Beyond the Caregiver Stress Model: Implications of Sense of Entrapment for Abuse of Older Persons with Dementia By Family Caregiver

Background: Behavioral and psychological symptoms of dementia (BPSDs) have been identified as one of the most distressing aspects of dementia caregiving. Previous research has confirmed the association between care recipients’ BPSDs and caregiver stress, burnout symptoms, poor physical and health, etc. There is also accumulating evidence on the association between BPSDs and caregiver abuse and neglect. A 6-month prospective study of 141 family caregivers showed that once family caregivers enter into the abusive cycle, abuse becomes habitual and reduction in BPSDs of caregiver stress does not result in a corresponding reduction in abuse (Yan, 2014). In view of the global aging population, it is expected that number of older persons with dementia will increase rapidly. It is essential that we identify point of prevention and early intervention of abuse in the population with dementia. In the present study, the researcher argues that caregivers’ subjective sense of entrapment, instead of BPSD and caregiver stress, predisposes them to abusive behaviors.

Methods: A total of 592 family caregivers of older persons with dementia provided written consent and were individually interviewed. Participants provided information on their demographic characteristics, the caregiving context, abusive behaviors directed at the care recipients (Modified Conflict Tactics Scale), caregiver stress (Zarit burden Interview), sense of entrapment (Sense of Entrapment Scale).

Results: Abuse was common in this sample, 52.5 and 11.1 per cent of the respondents indicated that they had verbally and physically abuse the care recipient in the past month respectively. Another 1.2% indicated that their behavior had resulted in injury in the care recipient. Results of hierarchical regression analysis showed that while caregiver stress mediated the association between BPSD and abuse, caregiver sense of entrapment is independently associated with abuse even after controlling for caregiver gender, kinship, care recipient BPSD and caregiver stress.

Implications: Managing caregiver subjective perception of the caregiving situation provides a plausible way to prevent and intervene abuse of older persons with dementia. It is important to promote the strengths of caregivers and prepare them for the challenges of caring for someone with dementia.