Abuse of older people with dementia: a review

A review undertaken for Ireland’s National Dementia Strategy (Cahill et al. 2012) provides evidence on the prevalence of dementia and on the provision of dementia care in Ireland. Findings indicate that there are 41,740 people with dementia in Ireland, most of whom are over 65 years of age. A significant proportion of these older people, 23,058, live in the community where care is provided, in the main, by family caregivers, primarily women, within an embryonic and disjointed community support services infrastructure (Cahill et al. 2012). Family caregivers of older people with dementia may be unaware of actions that are abusive (Beech et al . 2005). Moreover, such actions may have consequences for the older person. For example, in a study entitled Caring for Relatives with Dementia (CARD) (Cooper et al. 2009), over half of caregivers self-reported perpetrating physical or psychological abuse of their care-recipient and one third met the criteria of significant abuse. Elder abuse has received considerable attention in public discourses, policy reports and research as the issue has increasingly been discussed and studied and attempts have been made to address it. At the same time, new perspectives have transcended the traditional, medical perspective of dementia, allowing new understandings from other disciplines to emerge, which draw attention to the economic and social implications of the condition (Cahill et al. 2012). In this context, a link between dementia and a higher risk of elder abuse has been established (Hansberry et al. 2005; Cooney et al. 2006). It is widely accepted that the effects of dementia can render older people more susceptible to exploitation by others and can severely impair their ability to seek help, advocate for themselves or remove themselves from potentially abusive situations (Bonnie and Wallace, 2003). Moreover, the higher risk of elder abuse for this population cohort may be related to a number of interacting and reinforcing factors, including the greater likelihood of cognitive impairment, depression, behavioural difficulties, social isolation and dependency (Coyne et al. 1993; VandeWeerd and Paveza, 2005; Hansberry et al . 2005; Selwood and Cooper, 2009). Several authors attest to the unique challenges, demands, stresses and burdens associated with caregiving in dementia (Coyne et al . 1993; Lachs and Pillemer, 2004; Schulz and Martire, 2004; Hansberry et al . 2005; Bertrand et al . 2006; Drossel et al. 2011). These factors, in combination, may place an older person with dementia at increased risk of abuse. Similar to global estimates (WHO, 2012), it is projected that the prevalence of dementia in Ireland will increase dramaticallwcoming decades with the most marked increase expected among those aged 85 years and over (Cahill et al. 2012). With the continuing rise in the number of older people with dementia and the recognition of their particular vulnerability to abuse and neglect, it is important to examine the issue of abuse of this subgroup of the older population. Moreover, in the recent Irish National Positive Ageing Strategy (DoH, 2013), the national goals emphasise protecting the health of older people throughout the life-course, enabling older people to live in confidence, security and dignity in their own homes and using evidence-based research to respond to population ageing issues in Ireland. Within these foci, ascertaining the extent of elder abuse in people with dementia, the risk factors for its occurrence and the particular challenges that the presence of dementia presents when dealing with suspected cases of elder abuse are necessary steps in the development of best practice approaches to detecting, preventing and managing abuse of older people with dementia and for informing future research.