Abuse and Stress

The BBC reports on a study published in the BMJ (British Medical Journal) which questioned carers of people who suffer from dementia and found that

a third admitted “significant abuse”

Predominantly, this abuse is emotional and verbal abuse however in some cases physical abuse was admitted too.

The study, which was undertaken at University College, London found

In total 115 carers reported at least some abusive behaviour, and 74 reported more serious levels of mistreatment.

More than a quarter of the carers admitted screaming or yelling at their relative, while just under one in five said they had used a harsh tone or had sworn.

Other abuse recorded included threats to send the relative to a care home, or to stop caring for them.

A far smaller number admitted hitting, slapping, shaking or rough handling of the person with dementia

I’d like to say I am surprised by the findings but I’m not. The timing is particularly pertinent as later today I am being tasked to make an assessment of someone who is living in an abusive environment where the main caregiver has been over-stretched to the point of creating an environment which had previously been wholly positive.

image doll damned at Flickr

The research points to carer stress and lack of carer support leading to abuse in the home setting. Often it is carers being pushed through lack of services or lack of support.  It is definitely a scenario I recognise.

So what can be done?

Obviously more support and provision of services.

I’d like to see more direct time being spent with carers by even if it is just to talk things through. Of course it doesn’t have to be professionals as user-led support groups can work very well as support networks, but generally, I’ve found that with older people (as predominantly, the carers in question are partners or siblings who are similar in age to the person being cared for) there are concerns about actually getting to groups, providing respite care or a sitting service while they attend the group and the cultural unacceptability of allowing someone else to look after a loved one.

When I have been able to, I try to give time to speak with carers. It is, for the most part, welcomed wholeheartedly. Sometimes just talking through things with someone else can be some kind of respite (admittedly not much).

In fact, the Carers Assessments that we undertake are often a jump-point for a more extensive discussion about the nature of care and the need to devote time and services to the person providing that care.

If I were able to provision any service in the world with no thought to cost (I’m not a manager, I can do this), I would provide allocated workers to specifically work with and alongside carers but capacity doesn’t really allow this at the moment.

However, if care at home and a reliance on informal care is to be maintained and quality of life sustained for both the patient and the carer, support needs to be provided for both.

Not the cursory ‘let’s have an assessment’ support but genuine and ongoing space for the carer to express frustrations. Practical support when necessary and financial support to remove some of the worry and stress that will spill out.

The study recommends more awareness by professionals in discussing abusive behaviours with carers and not regarding the issue as taboo.

They wrote: “Professionals are often reluctant to talk about abuse, perhaps because of a fear that discussing and acknowledging it would necessitate referral of an adult for protection and trigger a punitive response such as removal of the person with dementia.

“This may result in an ‘all or nothing’ approach to abuse, where it is ignored until the problem becomes serious.

“Similarly clinicians may not consider abuse when seeing most carers, if abuse if perceived as a rare action purposefully perpetrated by amoral abusers.”

Ultimately, services in particular and society in general needs to become far more attuned to the abuse of vulnerable adults and look at reasons and causes as well as what can be done regarding prevention.

4 thoughts on “Abuse and Stress

  1. Unfortunately, we see this type of case all too frequently in the emergency department. I especially like the point you highlighted re: addressing the topic of abuse “head on”. Is it the fear of offending people that keeps this from happening?

  2. Yeah, I’ve made adult protective services referrals as well. And I know those workers are overwhelmed–over here they actually cover a few counties as opposed to just one.

  3. A THIRD? That is a really frightening statistic. I wonder what the public reaction to that will be? If it was reported that a third of kittens were abused, then Joe Public would be up in arms. Sadly I somehow doubt that this figure would get the same reaction.

    Lola x

  4. SWE – I definitely think there is an element of ‘steering away from difficult questions’ to the lack of directly asking about abuse.

    Reas – I honestly think there is so much far less attention, time and resources spent on adult abuse because even thought the victim is very vulnerable, it doesn’t have the emotive capacity of issues of abuse of younger people. It also operates in a different environment but, I would venture a guess that it might be an area where more preventative work could go a lot further.

    Lola – I know, and I agree.

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