Risk factors for potentially harmful informal caregiver behavior

OBJECTIVES: Caring for a sick or disabled relative has been linked to compromised caregiver health, and risk factors for negative caregiver outcomes have been studied extensively, but little attention has been given to care recipient and caregiver health as risk factors for potentially harmful behavior by informal caregivers. This article explores such risk factors. DESIGN: Structured interviews from baseline assessment of the Family Relationships in Late Life Study. SETTING: Three U.S. communities. PARTICIPANTS: Referred, volunteer sample of 265 caregiver/care recipient dyads. Caregivers were primarily responsible for care of an impaired, community-residing family member aged 60 and older and providing help with at least one activity of daily living (ADL) or two instrumental activities of daily living (IADLs). MEASUREMENTS: Self-reported care recipient demographics, cognitive status, need for care, and self-rated health; self-reported caregiver demographics, cognitive status, amount of care provided, self-rated health, physical symptoms, and depression. Care recipient reports of potentially harmful caregiver behavior, including screaming and yelling, insulting or swearing, threatening to send to a nursing home, and withholding food, were the main outcome variable. RESULTS: The following were significant risk factors for potentially harmful caregiver behavior: greater care recipient ADL/IADL needs (odds ratio (OR)=1.12, 95% confidence interval (CI)=1.03-1.22), spouse caregivers (vs others; OR=8.00, 95% CI=1.71-37.47), greater caregiver cognitive impairment (OR=1.20, 95% CI=1.04-1.38), more caregiver physical symptoms (OR=1.07, 95% CI=1.01-1.13), and caregivers at risk for clinical depression (OR=3.47, 95% CI=1.58-7.62). CONCLUSION: Potentially harmful caregiver behavior is more likely in spouse caregiving situations and when care recipients have greater needs for care and caregivers are more cognitively impaired, have more physical symptoms, and are at risk for clinical depression. This risk profile is similar to that for negative caregiver outcomes.