant abuse.
One hundred and fifteen (52.3%) carers reported some abusive behaviour and 74 (33.6%) reported significant levels of abuse. Verbal abuse was most commonly reported. Only three carers (1.4%) reported that actual physical abuse sometimes occurred.
This was the first representative survey to ask family carers about abusive acts, say the authors. It suggests that any policy for safeguarding vulnerable adults must consider strategies directed towards families who provide the majority of care for older people, rather than exclusively at formal carers.
The findings also highlight the need to consider elder abuse as a spectrum of behaviours rather than an "all or nothing" phenomenon, they add. This could help professionals to feel more able to ask about it and offer appropriate assistance, they conclude.